First Health Part D Value Plus Pros And Cons

First Health Value Plus is one of three plans from First Health Part D

If you are new to Medicare you may be surprised to learn that you have more than two dozen Medicare Part D plans to choose from.

First Health Part D offers three plans, the most basic of which is the First Health Part D Value Plus plan.

In addition, they offer the First Health Part D Premiere and Premiere Plus plans.

As you compare Part D plans, aspects to focus on are; whether or not all your drugs are included in the plan’s formulary and the overall cost of using the plan.

There is not a single drug plan that can be considered the best for everyone. You must weigh a plan’s cost and benefits against your own needs and budget.

What follows is a brief overview of the First Health Part D Value Plus plan.

Plan costs

When analyzing the cost of a Part D plan you must make a distinction between having the plan and using the plan. Having the plan will require premiums while using a plan may require a deductible and cost sharing for filled prescriptions.

Premiums

The Value Plus plan is a national plan and premiums vary by State. Monthly premiums are in the mid $20’s to mid $30’s range. This places the plan’s premium below the national average.

Your premium can vary from the standard premium for your State if you receive extra help or if you are required to pay a late enrollment penalty.

Deductible

There is no annual deductible required for this plan, you have first dollar coverage. The maximum allowed deductible for a 2013 Part D plan is $325.

As a point of comparison, the AARP MedicareRx Saver Plus plan insured through United Healthcare has the lowest monthly premium at $15.00 but requires a $325 annual deductible. The deductible amortized over 12 months is $27.08 – as much as the First Health Part D premium in many States.

Cost Sharing

Paying copayments and coinsurance amounts are a form of cost sharing. The Value Plus plan has four tiers. Amounts assume preferred pharmacies.

Tier 1 – $0 copay
Tier 2 – $35.00
Tier 3 – $70.00
Tier 4 – 33%

You will pay more for using non-preferred pharmacies in the First Health Part D network.

This plan does not include extra coverage in the gap, although you will receive a 52.5% discount on brand name drugs and a 21% discount on generic drugs while in the gap as part of the legislation to close the gap by 2020.

Formulary

Although the First Health Part D Value Plus formulary is not a plan cost, it directly affects the cost of using the plan. A formlary not only lists all the drugs included, but also lists tier placement of each drug.

Tier placement for a specific drug can vary from plan to plan and have an impact on the overall plan cost.

The Value Plus has a basic formulary and will include the most popular medications used by people on Medicare. The First Health Premiere and Premiere Plus plans have enhanced formularies.

Pros and cons – who should enroll and who should not

The obvious first. If your medications are not included in the formulary they will not be covered by the plan and you should probably not join if there is a plan available that includes all your medications. The basic formulary for some people may be listed in the con column.

Assuming all your drugs are covered by the plan, you should focus on the over all cost of using the plan. This will require some calculation.

You can also compare Part D plans at medicare.gov and enter your list of medications. Plans will, by default, display with the lowest estimated annual retail drug cost first.

Interestingly enough, if you compare plans without entering your drugs, the First Health Part D Value Plus plan is listed as having the lowest estimated cost of all national plans. Most people would place that in the pro column.

One aspect of this plan that may be seen as a positive is that in tiers 2 through 4 have a fixed co-pay amount and not a coinsurance percentage as in years past..

Medicare rates plans by assigning one to five stars. The Value Plus plan is rated at 2.5 stars (2012 rating). You may or may not find this to be an issue.

Pros