Humana Walmart-Preferred RX Plan Review
Should you enroll in the Humana Walmart-Preferred RX Plan?
There is a lot of buzz surrounding the new 2011 Part D plan from Humana. The most significant feature is the plan’s premium, touted as the lowest Part D premium for 2011. At $14.80 per month, the Humana Walmart-Preferred RX Plan looks pretty enticing, but is it for everyone?
Plan Benefits
Members of the Humana Walmart RX plan are required to pay a $310 annual deductible for all tiers.
Below are copays at preferred pharmacies. Preferred pharmacies include; Walmart, Sam’s Club and Neighborhood Market Pharmacies.
- Tier 1 Preferred Generics $2 copay.
- Tier 2 Generics $5 copay.
- Tier 3 Non Preferred Generics and Preferred Brand 20% coinsurance.
- Tier 4 Non Preferred Brand 35% coinsurance.
Copayments and coinsurance using the RightSourceRx mail order plan.
- Tier 1 $0 copay.
- Tier 2 $0 copay.
- Tier 3 20% coinsurance.
- Tier 4 35% coinsurance.
Staying within the preferred pharmacy network will give you reasonable copayments. This is not the case with non-preferred pharmacies. So if you use popular pharmacies such as Walgreens, CVS, Safeway, Rite Aid, Kroger…… the list goes on, you will pay much higher copayments.
At non preferred pharmacies you will pay:
- Tier 1 $10 copay.
- Tier 2 $10 copay.
- Tier 3 37% coinsurance.
- Tier 4 50% coinsurance.
Analyzing the data
There are many 2011 Part D plans that do not require an annual deductible. So aside from copays and any expenditure in the donut hole, the monthly cost is very straight forward. It’s the monthly premium.
With a 2011 Part D insurance plan that requires an annual deductible, we need to do a little math. This will not apply to those who do not require any medications, but have Part D just in case or to avoid a Part D late enrollment penalty down the road. But if you are taking any amount of medications, it’s fairly safe to say that they will cost at least $310 over the course of the year.
The annual deductible needs to be amortized over 12 months. That would equal $25.83 per month. Added to the monthly premium of $14.80, you now have a monthly cost of $40.63.
The most likely real monthly cost of this Humana Walmart Part D plan is in line with the average price of Part D nationally. Certainly, plans with expanded formularies, including Humana Complete PDP will be considerably more.
As a point of comparison, AARP MedicareRX Preferred falls into the average price range and you do not lose the freedom to choose from a much larger network of pharmacies. This should be taken into consideration.
The bottom line
If you do not require any medications or only an occasional medication for a short time, the low price is a big benefit. Having this plan and making it through 2011 without any required medications will keep an average of $300 in your pocket. Now the question…. what percentage of people on Medicare require no medications?
We have not addressed the 2011 formulary for the Humana Walmart-Preferred RX Plan because everyone’s needs vary. But the formulary is even more important than monthly premium and copay amounts. If your drugs are not on the list, who cares what it costs?
Assuming your medications are included in the formulary, the biggest benefit may be the copayments for Tier 1 and Tier 2 drugs using the RightSourceRX mail order plan. After all a Tier 2 drug is often in the $40+ range with many other 2011 Part D plans.
The bottom line? This plan could be a big benefit for certain groups of people, but for others, maybe not. You will need to get your hands on the formulary, decide if you can stay with preferred pharmacies or use the mail order option and look at your individual situation. Whether or not the plan is for everyone or not, is not critical. The good thing about the Humana Walmart-Preferred RX Plan is it offers more choice and fits the bill for certain individuals.
Did you enjoy this post? Why not leave a comment below and continue the conversation, or subscribe to my feed and get articles like this delivered automatically to your feed reader.
Comments
Christina, When you first become eligible for Medicare it can be confusing to choose a Part D prescription plan. Here is the formulary for the Humana Walmart-Preferred RX Plan. You should review formularies when you compare 2011 Part D drug plans.
If you are new to Medicare, I really suggest that you find a local agent that you can trust. If you want to forgo the agent you can visit the respective websites for any company that you are interested in. Applications for 2011 Part D plans can be submitted; to an agent, through the mail, online and through telephonic enrollment. Methods will vary depending on the company. If you are interested in Humana PDP plans, visit http://www.humana.com.
