PDP Premiums

(Not an agent)

Know you are now very, very busy, but I am curious after my first planfinder run.

I will be interested to see what you have to say about BC PDP's this year after you have had a chance to look for awhile.

Do Independent Agents get commissions for sale of BC PDP's?

Thank you.

BC is different in a lot of states. To make it more confusing, you have BCBS and Anthem, which are different, but look the same.

To answer your question, in KS, for 2025 BC PDP, yes, they are commissionable. The essentials plan is looking competitive. What are your thoughts LD?
 
BC is different in a lot of states. To make it more confusing, you have BCBS and Anthem, which are different, but look the same.

To answer your question, in KS, for 2025 BC PDP, yes, they are commissionable. The essentials plan is looking competitive. What are your thoughts LD?
I like it. I think it is a very nice option for the T1, T2, and T3 meds I have in my drug list.

I have a Dillons not too far from my home, much easier to drive to than WalMart or Walgreens. Cigna and Dillons seem to have had a parting of the ways. That and $0 vs $3 leaves me with WC or BC rather than Cigna.

BC pricing is acceptable to me.

You guys talk about pricing on CMS not being reliable, that it can change. If I understand correctly, some of the agents say one should look at the tier pricing tables.
WC goes $0, $5, 25%, 41%, 25%
BC goes $0, $2, 20%, 48%, 27%

WC puts 3 items on my list in T4. BC puts 2 of those in T3 and 1 in T2.

1 item on my list, a med some dental professionals will use for sedation dentistry, is not covered by any of those 3 plans. Everything else on my list is T1-T3. BC and Cigna assign the same tiers to everything on my list, except for one item which is T2 on BC and T1 on cigna.

And BC drops the deductible to $425.

I had just figured I would need to be continuing with WellCare, but it looks to me like the BC plan is a solid option.

I hope you can see that plan as beneficial for at least some of your clients.

regards
LD
 
everything is a mess, In NY Nassau county lest expensive is WellCare at $36

so many meds used to not cost much now is like a 50% cost share after a 600 deductible

Yea some areas wellcare is $0 but if anyone is taking any higher tier drugs and not over 2000 is getting got

and then I keep running into where a high plan for $115 or so but the out of pocket is showing like $900 and then $0 for the rest of the year

how does this make sense

ca I tell people to go this way with any confidence
 
I like it. I think it is a very nice option for the T1, T2, and T3 meds I have in my drug list.

I have a Dillons not too far from my home, much easier to drive to than WalMart or Walgreens. Cigna and Dillons seem to have had a parting of the ways. That and $0 vs $3 leaves me with WC or BC rather than Cigna.

BC pricing is acceptable to me.

You guys talk about pricing on CMS not being reliable, that it can change. If I understand correctly, some of the agents say one should look at the tier pricing tables.
WC goes $0, $5, 25%, 41%, 25%
BC goes $0, $2, 20%, 48%, 27%

WC puts 3 items on my list in T4. BC puts 2 of those in T3 and 1 in T2.

1 item on my list, a med some dental professionals will use for sedation dentistry, is not covered by any of those 3 plans. Everything else on my list is T1-T3. BC and Cigna assign the same tiers to everything on my list, except for one item which is T2 on BC and T1 on cigna.

And BC drops the deductible to $425.

I had just figured I would need to be continuing with WellCare, but it looks to me like the BC plan is a solid option.

I hope you can see that plan as beneficial for at least some of your clients.

regards
LD

Yes CMS medicare dot gov, is not entirely consistent, it may show one thing now, and something else later. There is no accountability (on CMS) when it happens. You are wise to look at the tiers and the formulary.

I too see the BC as very competitive to WC, which is appealing to me. I have about 300 WC members in KS, so I am excited to have a place to move them that is good for the consumer, and for myself. Im still a little bitter about WC.

Have you tried to get a formulary exception for your sedation med? Some companies are a little more friendly with exceptions than others, but it's worth a shot. You might ask your pharmacist about it. You can also ask for a tier exception too, if needed.

Since BC has that $425 deductible, I believe that makes their plan an enhanced plan, better than the CMS benchmark, as opposed to WC, which also gives them a competitive advantage.

Now, BC says they have a bunch of "mom and pop" pharmacies in their preferred network, but all the "mom and pop" independent owned pharmacists I have talked to said that is not exactly true. So, I would like to see BC put up or shut up, and provide some transparency as to who these "mom and pop" pharmacies are... the competition isnt doing any better, but if BC is gonna market under that premise, then I think they should in fact do what they say they are doing.
 
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