Part D Have I got this right?

[marko]

Ok, so I have six months to Medicare (can't quite believe I'm writing those words!) but I'm starting some early investigations.

I'll admit up front that I haven't yet made a deep dive into all of this but I'm wondering if I've got this right about Part D:

The retail price of my only two prescriptions come to about $30 a month ($360 a year total).

In poking around with most Part D sites, I see that I can be covered for roughly $45 a month ($540 a year) with a $400 deductible. ($0 deductibles are available for a lot more)

As such, it seems I have to spend $400 a year before that insurance kicks in.

So if I've got this right, I have to spend $540 a year on insurance PLUS another $400 deductible ($940) before any of my lousy $35 a month Rx's are paid for?

How can this be?

I also learned that if I do not get coverage right at 65 I will have to pay a penalty if/when I finally do completely loose my mind and sign up for this.

I'm sure hoping one of my friends here can tell me that I'm completely missing something. (As most of you know it wouldn't be the first time)

 

[Walt34]

I think you're right but wait for others more informed than me to post.

What I wanted to point out is don't assume that the prescriptions you're on now will remain the only prescriptions you take in the future so you may be ahead buying the Part D insurance even if you don't really need/want it now. One prescription I'm on is just a hair under $500/month.

 

[marko]

I think you're right but wait for others more informed than me to post.

What I wanted to point out is don't assume that the prescriptions you're on now will remain the only prescriptions you take in the future so you may be ahead buying the Part D insurance even if you don't really need/want it now. One prescription I'm on is just a hair under $500/month.

Yeah, I'm aware that as father time slogs on I will hopefully live long enough to need more Rx's. Of course my 87 year old mom is on a single simvastatin and a multiple vitamin.

At a $1000 a year I could roll the dice and end up way ahead...or way behind.

 

[REWahoo]

OP, I feel your pain.

DW and I both have a part D plan, the least expensive we can find. I take no prescriptions and she takes three that we can (and do) buy directly from a local discount pharmacy for around $300 per year, substantially cheaper than what the insurance company charges.

We keep the part D plans only as insurance against potential (and likely) future needs for more expensive meds.

 

[aaronc879]

There needs to be people like you who pay more than what you use to cover those who use more than they pay. I wouldn't complain too much. There is a good chance you will be on the other end within 20 years.

 

[TrvlBug]

DH is in the same situation. Retail price of his drug is $7.50 month. Our Part D premium is $18.50 month + the high income 'penalty.' Fortunately, it's a Tier 1 drug and if we order through the mail, the cost to us is $0.

 

[FIREmenow]

I'm 10 years away - can you not add it later? You have to commit now and that lasts forever?

 

[kaneohe]

DH is in the same situation. Retail price of his drug is $7.50 month. Our Part D premium is $18.50 month + the high income 'penalty.' Fortunately, it's a Tier 1 drug and if we order through the mail, the cost to us is $0.

to the OP: try using the medicare plan finder here: https://www.medicare.gov/
(find health and drug plans). You may also find that generics from mail-order
are 0-low cost.

 

[rodi]

We just signed up DH for medicare (starts Jan 1st). For part D we opted for the very cheapest we could find - in our zip that was Humana Walmart at $17/month. DH is on one med (statin) which is super cheap... We'll price it out to see if mail order through Humana or through GoodRX is cheaper when it's time to renew the script.

There are penalties if you sign up later for part D... so we opted to sign up during his initial enrollment.

 

[niven]

The retail price of my only two prescriptions come to about $30 a month ($360 a year total).

In poking around with most Part D sites, I see that I can be covered for roughly $45 a month ($540 a year) with a $400 deductible. ($0 deductibles are available for a lot more)

As such, it seems I have to spend $400 a year before that insurance kicks in.

So if I've got this right, I have to spend $540 a year on insurance PLUS another $400 deductible ($940) before any of my lousy $35 a month Rx's are paid for?