David
I am confused, if I change just the part D of my insurance, does that effect my Plan F with my insurance company I have now? At this time all my insurance is with one company, and Part D is going WAY up. I am satisfied with my F plan for other insurance needs. So am I stuck with their part D plan?
Carol, You can change your Part D without affecting your Medicare supplement Plan F. It is not necessary to have your Medicare supplement and Part D insurance with the same company. For example, Mutual of Omaha offers Medicare supplements, but does not have any Part D products. In this case you would need to choose a stand-alone Part from another company, like AARP or Humana. Start now to compare 2011 Medicare Part D plans as enrollment began November 15 and ens December 31.
David
The counsellors at the Humana Walmart plan lead one to believe that a network non-preferred pharmacy (like CVS) would be more expensive than in the limited Walmart pharmacies, but only a few dollars if you needed some meds that are not on one’s regular maintenance schedule. What do YOU consider to be”much higher payments” when you say, “Staying within the preferred pharmacy network will give you reasonable copayments. This is not the case with non-preferred pharmacies. So if you use popular pharmacies such as Walgreens, CVS, Safeway, Rite Aid, Kroger…… the list goes on, you will pay much higher copayments.”?
Diane, I guess in all fairness the terms, “only a few dollars” (as stated by Humana representatives) and “much higher payments” (as stated in the article), are both relative terms. Remember, the Humana representative wants you to join their plan. I was thinking of seniors on a fixed budget, maybe deciding whether to buy medications or pay the heating bill this winter.
Let’s look at the cost-sharing; both at preferred pharmacies and non-preferred pharmacies for the Humana Walmart Preferred RX plan:
Tier 1 – preferred pharmacies: $2 non-preferred pharmacies: $10
Tier 2 – preferred pharmacies: $5 non-preferred pharmacies: $10
Tier 3 – preferred pharmacies: 20% coinsurance non-preferred pharmacies 37% coinsurance
Tier 4 – preferred pharmacies: 35% coinsurance non-preferred pharmacies 50% coinsurance
Each person should look at their required medications and do the math. Once you have hard data on your out-of-pocket expense, I think that the term “much higher payments” is warranted. The bottom line is this: if you are going to enroll in the 2011 Humana Walmart-Preferred RX plan, you will maximize the benefit if you use preferred pharmacies and the Humana Right Source RX mail order option.
Does anyone know where I can find:
1. A list of the “preferred pharmacies” for the “walmart $14.95″ Humanna Plan?
2. The prescription formulary for this plan ?
Jim, The preferred pharmacies for the Humana Walmart-Preferred RX Plan are any Walmart, Sam’s Club or Neighborhood Market Pharmacies. In case you are not familiar with Neighborhood Market Pharmacies, they are a chain owed by Walmart.
The formulary will vary depending on where you live. Here is a link to the Humana Website. Scroll down to find the plan and your specific State to find the printable drug list.
I just found out about the $14.80 premium choice. I called Humana and was told that it is too late to enroll. I explained to them that I was not sent any info regarding the choice, and feel that I should still be eligible for the change. I only take meds for hypertension, so it doesn’t take a brain surgeon to see that I could save money with this plan. What can I do to switch at this time Hope you can help.
Karen, I’m sorry to say that Humana couldn’t switch you now even if they agreed with your argument. Their hands are tied by federal law. Comparing plans is the responsibility of the Medicare beneficiary during the Annual Enrollment Period. Companies are under no obligation to inform you about all plans available. Part D plans end each year. As a protection to you, if you do not enroll in a new plan for the coming year, your plan will automatically renew if it is going to be available (some plans non-renew). I know it sounds like common sense that you would have been notified about plan options. If you receive extra help (low income assistance) you can change plans any time. Doesn’t make a lot on sense!
Thanks for the information, it has made me feel empowered that I did make the decision to change as it applied to me and your info tells me that I did understand the pros and cons of the plan. It basically works best for two classes of people as I see it. #1 those who take very limited or no meds as I do, or those who take multiple brand name drugs well in excess of the $310 deductible such as my sister’s situation. It initially just seemed like one of those too good to be true offerings, but seems to suit some perfectly.
