Page 4 - Diane Peasley's Medicare Evaluation

2) The Regence MedAdvantage + Rx Primary PPO Plan. This plan is sponsored by Regence
Blue Shield and it also has an above-average 4-star quality rating from Medicare. It’s not
clear whether all of your doctors are in this plan’s network. As shown in Appendix A3,
Multicare Health Services is listed in this plan’s network, and all of your doctors are
shown as Multicare providers. But it’s possible that one or more of them may not be in
this plan’s network, since their names are not separately listed except for Dr. Titova.

This plan has a smaller but still good-sized network of more than 10,000 providers. Its
out-of-pocket risk is higher, though -- $6,700 for network services and $10,000 for
combined in and out-of-network services. Moreover, unless it’s an emergency if you go
to an out-of-network doctor you will pay a steep 50% of the cost.

In this plan the annual cost for your Rx drugs is $12,653, which includes premiums,
deductible, and co-payments. As with the Aetna plan, you will get the lowest prices at a
Walmart pharmacy.

Rx Drug Plan Coverage

As noted, you will get the lowest Rx drug costs if you switch to monthly at a local pharmacy. The
lowest annual cost of any option, including Advantage plan Rx drug coverage, is the Humana
Walmart Rx prescription drug plan, which is the Part D stand-alone plan you would enroll in if
you decide to acquire a Medigap policy. In the Humana Walmart Rx plan, your estimated
annual costs in 2018 are $11,161 – again, that includes premiums, deductible, and co-pays.

If you want to continue to get mail-order refills, the lowest cost Part D stand-alone plan is the
AARP MedicareRx Preferred prescription drug plan, but its estimated 2018 costs are $1,000+
more than the monthly refill costs in the Humana Walmart Rx Plan.

As you are aware, two of your drugs – Enbrel Sureclick and Tracleer – are very expensive. All of
the plans in your evaluation indicate that these two drugs may require prior authorizations
from your doctors. Typically that’s not a problem, but in some cases your physician may need to
write a letter to the plan explaining why you need these drugs.

Depending on the Rx drug plan you choose, you will probably spend 40% or more of your
annual costs in January and early February. The way Part D’s benefits are designed, your costs
drop substantially when you reach what’s called the “catastrophic coverage level.” After that,
your costs will be level for the rest of the year. You can see the monthly Rx drug spending
patterns for the two Advantage plans in Appendices C2 and C3 – and for the Part D stand-alone
plans in Appendices D2 and D3.

In managing your Rx drug costs, it’s important to re-evaluate your coverage each year during
Medicare’s annual open enrollment (October 15 – December 7). Drug plans frequently change
their formularies and pricing, and it’s not unusual for the low-cost plan one year to be a much
higher-cost plan the following year.

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