Medicare Part D Prescription Plans

[harllee]

I am on Medicare and currently have Humana Walmart as my Prescription Part D plan. It is that time of year when you can change Part D plans (from 10/15 to 12/7). I got on Medicare.gov to see if there is a better plan for me. On Medicare.gov, you put in your location, what prescriptions you take, etc and the website gives you a list of Part D plans available for you and the cost.

I am fortunate that I don't currently take any prescriptions, but you never know what the future holds so I want to continue to have a Part D plan.

Anyway, Medicare.gov shows me a plan named "Envision Rx Plus" for which the premium will be about $100 per year cheaper than my current Humana Walmart and, in addition, the Envision plan will have an annual deductible of $100 less than my current plan. The preferred pharmacies that Envision uses (CVS and Rite Aid) are convenient for me.

I am inclined to move my coverage to Envision, but I wanted to ask here whether anyone has any experience with Envison Rx.

Thanks!

 

[CRLLS]

Must be different premiums in different states. I just signed up for Medicare that starts Nov 1st. I also chose the Humana Walmart plan. I just looked at "Envision Rx Plus" for 2017 and it is $144 more annually for me. And the annual deductible is the same ($400). For 2018, the "Envision Rx Plus" would be 77 more in annual premiums

However, if it is cheaper for you, then why not go there? At the expense of slightly higher premiums, the "Envision Rx Plus" plan appears to have lower copays for tiers 3, and 4. You can always change plans next year if you don't like it.

 

[omni550]

Must be different premiums in different states. I just signed up for Medicare that starts Nov 1st. I also chose the Humana Walmart plan. I just looked at "Envision Rx Plus" for 2017 and it is $144 more annually for me. And the annual deductible is the same ($400). For 2018, the "Envision Rx Plus" would be 77 more in annual premiums

However, if it is cheaper for you, then why not go there? At the expense of slightly higher premiums, the "Envision Rx Plus" plan appears to have lower copays for tiers 3, and 4. You can always change plans next year if you don't like it.

+1

I just checked my MI zip code and my snowbird FL zip code, just for comparison purposes.

As you can see, it varies a LOT. That's not a typo --> $117/mo in FL.

MI: $12.60/mo, $300 deductible for Tier 3-5
FL: $117.00/mo, $405 deductible (no tiers specified)

omni

 

[Sunset]

+1

I just checked my MI zip code and my snowbird FL zip code, just for comparison purposes.

As you can see, it varies a LOT. That's not a typo --> $117/mo in FL.

MI: $12.60/mo, $300 deductible for Tier 3-5
FL: $117.00/mo, $405 deductible (no tiers specified)

omni

I wonder if they think a lot of potential customers (old folks) live in FL

 

[harllee]

I can't believe how much the premiums vary state to state. Here in North Carolina the Envision RX plus is $12.50 per month and Humana Walmart is $20.40 per month for 2018. Wonder why the premiums vary so much from state to state? Do drug costs vary so much from state to state?

 

[mf15]

We have used it for 2017,works well for us, I see no reason to change for 2018. I do notice that they have changed the preferred pharmacy network from 2017, which was Walgreens.
My cost for 2018 is $12.60/month.
Old Mike

 

[audreyh1]

If you are't taking any prescription drugs I guess the trick is to buy the cheapest Part D plan until you do have a long-term prescription.

 

[CRLLS]

+1

I just checked my MI zip code and my snowbird FL zip code, just for comparison purposes.

As you can see, it varies a LOT. That's not a typo --> $117/mo in FL.

MI: $12.60/mo, $300 deductible for Tier 3-5
FL: $117.00/mo, $405 deductible (no tiers specified)

omni

Unbelievable. Not your comment, but the difference between states. I wonder if these PDP plans are regulated by state insurance boards and some states are more diligent about keeping costs down?

The changing deductibles and tier coverages from state to state just don't make any sense to me.

 

[omni550]

I wonder if they think a lot of potential customers (old folks) live in FL

Ummmm...everyone on Medicare Part D is 65 or older, I believe. Some would say they're all "old folks".

omni

 

[athena53]

Unbelievable. Not your comment, but the difference between states. I wonder if these PDP plans are regulated by state insurance boards and some states are more diligent about keeping costs down?

The changing deductibles and tier coverages from state to state just don't make any sense to me.

Insurance IS regulated by state. That's why deductibles, copays, etc. can vary. The rates will depend upon experience in that state (plus an expense load). Rates must be approved by state insurance commissioners- I've dealt with them on the property-casualty side. It's more political in some states (especially where the Commissioner is elected and not appointed) but in the end they have to balance the need to keep rates reasonable with the need to make sure that the insurers stay solvent and remain in the market.

 

[travelover]

If you aren't taking any prescription drugs I guess the trick is to buy the cheapest Part D plan until you do have a long-term prescription.

This is my current situation. I know that different plans cover different drugs, but is there some kind of a minimal number / type of drugs that must be covered?

 

[REWahoo]

This is my current situation. I know that different plans cover different drugs, but is there some kind of a minimal number / type of drugs that must be covered?

Not sure. I think they all offer coverage on a reasonably comprehensive list of drugs, the variance is the discounts offered on each.

FWIW, I'm also in the same situation of being drug-free but my DW takes three maintenance prescriptions. The lowest cost plan available in our area (Humana Walmart) for me is also the lowest cost plan for her.

