I Came Within an Inch of Being Wiped Out Financially

Those of you who start to see some grey hair and are on or soon will be on Medicare (or have a friend or relative on Medicare) this might be one of the most important posting I have done. I came within an inch of being wiped out financially by an underhanded insurance trick.

As you know each year from October 15 to December 7 you can change Medicare plans, this includes Part D drug coverage. If you fail to make a change you will be continued in your present plan by default and you cannot change plans until October 15 of the next year.

What some of you might not be aware of is that Medicare Part D has a handy dandy “Medicare Plan Finder”. You enter your list of drugs that you are taking and sign in with your Medicare Part D information and in short order it will give you what your out of pocket cost will be in your present plan and the from the least expensive to most expensive plan that is offered in the area you live, for the coming year.

Every plan has a schedule of drugs they will pay for which is called a “formulary”. Medicare requires a certain number of drugs to be covered, but they don’t dictate which ones have to be in a plan. This is the function of the “Medicare Plan Finder” to tell you, based on which drugs you use, what drugs will be covered and which drugs are not covered based on the “formulary” and what your out of pocket cost each plan will be.

I am using a SilverScript plan for 2018 and with a little confusion at the start the plan covered my two very expensive medications. With Medicare paying the major share of the cost, I was able to get a grant from a non-profit organization to pick up most of the remaining cost. Here is a critical point: without Medicare paying the major part of the cost, the non-profit would not have participated in helping me pay the remainder of the cost.

I was happy with the arrangement and plan so I said to myself, “There is no need to check I will just let it default and continue on with the same plan in 2019”. This would have been a fatal mistake.

Without telling me or giving any indication of what the new 2019 plan would cover, SilverScript took the two very expensive drugs off their formulary.

I had a strong feeling one day that I should run the Medicare Plan Finder just in case and to my horror it told me that my out of pocket cost (what I was going to have to pay) in 2019 was going to be $207,000 for my present SilverScript plan. I spent hours on the phone because I was sure there was a mistake, but the bottom line is there was no mistake they did it on purpose to avoid this cost.

Needless to say I have switched plans, which is still high, but only 1/10 of what my present plan would have been. I thank the Lord the prompting me to check and my advice is: ALWAYS, ALWAYS, ALWAYS CHECK YOUR PLAN IN THE MEDICARE PLAN FINDER before December 7.