Re: BEWARE of Medicare Advantage Plan Drug Coverag... - Page 2

quilter61 · ‎03-22-2010

My Medicare Advantage Plan moved one of my drugs to a tier 4. Can't afford it at this tier. This is a generic drug and I can't take any other drugs in this category, due to side effects. I met with my insurance broker this week and she found a plan that covers it at 0 cost. Will probably be changing to this different Advantage plan. It covers all my doctors and some copays are less than my current plan and it has more dental coverage.

There are a lot of changes for 2026 in Medicare plans. I did ask the broker how one plan covers and another doesn't. She explained that probably not many consumers are using that drug in my current plan. It really pays to check this info every year.

Lisa now in AZ · ‎03-11-2010

I had the same issue. My regular pain medication that I rely on has been moved from a Tier 2, which cost $12 to a Tier 3, which means I have to pay the whole cost myself until I meet the increased deductible. I have a meeting with my Medicare insurance guy to see what other options I might have. I hate to think that there are people who now have to go without their medication. I would definitely see if you can get it from Canada.

mrshckynut · ‎06-19-2011

@Marp have you tried to find out if you qualify for the medicine discounted from the manufacturer? my spouse did this with 2 of the real expensive ones and qualifed for both of their discount programs

mrshckynut

Icegoddess · ‎03-19-2010

To add insult to injury, Insurers can change their formularies any time they want throughout the year. So, you may sign up for a plan that covers your drugs and then later in the year, they could change the tier of that drug or drop it entirely from their formulary.

On a good note, I listened in on a Webinar given by Boomer Benefits about open enrollment and they said that any drug that required authorization, would likely need to be re-authorized again each year, but that it appeared Insurers would be mostly re-authorizing them.

Rockycoast · ‎03-02-2016

My husband and I just compared Medicare Advantage plans. We are staying with what we have. Our advantage plan is great for us. We do not want to change to a different plan.

There is an cost increase of course and we have less dental coverage which is not a big deal to us. We get to keep our doctors and the few meds that we take are still covered. That was the big deal to us. We emailed our agent and let him know we would be staying. He said it sounded good and if any changes or if he thinks a better plan is good for us he would let us know.

Cakers3 · ‎06-17-2015

I just received a notice in the mail today that one of my meds will no longer be covered.

When the update went out in September for 2026 coverage it was "Good news! All your prescriptions are covered in 2026 as they were in 2025!"

Yes, they can change in the middle of the year too.
I had a very small copay for this medication but mid 2025 it doubled.

I am very concerned for everyone. Premiums are set to rise and many will lose coverage. This from my PCP, not some off the wall website.

Next year is going to be a disaster.😢

"" Compassion is a verb."-Thich Nhat Hanh

kaydee50 · ‎02-07-2011

Fortunately, neither DH nor I take any medications. But it bothers me that they can drop a drug or increase the price drastically during the year??? This does not sound legal or ethical to me. It's like changing the rules in the middle of a game. How does this happen??

Carmie · ‎10-25-2010

Everyone absolutely should review their RX coverage for 2026 regardless if they have an Advantage plan or a Part D RX plan.

There are many changes being made. Some drugs have been dropped and some added. Most notably is the deductible that must be met before anything is covered. For many plans, it is $615. You may not have had a deductible before.

There is gonna be a lot of disappointed people come 2026 because they didn't check their benefits.

@Marp I would advise you to directly call your insurance company and check to see if this drug will be covered or not. Sometimes Providers/doctors get confused with benefits. I would double check just to be 100% sure.

CelticCrafter · ‎03-09-2010

@Carmie wrote:
Everyone absolutely should review their RX coverage for 2026 regardless if they have an Advantage plan or a Part D RX plan.

There are many changes being made. Some drugs have been dropped and some added. Most notably is the deductible that must be met before anything is covered. For many plans, it is $615. You may not have had a deductible before.

There is gonna be a lot of disappointed people come 2026 because they didn't check their benefits.

@Marp I would advise you to directly call your insurance company and check to see if this drug will be covered or not. Sometimes Providers/doctors get confused with benefits. I would double check just to be 100% sure.

@Carmie I disagree with you, you may be the insurance expert, but that's not true. None of my husbands medications are subject to the deductible or a co-pay.

cindyNC · ‎08-01-2019

My BF gets a lot of spam/scam calls this time of year from various Medicare Advantage plans. They disguise their name on the caller ID. I got so frustrated one day that I started telling them he was in jail.