The nice thing is you aren't locked in - you can change each October if you find you can get a better deal from another plan.

 

[mf15]

If you are on any expensive drugs, you really need to check the plan formulary, also formularies may change at any time. An easy way to do this is on the medicare site where you plug in your drugs/dose/frequency and then look at plans that include this drug and its price. Part D plans can be tricky, pay close attention if the drug is on the plan or not.
Old Mike

 

[meierlde]

Note one item to compare is are tier 1 and 2 drugs (generics) included in the deductable or offered without a deductable. I take generics, and the Humana Walmart plan does not include them in the deductable. But also I tell my doctor that I prefer generics, because it appears that the period when drugs are under patent is sort of a phase 4 trail with the number of bad drug lawyer adds one sees on tv. By the time a drug goes generic if there are going to be problems they likley will have appeared already, and the drug be more restricted in its use. I suspect with something like 90% of prescriptions being generic, if you start a med it will likley be a generic, not one you see advertised on tv which are the ones that cost a lot.

 

[rodi]

We went with the cheapest plan for DH... his only med is a generic statin drug... Cheapest in our area is the Humana Walmart plan.

 

[mf15]

Well generics are fine for the most part, I had a difficult time with any manufacture of generic Flomax, prior to medicare when I was still working I paid for real Flomax myself,big difference.
Generics are approved according to bioequivalence, basically the concentration of the active compound has to be within some range of the brand name drug,and that range can be wide. Also as far as I know different side reaction compounds are not accounted for, nor is there human testing,except perhaps in special cases. So in certain drugs you get what you pay for, in the case of generic Flowmax it was a bunch of side effects.
Old Mike

 

[meierlde]

I just checked and 86.4% of prescriptions are generic and another 5% are branded generic.

 

[Chuckanut]

Humana Walmart Plan??

Does that mean you have to use a Walmart pharmacy? I ask because the nearest Walmart is not very near to me, it would be a hassle to visit under normal conditions and are real pain if one was seriously sick.

 

[REWahoo]

Humana Walmart Plan??

Does that mean you have to use a Walmart pharmacy? I ask because the nearest Walmart is not very near to me, it would be a hassle to visit under normal conditions and are real pain if one was seriously sick.

No, you don't have to use a Walmart pharmacy, but the cost will be less if you do.

Here is a link to the Humana Walmart RX Plan. You can input your zip code to see what pharmacies are in their network and the applicable copays:
https://www.humana.com/medicare/products/drug-plan/2018-walmart-rx

 

[Chuckanut]

No, you don't have to use a Walmart pharmacy, but the cost will be less if you do.

Here is a link to the Humana Walmart RX Plan. You can input your zip code to see what pharmacies are in their network and the applicable copays:
https://www.humana.com/medicare/products/drug-plan/2018-walmart-rx

Thanks. I will probably pass on this one since the low cost advantage won't really be available to me for practical purposes.

Any other Medicare Part D Rx plans people might like to recommend? I don't take any drugs on a regular basis, so I am open to any plan with descent service that will reasonably cover whatever might happen in 2018.

 

[aja8888]

I use Aetna Rx and get my one prescription at Costco. It cost me about $300/year in premiums to buy $28 worth of pills (4 x $7). But you need a plan....for later on....

 

[audreyh1]

I use Aetna Rx and get my one prescription at Costco. It cost me about $300/year in premiums to buy $28 worth of pills (4 x $7). But you need a plan....for later on....

Yes, you need to carry part D. But since you can change annually, you can get some relief within 12 months if you are start to need expensive medications. Seems pointless to figure that out ahead of time - it's unknowable. So carry the cheapest until needed, I would think.

Would those pills still cost $28 without your part D plan?

 

[aja8888]

Yes, you need to carry part D. But since you can change annually, you can get some relief within 12 months if you are start to need expensive medications. Seems pointless to figure that out ahead of time - it's unknowable. So carry the cheapest until needed, I would think.

Would those pills still cost $28 without your part D plan?

Probably would cost a bit more and I am using the cheapest plan out there; $0 deductible and ~$28/month.

DW, on the other hand, makes out except for the donut hole as we burn through that. Plus, she has to take Forteo for her osteoporosis and that is about $1K OOP/month, after Part D coverage. We spend quite a bit of time choosing an annual drug plan for her. This year she started three new drugs mid year and two were not in the formulary. Her doctors petitioned Humana and got coverage. It's a challenge from year to year with her drug plans.

 

[audreyh1]

Probably would cost a bit more and I am using the cheapest plan out there; $0 deductible and ~$28/month.

DW, on the other hand, makes out except for the donut hole as we burn through that. Plus, she has to take Forteo for her osteoporosis and that is about $1K OOP/month, after Part D coverage. We spend quite a bit of time choosing an annual drug plan for her. This year she started three new drugs mid year and two were not in the formulary. Her doctors petitioned Humana and got coverage. It's a challenge from year to year with her drug plans.

Yeah - it seems like once you are on major expensive prescriptions, you have to deal with reviewing drugs covered by plans each year.

Interesting that the doctors were able to petition Humana and get coverage.

 

[harllee]

Chuckanut, go to Medicare.gov, click on Part D plans and put in your information and it will give you a list of Part D plans available for you. Medicare.gov gives the plans ratings. You can then ask on this Forum about specific plans you are interested in.