[gloryblaze]

Yeah, but they don’t have discretion to deny a Part D claim if the drug is listed on the formulary. It is either covered or it isn’t.

Sounds good, but the dosage or the need may be argued.

[steve86]

From quick reading it appears that a denial can come only from 1) Need to use less expensive drugs first (step therapy) - which is clearly documented in the contract or 2) Because the plan covers only 30 per month, etc., and not more, or 3) Because prior authorization wasn’t obtained for certain drugs (this is the area where they may have some discretion — it isn’t a factor for common drugs).

[thinden]

Please hep me understand the math on these zero premium medicare advantage plans.

How can an insurance “spread the risk” among a large universe of policy holders paying zero premiums, yet getting dr, hospital, labs, Rx, dental & vision ++ m

Where’s the money coming from to pay for all this if not the policy owners???