Medicare Part D: Why is it so important for your clients?

Paul Lucas  00:00:07

Hello, everyone, and welcome to the latest edition of Insurance Business TV and a healthcare special as we dive into Medicare Part D, it, of course helps pay for the prescription drugs each of us need. And even if your clients don’t require anything right now, they could be well worth considering for the future. So let’s find out a little more about it and why it might be right for your clients. To do that. We welcome TJ Gibb, the leader of Medicare Part D at Humana TJ, welcome to Insurance Business TV.

TJ Gibb  00:00:38

Thank you, Paul. Great to be here.

Paul Lucas  00:00:40

So TJ set the scene for us a little bit. Tell us a little bit more about Medicare Part D and why would somebody need a prescription drug plan?

TJ Gibb  00:00:48

Sure. Well, first of all, we need to think about the federal program called Original Medicare. And with Original Medicare, it’s predominantly for individuals who are above age 65. There’s also the ability for certain individuals with disabilities to apply for the program if they’re under age 65. But Original Medicare has two parts to it. One is the part a program which is or hospital coverage. And the Part B program is for medical or physician coverage. And so you need another program to cover prescription drugs called Medicare Part D. And we’ll spend a lot of time talking about that. Something also that you really need to keep in mind is that even if you don’t take prescription drugs today, and you try to enroll in a Medicare Part D program later, you will have an enrollment penalty. So it’s important to think about that at this time.

Paul Lucas  00:01:44

Well, let’s talk a little bit more about Part D. And just tell us when you spoke about some of the other coverages that are how does it work alongside other coverage?

TJ Gibb  00:01:51

Well, Medicare Part D or Prescription Drug Plans are offered by private insurance companies such as humana. And what we typically see is that customers will buy Medicare supplement with that or Medigap coverage also provided by independent insurance companies. But the Medicare supplement plans do not have drug coverage. So you would pair a prescription drug plan for Medicare Part D with a Medicare supplement plan. And a Medicare supplement plan is important because it does help some of the out of pocket expenses from Medicare Part A and Part B. Yeah, I would just say, if you have questions about that, as an agent, you really should contact us directly rebel lot of people that can help you with that. We’ve got great digital tools that can help you with that, or Medicare.gov also has many resources if you have an interest in learning more great that you spoke about agents that are TJ. So what would you say are the benefits of prescription drug plans to broker agent prospects and their clients as well? Well, for agents, one of the most important things to think about is that prescription drug plans. The mission is really to offer a safe and affordable medication for customers. And you want to look at the prescription drug program, make sure that it covers the wide range of drugs and things that your customers need. But there’s other benefits as well, such as vaccines for shingles, RSV, T dab, and those are also benefits of prescription drug plans. There’s also plan costs that you have to consider. And so you’ll have monthly premiums that were required to be paid by your customers. You also have deductibles, co pays and coinsurance. coinsurance if you’re not familiar with that term is a percentage of the drug costs that your customer would be responsible for based on the benefits of the program they select. In addition, there are limited income programs, such as extra help, which is the government program that allows individuals to pay sometimes zero premiums for their product that they have, and also can subsidize their co pays and coinsurance costs deductibles. And so there’s lots of ways to to really handle that from a consumer perspective. In addition, people who have limited financial resources, they also can qualify for patient assistance in certain situations. And Patient Assistance is programs run by drug manufacturing companies and charitable organizations where they can assist in out of pocket costs for certain drugs for certain consumers that qualify.

Paul Lucas  00:04:34

So obviously a lot of advantages with Medicare Part D. But you mentioned earlier that it is offered by several insurance providers. So how does Humana stand out from the others that are out there?

