Part D Plan Finder Confusion
- Thread starter refiman1
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- #12
- 1,199
Time for his client to move to another agent that understands how cost are calculated through the stages of part D
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- #14
Oh I'm sorry yogoogledbag, something you wanted to offer?
Since your previous 2 answers were either nonsense or repeated what I originally posted.
You first mentioned some nonsense about UHC not covering it. Great, UHC is not even involved in the discussion.
Then you break down some nonsense about 7 vials over 800. Right that's what was originally posted in comment numbnuts and led to my confusion
But you are right. Time for your dozen or so clients to move on and get accurate information instead of your nonsensical bullshit. Its about the only thing you have been right about.
But if my clients were to move on, I certainly wouldn't be sending them to an incompetent like you.
Shoo troll before I swat ya.
Since your previous 2 answers were either nonsense or repeated what I originally posted.
You first mentioned some nonsense about UHC not covering it. Great, UHC is not even involved in the discussion.
Then you break down some nonsense about 7 vials over 800. Right that's what was originally posted in comment numbnuts and led to my confusion
But you are right. Time for your dozen or so clients to move on and get accurate information instead of your nonsensical bullshit. Its about the only thing you have been right about.
But if my clients were to move on, I certainly wouldn't be sending them to an incompetent like you.
Shoo troll before I swat ya.
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- 11,280
Make sure to get a scope signed prior to the meeting...
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- #16
Well since you shown yourself to be totally incompetent and useless in that regard, any competent agents that know what they are talking about wanna give it a try?
Walmart sells Novolin products as a loss leader. Its $20-30/vial for a cash (no insurance) price. Its $290 using the contracted rate.
Pull the damn drug out of the plan finder, tell the client to pray that Walmart keeps selling it for $170 and to not use his Part D plan for insulin. Depending on the store, he may get his insulin at Walmart and his other scripts somewhere else, if Walmart won't do the insulin as cash.
Its no different then getting an RX via Canada, its just confusing because its Walmart
- 1,199
Question: Assisting two clients moving from MAPD to Med Sup. One client on Novolin 70/30. Both were approved and was assisting them in enrolling through the Part d plan finder. After entering that drug, showed his estimated OOP at 3.5 k annually with the lowest cost Part D plan per the finder.
Currently pays around 850 annually with his MAPD plan.
The pharmacy he uses was also selected. Called pharmacy and stated I had no coverage. Cash price $170.00 month. Part D plan finder states with Rx plan 290/ month.
I then searched his current MAPD plan in the plan finder, which also stated his estimated OOP for prescription for 2016 was about 3,500, roughly the same.
Then had client call to ensure pricing for 2016, thinking this could be a bombshell in the making. They confirmed pricing for 2016 was 30.00 more annually than 2015. 45 month co-pay as it was a tier 3 preferred pharm drug at that pharmacy. His plan details 45.00 co-pay a month per vial but he actually pays 45.00/month for 7 vials....every month...and never has hit donut hole.
Got spooked by the whole matter and cancelled his policy. Was not going to put this guy in the trick bag on his insulin. But am quite confused.
Final thing, even called the proposed part d plan, explained what the pharmacy told me and all those jokers at the carrier can do is read what the Medicare plan finder estimates to them, though it was that informational breakdown that led me to call them in the first place.
Summary: Both his MAPD plan and proposed Part D plan on Medicare .gov show his drug costing him around 3500 OOP annually. Actual OOP, using Wal-Mart pharmacy, about 25% of that cost.
Can't confirm if that pricing would also be applicable under a Part D standalone, though the tier and co-pay show to be exactly the same.
Any veteran Part d guys/gals wanna take a stab at explaining why this is and where I can get more accurate trustworthy info than Medicare plan finder?
Profound thanks in advance for your collective insight.
Walmart Relion/Novolin 70/30 is OTC so not covered on any part D plan.I am sure you know that OTC drugs don't calculate in to cost of pdp plans as they are not covered by pdp.For this reason when using the medicare.gov formulary finder it's going to populate data with prescription novolin 70/30 that cost about 830.00 monthly for 7 vials .It 's NOT going to calculate OTC Walmart Novolin in the TROOP .Also Walmart shoppers calling Walmart saying they dont have insurance and asking how much is the Walmart Novolin dealio are going to be quoted on the OTC Novolin thats 25 a vial not prescription strenght Novolin thats 130 a vial
I ran a formulary finder for Fl using 7 vials of prescription Novolin 70/30 monthly and just for that one precription the lowest TROOP cost pdp plan was about 3000.00. Humana Walmart RX at Wal-Mart was 3,139.00 - so why exactly does the results you calculated of a 3500 TROOP surprise you so much?
Hope this was insightful enough for you.
Wal-Mart Pharmacy $3,139.47
Mail Order Pharmacy $3,101.74
Novolin 70/30 INJ 70/30 $843.73 Every 1 Month $843.73 $168.75 $379.68 $42.19
MONTHLY TOTALS: $843.73 $843.73 $168.75 $379.68 $42.19
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- #19
Refer to this part of my quote...."Currently pays around 850 annually with his MAPD plan" 850 ANNUALLY WITH HIS MAPD PLAN, NOT 3139...NOT 3500, NOT 3000 $850.00 ANNUALLY. CONFIRMED WITH HIS MAPD PLAN.
But you ask, "so why exactly does the results you calculated of a 3500 TROOP surprise you so much?"
Gee, I dunno. I hope you aren't Part D certified.
I know I'm not, just trying to help someone improve their major med coverage and assist them in enrolling in an affordable med plan.
I guess your rebuttal to this will chastise me from moving them from an MA plan because Med Sups don't offer add-in bonuses like Silver Sneakers.
Whew.
- 1,199
]Refer to this part of my quote...."Currently pays around 850 annually with his MAPD plan" 850 ANNUALLY WITH HIS MAPD PLAN,
Need to know a zipcode and plan name to explain why only 850.00.......
-could be he was in an MA Plan like Coventry MA plans in Fl. that has all insulins in tier 1 -even in the gap
-could be a Diebeties SNP MA plan that covers insulins through the gap at tier 3
-could be that doctors gave him samples
-could be that he started the MA plan in mid year
- could be he had hoarded a supply from 2014 that he used in 2015
