I spent 2 hours on the phone with my insurance broker last week. A lot was explaining the $2000 limit. I have MA and want to switch plans.
The $2000 is what she calls ‘Medicare math’. Medicare will now allow a $590 deductible for prescriptions. Tier I drugs are still no copay, Tier II are a little more (don’t remember the percentage), and tier III can charge a 24% copay. Tier 4 and 5 are huge amounts percentages.
But the MA companies don’t HAVE to charge the max. I have Aetna which will be charging the $590 and then the 24%. Say you have Ozempic which is tier III. If it is $1000/mo, Aetna will charge $590 for the first month (and maybe 24% of the $410 remaining I don’t know how that works), and then the next month $240 until the patient reaches $2000 in copays. For United Health, they are sticking with the $420 deductible, but medicare will give credit for the $590. They are also sticking with the current copay of $47, but medicare will give credit for the $240 (24%), so you’ll hit your $2000 deductible without actually paying $2000 OOP. My math may not be correct, but I think you’d pay $420 plus $47 x 5.9 months, or about $700, while the other would pay $590 and $240 x 5.8 months = $1982 (so will have to pay a few $$ less than $240 in month 6)
All insurance companies are required to let you pay the $2000 max on a monthly payment plan so you don’t get hit with $2000 in Jan.
And that’s what I got from my 2 hour conversation.