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Deciphering Insurance Information May Lead To Better Coverage

Question: I have EnvisionRxPlus for 2019. I got a letter saying the premium increases to $37.50 a few weeks ago. I just got another packet offering me a different plan. What should I do?

Answer: There are times when I really wonder what the people designing these health insurance products are thinking. Your situation is certainly one of them.

In 2019 the EnvisionRxPlus plan for $16.50 was a very popular plan. It has a relatively low $360 deductible and gives you a reduced price for Tier 1 and Tier 2 Medications immediately, before the deductible has been met. It was also one of the lowest cost plans for 2019, so those individuals who took no medication felt a little better about paying a low premium for something they may not need.

As we look to 2020 this EnvisionRxPlus plan, CMS No. S7694-003, becomes EnvisionRxSecure for $37.50 per month. This new version has a $435 deductible and does not reduce the price of any medications until the deductible has been met. That is a very different plan, but has the same CMS ID No. S7694-003.

Then for 2020 the same company, introduced a new plan, EnvisionRxPlus, CMS No. 7694-121. This new plan has a premium of $13.70, and a deductible of $335. It gives you a reduced price for Tier 1 and Tier 2 Medications immediately, before the deductible has been met. Doesn’t that coverage sound familiar?

You bet it does.

Medicare saw that situation, which I would call a “bait and switch,” and reprimanded the company. It required the company to inform consumers of the new alternative plan that is very similar plan to its current plan. The company also needed to offer its customers an opportunity to switch to the New EnvisionRxPlus plan at $13.70 for the 2020.

That explains the second packet that you have. If you don’t take any medications, the new EnvisionRxPlus could work for you. The new EnvisionRxPlus has a premium of $13.70, and is one of the lowest premiums available this year. That means you will pay low premiums for your part D coverage for 2020 if you enroll into this plan.

If you take medications, you need to do a little more research. You could use the medicare.gov to review your medication options. You could call (800) 633-6223. You could call EnvisionRxPlus directly to review the 2020 formulary and how that covers your medications. The EnvisionRxPlus plan has a website that you can use to look up your medications, but that only allows you to look up their own formularies.

The benefit of using medicare.gov is that you can compare all the available plans with your medication list to see if this new EnvisionRxPlus plan is the best plan for you.

I wish I could say this is the only time something like this has happened, but it has happened before, with other companies. Reading the material you are sent each year is important. Also realizing that letting your insurance roll over year after year, without paying attention to it, is not a good idea, especially with Part D coverage.

Sometimes deciphering all the information you receive can be confusing. You are working on getting yourself the best insurance coverage for your situation.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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