TJ Gibb  00:04:46

Well, we really feel that we are incredibly consumer focused. And I know a lot of companies probably say that but we really try to make our tools easy to use so our customers understand the benefits. They have, it’s really easy to understand. And they’ve got the ability to do this through digital means we’ve also got analog means where we can have contact centers with live individuals helping our customers. But back to our digital tools, we’ve had dashboards that really enable people to manage the program themselves, and mobile apps and other tools that really help consumers manage their program as as they need to, for example, on the dashboard, what it does, it gives you the ability to track your current drug spend, as well as predict future drug spend, you can look up things like pharmacies that are in the network, or they preferred koshary, pharmacy or a standard pharmacy, and really gives you all the program benefits all in one place and very easy to use dashboard. In addition, we do cover a number of preferred pharmacies, and a lot of them will be familiar names like Walmart, Sam’s Club, very large national grocery chains, and Costco. As well as we’ve got a mail order pharmacy that is owned by Humana call center, well pharmacy, and we find that be a very convenient option for our customers as well. In addition, on the digital tools, if you’re using the Humana plan application, or the center while application, we have a single sign on process, where you don’t have to go back and forth between the digital tools, you sign on one time, and you have access to all the benefits of your plan itself. And then within the stairwell pharmacy program as well. We do have something called Smart summary. And was smart summary. It’s a monthly statement that reviews any of your drug spend, we also have educational items that can be in that smart summary. And then we have a program called maximize your benefits. And that is a program that allows you to look at drug alternatives, maybe there’s a more convenient or low cost way to access those drugs. And so we help you do that through those resources as well. So for brokers and agents who are looking to offer these plans to their clients, what tips should they be given to them? Well, every broker really would like to have a loyal customer. And in order to do that, you’ve got to really focus on getting the right plan for them. And individuals are all unique, they all have unique situations and unique needs, it’s you need to really deeply understand that in order to deliver the right plan for them. And that really starts with what medications are they taking. And if you look at the medications they’re taking, you can match that with the plan that will be best for them, you have to make sure that medication is covered by any plan that you’re recommending to them, because there’s no plan that offers all medication. So you’ve got to be really thoughtful about that. And then the drug pricing is very important. And so any given plan, depending on the pharmacy, you use and the benefit stage are in the drug cost can be different. And so you want to look very closely at that as well. And some of the tools we talked about earlier, they can help you do that. And something else we think is really important is the digital tools that we’ve spoke of, you have to really make sure you’ve got contemporary tools, the carrier that you’re with, has actually invested in those tools and made it easy to use. And so you’re not in a situation where it’s just really difficult to manage your program, what it should be really simple and easy for any given customer. And then if you think about our older adults that we serve, many of them have chronic conditions. So they’re going to have more than one medication they take. So the items I just mentioned, you’ll need to think about that for all the different medications that the senior is taking. And if you do all those things, we think that you can create a positive experience for your customer, you can partner with somebody like Humana to, to deliver on that and have a great experience for all and ultimately treat that loyal customer that you’re looking for. And something else that’s really important is looking at the benefits every year. So every prescription drug plan has to refile their benefits each year. So in most cases, you’ll see changes to the benefits, you could see changes to the drugs cover, you could see changes in the pharmacies that are in network or preferred status versus standard. So it’s really important to look at all that. And in 2025, there’s been meaningful changes to the drug program through regulatory adjustments from the government. And so with that, you really have to look at the benefits themselves again for 2025 with your customers, for example, the coverage gap phase is going away. And so the benefit now will have three phases it will have the deductible phase, the initial coverage phase and then the catastrophic phase. And something also is a really meaningful change this year is in the catastrophic phase, your maximum out of pocket will ultimately be $2,000. And so as you think about that for your customers, you need to look at how much drug spend, they have, will they hit the maximum out of pocket through all the phases. And lastly, there’s another program called Medicare monthly payment plan. And that allows your customers to balance their payments throughout the year. And so they would create more of a monthly payment stream than just having to pay all your costs upfront. So lots of things to consider. But we’re happy to help you at Humana.

Paul Lucas  00:10:34

Now, plenty to consider, but lots of great tips and some fantastic insights as well. So huge thanks for your time today, TJ and if anybody does want to find out more, how can they get in touch?

TJ Gibb  00:10:45

Sure, you can always go to www.humana.com. That’s an option or if you have a local sales team that you work with, you can certainly contact them as well.

Paul Lucas  00:10:56

Now I’m sure many people will be reaching out. But when you’re done contacting TJ and his team, make sure you come right back here for more expert insights and Insurance Business TV.