I signed up in February for this plan. Imagine my surprise when after having my 4 prescriptions filled for the first time, I got the summary showing that I had paid $404 dollars out-of-pocket. When I called to ask about my $310 deductible, I was told that if the cost of medicines goes over $310 in the process of filling your prescriptions, you have to pay the total because the company has no way to know that you have satisfied your deductible. When I asked if that meant that I should only fill prescriptions at the beginning of each year that total just the $310, or as close to it as I can, I was told that’s pretty much it! I’m sorry, but I still don’t understand that. If the company that’s handling my prescriptions doesn’t know when I’ve paid out my $310 deductible, who does?
Linda, Why would you need to wait to get a summary to be surprised? Didn’t you pay for them at the pharmacy? My guess is that three prescriptions together didn’t meet the $310 deductible and that meant that you would need to pay for the fourth. You pay the copay once the deductible is met. If there was any confusion it sounds like it was on the pharmacy’s end. They should be able to calculate if any of the 3 prescriptions (in some combination) would reach $310.
For 2012 maybe you should consider a Part D plan that does not require a deductible. That may give you more certainty.
Thank you for your answer, Dave. However, I used the mail away pharmacy and the first 3 (cheaper) prescriptions were filled and billed first; I did not know the cost for them until they arrived, but I knew that I would pay for them out of pocket. The last and most expensive drug also came from the mail away; I had to give them a credit card # before they shipped it. The amount that they stated was almost the whole of my deductible. I assumed, until I got my summary, that the pharmacy would realize that I had met my deductible and fix that. I expected that they would apply that last drug to the rest of my deductible and then bill me the 20% of the rest as my co-pay. And it does seem that the plan paid part of it and I paid 49% of the rest of the cost. I can’t make the math of this work out no matter how I figure it. Right now I still have paid out $404 (Oh, yes, and then because of something I don’t understand, one of the first drugs I paid for out of pocket wasn’t on that February summary; that means I will have out of pocket of closer to $430). What is it that I don’t yet understand?
Linda, I’m sorry I didn’t realize you used the mail order pharmacy. I’m in the same boat as you. Sounds like you need to get clarification from Humana. This experience may be all the more reason to choose a Part D plan for 2012 that does not require a deductible. When you amortize the $310 annual deductible over 12 months and add it to the Humana Walmart Preferred PDP premium of $14.80 you are actually paying $40.63 per month (more in your case). You can surely find a plan for about that premium and avoid this whole problem going forward.
I am really sorry my representive talked me into taking the walmart preferred plan. I was prescribed 4 more drugs the first of the year. There was no generic for them. I really am paying much over what I paid for the first policy.
Lois, If you have a representative “talking you into” Medicare Part D coverage you need to fire that representative and find another one. An agent should be a consultant not a manipulative sales person. Unfortunately you are going to have to tough it out until you can enroll in a 2012 Medicare Part D plan.
The Medicare Part D Annual Enrollment Period is changing for 2012 plans. You will be able to enroll or change Part D coverage beginning October 15 through December 7 for a January 1, 2012 effective date.
This plan is a joke. Don’t do it. It is now Aug. They have not paid out anything for the drugs I take and now I need a perscription for Nexium and they won’t cover it or they won’t authorize it. It will cost me over $300 dollars for my drugs a month and this plan pays nothing. The lesson is you get what you pay for. And for this plan it is nothing. Medicare part D is a joke. They started out with low cost to the plans now they are very costly, the formulary get’s smaller and they cover very little.
Mary, It sounds like you enrolled in the wrong plan. For someone who requires drugs not on the formulary it would seem like a joke. For people whose drugs are on the formulary it may be the right plan. When you compare Part D plans for 2012 dig deep into each plans formulary to make sure you get a better experience.
Hi, Can you tell me if the 2012 Humana Walmart Preferred RX Plan will have all the same benefits that it has in 2011. I do understand that the premium is going up to 15.10. Thank you. Sandy
Sandy, Information on Part D plans will not be publicly available until October 1. You should receive in formation including a plan formulary from Humana.
