Medicare prescription drug coverage is just one component of a health insurance package, but it's one that enrollees use most frequently and highly value. Equipping brokers with tools and information to assist beneficiaries in taking full advantage of their plan makes for satisfied customers and helps to grow your business.

Below are answers to some of the most commonly asked questions we receive from brokers to help you guide your clients as they navigate their Part D plans.

How do I help my clients maximize their Medicare Part D benefits?

Almost all older Americans use at least one prescription drug and more than one-third take five or more, making the cost of their medications a top concern. Being knowledgeable about the tools and services offered by your client's Medicare Part D plan can help them reduce their costs and better manage their medications.

Humana has several tools that Part D plan members should understand. A mobile app and easy-to-use online dashboard allow them to track their drug spend, anticipate upcoming costs, access drug pricing and lower-cost alternatives, and verify a pharmacy's in-network status. Members are also able to locate the thousands of network retail and mail-order pharmacies across the county. And, for members enrolled with applicable plans, they may further reduce out-of-pocket expenses using a preferred cost-sharing pharmacy, including many well-known retail chains and CenterWell Pharmacy, which offers prescription drug home delivery.

What are value-added items and services and how are they used?

Value-added items and services (VAIS) cannot be discussed with clients before enrollment and are typically included in Medicare Advantage plans but are also available to prescription drug plan (PDP) members. VAIS are not plan benefits or part of the plan's benefit package. VAIS are discounts on health products and other services that are offered by a third-party company with the PDP facilitating access for its enrollees. 

Remember, VAIS may not be marketed to prospective enrollees or used as an inducement or incentive for enrollment, but instead are discounts that Medicare Advantage plans and Part D sponsors pass through to their members after enrollment.

For more information on VAIS, see page 62 of the CMS Medicare Managed Care Manual. 

What are some cross-selling strategies to implement?

Humana recognizes the importance of cross-selling opportunities to help independent agents grow their business. We recently completed an initiative providing agents in targeted test markets with details of Humana's various products and the value they can provide clients, to enhance your client relationships by selling a combination of Medicare supplement insurance, PDP and individual dental, vision and hearing plans.

During the upcoming Medicare annual enrollment period (AEP), agents will continue to see the cross-selling promotion on Ignite, our agent communication platform. 

What changes are coming to Part D in 2025 under the Inflation Reduction Act (IRA)?

There will be several substantive changes to Part D in 2025 under the Inflation Reduction Act, as well as the continuation of some already implemented rules from the IRA that will help reduce prescription drug costs for Medicare Advantage prescription drug (MAPD) and PDP enrollees:

• Members will continue to benefit from low copay, no more than $35 per month, for covered insulin products, as well as receive recommended vaccines at no cost.
• The Coverage Gap phase, also known as the donut hole, will be eliminated in 2025. This relieves enrollees of the surprise—and often higher out-of-pocket costs—that could occur when they move from the initial coverage phase to the Coverage Gap and may pay up to 25% of the cost of a generic or brand drug.
• Out-of-pocket costs will be capped at $2,000, down from $3,300 in 2024, at which point the beneficiary will enter the Catastrophic phase when all covered Part D drug cost sharing is eliminated and members pay nothing for the remainder of the year.
• For the first time, the Medicare Prescription Payment Plan will be an option for enrollees, allowing them to pay their out-of-pocket Part D drug costs through monthly payments to the Part D plan sponsor over the course of the plan year.

Beyond knowing about these upcoming IRA changes, it's important to review a plan's formulary, pharmacy network, plan design, premium and expected member out-of-pocket spend—which can change every year. 

Are there any key considerations I should be aware of for my clients' caregivers?

If your client has a caregiver that helps them make healthcare decisions, then it's always helpful to include the caregiver in discussions regarding the specifics of your client's plan, as well as the changes to Part D under the IRA explained above. It's also important to share information with caregivers on drug assistance programs for eligible beneficiaries such as the Part-D Low-Income Subsidy (LIS) program that can help reduce drug costs.

Caregivers should make sure they have an up-to-date Consent for Release of Protected Health Information (PHI) form on file with their client's plan provider so they can be kept informed of the member's health and prescription drug status. Humana provides easy access to PHI forms, as well as a caregivers toolkit with helpful tips and worksheets to better manage their loved ones' health and medications, in addition to resources offering further support for them and your client.

Learn more about Humana's prescription drug plans by visiting Humana.

TJ Gibb, leader of Medicare prescription drug plans, Humana, and Jay McKnight, PharmD, associate vice president, Humana.