When I googled the question about anthem dropping part D coverage, Google said that a person could pick a new plan or they would be automatically switched to a new plan.
I couldn’t find an article for that specific question, I’m sure there are ones out there.
I believe that does happen with Part B if an Advantage Plan goes away and you do not choose new, you default to Original Medicare. Not sure about Part D.
Since Anthem completely dropped Part D, plans did not automatically convert to anything else. Members were required to actively select a new Part D plan during the specified time period. Because the plan was ending, members were given an SEP (Special Enrollment Period) that ran until February 28. I found a lot of social media about this last fall; people were upset. It’s understandable that elderly members who just let plans roll over year to year might easily have missed this.
So the ship has sailed on getting another Part D right now. Hopefully OP’s in-laws will continue to only need inexpensive medications. The special manufacturer deal plans for expensive drugs often exclude Medicare recipients from eligibility. Whether or not someone without Plan D would qualify is an open question, depending on the drug company I guess.
As a side note, those with Plan D (or relatives on Plan D) really should check every fall during Open Enrollment to see if their plan is still the best. Much is dependent on the specific medications. I take one expensive brand name (Synjardy) with which I’m quite happy; the rest are generic. My previous Plan D company dropped it for 2026. The Medicare web site is very helpful for finding a new plan; you put in all the medications and where you live etc. and it shows you all the options and annual cost including premiums.
Re pharmacists discussing cost of drugs…under my new 2026 plan, I decided to use Walgreens for the 90 day refills instead of the mail order company so I could just pick them up in person. I had to call the pharmacy to straighten out the new insurance and the pharmacist asked if I was aware that the one drug was expensive. Yes, I said, about $700-800 the first time each year and well worth it!
There are two enrollment periods each year and I thought the current one ended on 3/31. They could switch to a Medicare Advantage plan which includes prescriptions without a separate Part D plan. I am not sure why you heard the deadline was 2/28. There may be something I am not aware of so no doubting, just asking.
And don’t forget that you/with your inlaws can always call their providers, tell them about a particular medication which is costly, and ask if there is either a generic or a feasible substitute.
My asthma inhaler went from $89 out of pocket to over $400 when I switched plans. I was horrified. Called the doctor who told me “Gee, I just don’t know how much things cost” (encapsulating so many things wrong with health care.) Half an hour later got a call back from the office- new scrip, older medication which likely would function the same way, much cheaper.
I picked it up at CVS- $20. I can’t tell the difference.
So for really elderly people- double check that any expensive meds they are on are really and truly what is medically necessary!
The Jan-March is only for people already in a Medicare Advantage Plan. The February 28 deadline was for people whose Plan D coverage from 2025 wasn’t available in 2026 because the company dropped it. It’s one of the qualifying events for a Special Enrollment Period.
You may qualify for an SEP if you experience specific life changes, including:
Moving: You move to a new address that is outside your plan’s service area.
Loss of Coverage: You lose creditable prescription drug coverage (e.g., losing employer/union coverage).
Plan Changes:
Your plan leaves Medicare, stops providing service in your area, or has a 1-star rating
Institutionalization: You move into, live in, or move out of a nursing home or other institution.
Financial Assistance: You gain, lose, or have a change in your eligibility for Medicaid or “Extra Help” (low-income subsidy).
Got it!
Do not switch to an Advantage plan.
When you look at drug plans, look not only at the cost of the meds and the monthly premiums but if there is one drug that is expensive check the other discount sites to see what it will cost there. I chose to stay on the zero premium plan and just get one med elsewhere.
** oops, meant to tag @mom60. Apologies
Use Cost Plus. It’s very affordable for meds especially if they are Tier 1/2. In many cases much less than Good RX. Buzz RX (yes it’s a real thing) is probably somewhere in between. The question is what meds do they take. Sometimes the actual manufactures can help with costs.
Also Wellcare is government subsidized so for those same tiers they are Zero deductible plans. Out of my 4 meds 3 are zero cost. The last one is only like $330 for the year but with Cost plus or by me Mariano supermarket pharmacy it is like $60/year. You read that correctly using Buzz RX.