Have you actually checked what the price of your meds would be under the Part D you're looking at? Perhaps the price of your meds would be substantially cheaper and bring the total cost down closer to the $540 that Part D would cost.

 

[REWahoo]

I'm 10 years away - can you not add it later? You have to commit now and that lasts forever?

You can add it later but you will pay a late enrollment penalty for each month you delay:

If you are subject to a late-enrollment penalty, you will pay your plan’s monthly Medicare Part D premium along with an additional penalty calculated as one percent (1%) of the annual national base Medicare Part D monthly premium for each month you were without creditable prescription drug coverage. The penalty is permanent and you will pay the penalty (adjusted each year for the annual base Medicare Part D premium) as long as you have Medicare drug coverage.

https://q1medicare.com/q1group/Medi...will-increase-by-4-5-&blog_id=579&frompage=11

 

[MBSC]

The Humana Walmart Part D plan is about $17 per month and has a $400 deductible. However, their Tier 1 and 2 drugs are exempt from the deductible. You can change plans during the annual open enrollment if you find yourself taking more medication in the future.

 

[marko]

The Humana Walmart Part D plan is about $17 per month and has a $400 deductible. However, their Tier 1 and 2 drugs are exempt from the deductible. You can change plans during the annual open enrollment if you find yourself taking more medication in the future.

Thanks! I looked into it and found that my Rx's are indeed Tier 1. I wasn't aware of this. THANK YOU for the tip!

I suspect other plans may also have this Tier 1 and 2 deductible exemption

Getting information like this is one of the great things about this forum!!

 

[aja8888]

I just changed my Part D plan as I found a cheaper one for the two inexpensive meds I take. I will pay the $22.50 monthly premium and never hit the $400 deductible fully as the meds are under $12 per quarter each.

DW, on the other hand, takes 9 meds and will be in the donut hole by June. Her annual projected OOP cost this coming year will be near $6 K.

 

[Souschef]

Donut hole

Be aware that there is a "coverage gap" called the Donut hole in Part D. My wife just hit it.
When your drug costs total $3310, there is a gap until your OOP hits $4850.
The plan resets on 1 Jan (whew)
I did find on one drug's website, a coupon for one month's supply free, which saved $165. I believe many drugs have similar offers

 

[TrvlBug]

I'm new to Medicare and am trying to wrap my head around Part D. DH on Medicare starting 9/1/2016 and we just received his Part D summary. He takes a statin drug that costs $7.50 a month retail from local grocery store pharmacy. According to Humana's summary, their retail price is $252.90 for 3 months...huh .

My concern isn't with this drug as it's a Tier 1 and there is no cost to DH on this plan. However, I'm thinking of when he has additional drugs (he was on 3 heart meds in 2015 and early 2016 before ablation (sp?) and hits the donut hole.

I guess I need to pay attention to what the particular plan charges for a particular drug. Unfortunately, you're stuck with what you've got until open enrollment.

This Part D seems like the biggest racket to me...unless I'm missing something. There has to be a better way. I need to do some more research to fully understand Part D.

 

[Silver]

I'm new to Medicare and am trying to wrap my head around Part D. DH on Medicare starting 9/1/2016 and we just received his Part D summary. He takes a statin drug that costs $7.50 a month retail from local grocery store pharmacy. According to Humana's summary, their retail price is $252.90 for 3 months...huh .

My concern isn't with this drug as it's a Tier 1 and there is no cost to DH on this plan. However, I'm thinking of when he has additional drugs (he was on 3 heart meds in 2015 and early 2016 before ablation (sp?) and hits the donut hole.

I guess I need to pay attention to what the particular plan charges for a particular drug. Unfortunately, you're stuck with what you've got until open enrollment.

This Part D seems like the biggest racket to me...unless I'm missing something. There has to be a better way. I need to do some more research to fully understand Part D.

It is my understanding that the TOTAL DRUG COSTS on the front page of your summary is what is used against the $3,310.00 donut hole limit. Not the retail cost. I'm in a similar situation and do not want to hit that limit.