Suzanne, As long as you have Medicare Parts A and B and live within the plan’s service area you qualify to enroll as long as you have a valid enrollment period option.
how can i get a copy of the full formulary, showing tier for drugs, or access to it on line. former company sent me one on signing up. can you do the same?
Madaline, Here’s a phone number for Humana where you can request a formulary for the Humana Walmart-Preferred Rx Plan: 1 – 800 – 833 – 0632
BEWARE BEWARE BEWARE!!!!! I switched my 76 year old mother to the Humana Walmart plan in April, 2011. She takes Tiazac 240 mil for her high blood pressure. She has an active prescription for the medicine that is good until April, 2012. The prescription also states she has tried the generic versions of this drug and they are unsuccessful for her, she HAS to have the name brand. Humana is now denying coverage for my mom’s medicine EVEN THOUGH they have “prior authorization” from her physician. They are a scam, a ripoff and if you decide to go with them I guarantee you that you will be sorry…run away as fast as you can!!!
G’Anna, It’s never any fun when you feel you have been wronged, but for the hundreds of thousands of people enrolled in the plan who are not having issues, even it there were lights and sirens attached to your email it would mean little. If you feel you have a valid complaint contact Medicare and make your case.
Sorry, David, G’Anna has valid issues with this Plan D. I had been taking Premarin, per my doctor’s advice, and it was listed on the formulary when I signed up on Nov. 1, 2011. On December 28, 2011, AFTER the open enrollment period had ended, I received a letter from Humana Walmart stating the Premarin was off their formulary for 2012. A list of covered meds was sent to my doctor on Jan. 6, 2012. Cenestin was listed as a replacement and my doctor wrote a prescription for that. When I went to pick up the Cenestin, it was denied by Humana Walmart. I spent two hours on the phone with them, to no avail. Their pharmacist overruled my doctor, which as I see it is practicing medicine without a license. I will not be enrolling in this plan again and as I live in an area with many seniors, will advise everyone I know to avoid this plan. And to boot, I plan to put signs on the rear window of our cars during the enrollment period that will state the truth~~
Avoid Humana-Walmart Plan D–a complete ripoff!
Laura, I understand how you feel. Score one for the machine and not the little guy. Vote with your feet and choose a new plan during the next enrollment period. User a local agent so you have someone else on your side if you run into troubles with your new plan.
Here’s another issue, if you can believe it!!
Cenestin was discontinued by the pharmaceutical company. Again, my doctor went over the list of covered replacements sent to him by Humana-Walmart, and decided on Menest. At this point, and knowing what a scam this plan is, it was no surprise that Menest isn’t covered. David, I’m voting with my feet AND my mouth. As I have several friends turning 65 this year, I’ve already advised them to avoid this plan like the plague. The above mentioned signs (Feb. 28th comment) will be placed in all three of our cars, and I will stand outside the local grocery store where the seniors in our area shop and hand out flyers during the open enrollment period. I do have a local agent, who spent a lot of time with me looking at plans to cover the one medicine I take. I only wish he could advise seniors to stay away from this plan, but, he is too ethical for that…..
Laura, I understand… you have to do what you have to do. Personally, I’d just move on and concentrate on creating positive energy! If I didn’t, I’d spend my life’s energy locked-up being angry at everyone I felt had wronged me.
I understand what you’re saying, David, but, anytime I can help others, especially fixed income seniors, stay away from a scam, if you will, then it can only be positive energy, time well spent. I strongly feel that an insurance company that sends a physician a list of medications stating that those medications are covered under the plan and he/she writes a script for two, not one, of the medications on said list, is really nothing more than a scam. They had no intention of covering any of the meds on that list. But, word of mouth is the best/worse advertisement.
In a multiple drug order. Why isnt the most expensive drug cost be added to the part d deductible first?
Donald, The only reason that it would not apply to the deductible would be if it’s not included in your Part D formulary.
Hello. Please help!! This is my first time choosing Part D coverage. Humana/Walmart plan sounds like it might be the right fit for me. How do I know if it covers my particular medications? How do I apply? I REALLY need someone’s guidance? Are you able to steer me in the right dirction? I don’t even know how to apply. Thank you.