Manufacturers can’t charge a different price or give a coupon to those on government insurance, including medicare. They can give it to you for free, but not reduced unless you don’t run it through your insurance (like use GoodRx or another discount program).
I did tell my doctor at the end of last year that one of my prescriptions was too expensive and she needed to find something else for this year. Turns out it was one of the drugs that medicare negotiated a reduced price for this year, but it would still have cost me about $50/mo and I said no. She found something else. I went to a retinal specialist and he said the meds would be about $800/mo until I met my deductible (and it is medical deductible, not prescription, so $5600/yr) and I said I couldn’t afford it. He said ‘No one can’ which I think was about the nicest thing a doc ever told me and then he got me into a medical study and I get the medication for free! Even better.
Mil is convinced they never got any notice from Anthem. I’m sure she is mistaken and it likely got tossed out. She doesn’t seem overly concerned and said if they can’t get it now they will just pay out of pocket till next year. She said they don’t take anything expensive except for some eye drops which were expensive even with the insurance. She hasn’t noticed any huge prescription costs when she’s picked up. My husband isn’t convinced they can figure out how to use any discount programs.
I’m going to send a message to his sister with what I’ve learned. She can help them try to use some of the suggestions.
Set up a reminder for October 15!
She asked my husband to put it on his calendar
If they use the same pharmacy all the time, the pharmacy may be able to put it in their files and use the discount programs automatically.
When using GoodRx it’s best to look your drug/dose/amount up on internet for your area first. Not all pharmacies participate and the drug prices vary between pharmacies within the same town. The caveat is GoodRx sells your info (just so you know).
And your insurance even with co-pay may not be the cheapest way to go. Check GoodRx first. On insurance we had one that was 70 bucks and GoodRx was 7 dollars.
Get a list of the drugs that your pharmacy may have as loss leaders. For example Publix has quite a few almost free generic drugs. And the perk is you can get 90 day refills vs only 30 since it’s not going through insurance.
We have a Medicare Supplement through AARP/UHC. They have a program similar to GoodRx for members, called Optum Rx. My H’s niacin is half the price on it compared to Costco (which is quite a bit less than the GoodRx price), and a fraction of the Medicare Part D price. It can be a lot of work to minimize prescription costs, but if an expensive drug is needed, it’s worth investigating. (Too bad this is necessary for older folks, who are less likely to be able to investigate.)
We found that mark Cubans cost plus is a good site for exploring cheaper options for medication.
My husband is on a med that is not covered by his Medicare part D but is very affordable on cost plus. It wasn’t covered by his BCBS when he had that insurance either.
For our generics, very affordable
That’s true, but anything you get off GoodRX or Simple Care (I think that’s it) that isn’t run through medicare will not count toward you OOP maximum ($2100 for 2026) so if it is small different, it might be more advantageous to pay more a few times and then get all the copays covered at the end of the year. Usually NOT a good deal for cheap generics but may be for more expensive drugs. I have a friend who was buying inhalers in Mexico because they were so much cheaper than in the US (her prescription plan didn’t cover it at all so she was paying full price) but last year when they capped the OOP for Medicare amount I told her to check and see if it was better to pay full price for a few months and then have it covered. By then she’d switched to a different (covered) inhaler. And now is moving to Mexico so she can get all she wants there!
So you need to be an accountant as well as an insurance expert.
I think anyone can use Optum or another mail order pharmacy (not sure if all insurances allow it). This year I have Center Well (insurance is Humana) and the only drug I have to pay for (so far) is Ozempic, and it is $94 for an 84 day supply. By far the best price I could find. Center Well seems to be cheaper than Optum, but that could be a difference in insurance companies too (Humana had the best pharmacy benefit for me this year, by a LOT). I can get a 100 day supply, 90 days at any other pharmacy for the same co-pay, if there is one, and only Ozempic is a different day count. I think a tier 2 drug is $10/30 day supply or $30/100 day supply and Tier 3 and above is a percentage of the cost (like Ozempic is the $94 for 84 days - someone else has to do that math!