 

[meierlde]

I'm new to Medicare and am trying to wrap my head around Part D. DH on Medicare starting 9/1/2016 and we just received his Part D summary. He takes a statin drug that costs $7.50 a month retail from local grocery store pharmacy. According to Humana's summary, their retail price is $252.90 for 3 months...huh .

My concern isn't with this drug as it's a Tier 1 and there is no cost to DH on this plan. However, I'm thinking of when he has additional drugs (he was on 3 heart meds in 2015 and early 2016 before ablation (sp?) and hits the donut hole.

I guess I need to pay attention to what the particular plan charges for a particular drug. Unfortunately, you're stuck with what you've got until open enrollment.

This Part D seems like the biggest racket to me...unless I'm missing something. There has to be a better way. I need to do some more research to fully understand Part D.

One possiblity is that the quote is based upon the branded drug not its generic equivalent. I believe that all the statins are now available in generic form. The question is when you entered the data did you use the generic or branded name, (e.g. Zocor vs Simvastatin, or Lipitor vs Avorvastatin)

I just checked goodrx and for Avorvastatin, the generic is about $10 while Lipitor (the branded equivalent) is $235. for a one month supply.

 

[TrvlBug]

One possiblity is that the quote is based upon the branded drug not its generic equivalent. I believe that all the statins are now available in generic form. The question is when you entered the data did you use the generic or branded name, (e.g. Zocor vs Simvastatin, or Lipitor vs Avorvastatin)

I just checked goodrx and for Avorvastatin, the generic is about $10 while Lipitor (the branded equivalent) is $235. for a one month supply.

Just checked the label and it's Simvastatin. We actually paid for 1 months' supply at just under $7.50 w/o insurance as we weren't sure we'd receive the 3 month supply in the mail before heading off on vacation, so am really confused with their 'costs.'

 

[audreyh1]

Just checked the label and it's Simvastatin. We actually paid for 1 months' supply at just under $7.50 w/o insurance as we weren't sure we'd receive the 3 month supply in the mail before heading off on vacation, so am really confused with their 'costs.'

Wow - that sounds like a racket!!!

 

[Hermit]

I get 3 month's supply of Simvastatin through Humana Pharmacy for free. Medicare Advantage.

 

[meierlde]

Thanks! I looked into it and found that my Rx's are indeed Tier 1. I wasn't aware of this. THANK YOU for the tip!

I suspect other plans may also have this Tier 1 and 2 deductible exemption

Getting information like this is one of the great things about this forum!!

Note that the AARP Walgreens plan also has the tier 1/tier 2 exclusion. (For 22 per month) I guess the decision partly depends if you are in areas where Wal-Mart has stores. If you read the details you find a strong warning about states that don't have many walmarts and the plan (such as much of New England)

 

[marko]

If you read the details you find a strong warning about states that don't have many walmarts and the plan (such as much of New England)

Well, Wal-Mart has been banned in Boston (really) but I think it's a law that there needs to be one within 15 miles of wherever you might be everywhere else.
Same law for Dunkin Donuts and McDonalds. That's my experience anyway.

 

[meierlde]

Just checked the label and it's Simvastatin. We actually paid for 1 months' supply at just under $7.50 w/o insurance as we weren't sure we'd receive the 3 month supply in the mail before heading off on vacation, so am really confused with their 'costs.'

The question might be what you typed in on the web site. If the label says subsituted for Zocor because your physician wrote it that way then that could explain it. (Just like I had a prescription once for Glumetza but found out the generic equivalent and told my physician to write the prescription for Metformin Er, saved at that time $120/month)

 

[TrvlBug]

Wow - that sounds like a racket!!!

My thoughts exactly. If I, as an uninsured consumer, can get this drug for $7.4x (probably even cheaper at Costco) per month, why is Humana's cost $252.90 for a 3 months supply? They are discounting it by $239.91. I feel like I'm in a medical shell game and I'm the sucker.