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Finding A New Prescription Plan If Yours Is No Longer Offered

Question: I got notification my Prescription Drug Plan coverage will no longer be offered in 2022. What happens now?

Answer: This year there has been a significant reduction in the number of stand alone Prescription Drug Plans (PDP’s) offered in New York State. In 2021 we have 28 plans, in 2022 there are 19. That means that 9 plans are no longer offered. All the individuals in those 9 plans will have to find new coverage.

It sounds like you have Original Medicare, a Medicare Supplement Plan (Medigap) and a stand alone PDP.

To review some of the changes that are happening to the PDP’s in 2022. Some of the PDP’s are offered by insurance companies that have multiple plans on the market, and these insurance companies have moved individuals to alternative plans the company offers.

There are two companies that have left the market entirely, Emblem Health & ExpressScripts. Everyone who has a PDP from either of those companies will definitely have to make a new choice for 2022. These individuals do have additional time to find a new plan, from October 15 to February 28, 2022. You could enroll into your new plan between December 8 and December 31 and your new coverage would begin 1-1-22. If you wait until after 1-1-22, that means you do not have prescription drug coverage for January and potentially February 2022. There wouldn’t be a penalty, but you would be without drug coverage for that period of time.

There are also two plans that changed names, both Cigna PDP’s. Most plans have increased their premiums and five plans lowered their monthly premiums.

The PDP changes each year can be in the form of the monthly premiums, the way your medications are placed in tiers, what those tiers cost, and the pharmacy network. If you take very little medication or no medication, there may be a cheaper option for you in 2022.

The information on the new 2022 plans are available via the medicare.gov website, as well as 1-800-MEDICARE. These are both available 24 hours a day, seven days a week between October 15 and December 7. So, anytime is the perfect time.

There are agencies and programs available locally to help you find new insurance such as, Office For the Aging (716-753-4582), Southwestern Independent Living Center (716-661-3070) has staff available to help with insurance issues. Senior Life Matters, (716-720-9797) can help work through these insurance issues all year long. Insurance companies also have staff available (Brokers and Insurance Agents) to help you make your decisions. Remember that a broker can ONLY talk about the products they offer (that they sell). Be sure to visit/talk to other companies before you sign the dotted line.

The average premium for all the plans in New York State is $42.43 per month. The minimum coverage allows for a $480 deductible. Next is the initial coverage stage. The initial coverage period ends at $4,430 in total drug costs. At $4,430 in total drug cost, you enter the coverage gap, where your cost for 2022 is 25% of the retail cost of your medications. Lastly is catastrophic coverage (5% of the cost). Most individuals do not take enough medication to enter the coverage gap or even close to catastrophic coverage.

If your plan is no longer available in 2022 you must evaluate the alternatives and enroll in something new to begin Jan. 1, 2022.

For the rest of you, your Prescription Drug coverage may not need to change, it is worth evaluating. I have seen many people who are paying too much for their coverage when they take very little medication, or who stay with a plan that doesn’t cover their medications adequately.

If your plan is no longer available you actually have some extra time make your new choice, but if you wait and make a choice after Jan 1, 2022 your coverage will be delayed to the first of the following month.

You know I never recommend waiting! Good luck and Happy Insurance Season to you!

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email at SLM@lutheran-jamestown.org.

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