Speaking of Medicare part D

[EvanC]

Speaking of Medical Part D

We’re in Maryland and have a Well Care Value Script PDP, Part D. Most of our drugs are tier 1 or 2. Recently I was put on a tier 3, cholesterol med that was $178 for three months. My question is does that $178 go toward my deductible and once I’ve met my deductible does the cost of that drug comes down? Or a better question is what happens once I meet my deductible? Which I never do.

My other option is to change pharmacies and use a Good RX coupon for that one drug which is $20. for 3 months. Isn’t that an amazing difference $20 Good RX (no subscription) vs $178 WellCare part D

We have been fairly luckey/healthy in not taking too many drugs. So I never thought much about our Well Care policy.

Any help and advice from this form to explain the part D process would be appreciated.
I also intend to put our list of drugs in to the Maryland Medicare website and see which part D plan comes out best and compare.

This group really get this stuff so I would sincerely, appreciate your Two Cents.

Thanks in advance to everyone on this forum.

 

[target2019]

What you pay goes toward deductible first.

I'm pretty sure that if you enter that drug into Well Care site, it will show you the cost as you pass through the remainder of this year.

I would go to another pharmacy with the GoodRx coupon.

 

[wolf]

Speaking of Medical Part D

We’re in Maryland and have a Well Care Value Script PDP, Part D. Most of our drugs are tier 1 or 2. Recently I was put on a tier 3, cholesterol med that was $178 for three months. My question is does that $178 go toward my deductible and once I’ve met my deductible does the cost of that drug comes down? Or a better question is what happens once I meet my deductible? Which I never do.

My other option is to change pharmacies and use a Good RX coupon for that one drug which is $20. for 3 months. Isn’t that an amazing difference $20 Good RX (no subscription) vs $178 WellCare part D

We have been fairly luckey/healthy in not taking too many drugs. So I never thought much about our Well Care policy.

Any help and advice from this form to explain the part D process would be appreciated.
I also intend to put our list of drugs in to the Maryland Medicare website and see which part D plan comes out best and compare.

This group really get this stuff so I would sincerely, appreciate your Two Cents.

Thanks in advance to everyone on this forum.

Also on WellCare. Part D. Can be confusing. Was only Tier 1. Generic.
Deductible did not apply. No costs for drugs. Only premium $8+.

THEN: Started Tier 5/6 jardiance. 1st prescription. 30 day. $500+
deductible applied.

2nd prescription. 90 day. $ 30.
Sounds good.

3rd prescription. 90 day. $295.

Yep. Look up "donut hole" for explanation. Once you spend near $4000+
You pay I think 25% of retail.

Definition of donut hole:

You enter the donut hole when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit.

Key word is, What plan pays. NOT what you paid.

Hard to explain. But I only spent about $530 this year. Then starting Jardiance (diabetis drug), I hit the $4000 limit on 3rd refill.

 

[GhostofTomJoad]

WellCare sucks it wet and hard. I get my inhalers and Tadalafil from Canada. Doctor prescribed a couple of diabetes drugs. One was $400/month, I forget the name. It's a syringe. Another is a pill, Farxiga. $389 at the drugstore for 90 day supply. I asked the drugstore, how much for ONE month at a time? Answer: $369. TWENTY dollars of difference?! Criminal.

It's extortion. So, doc is providing samples.

 

[Bikechuck]

What you pay goes toward deductible first.

I'm pretty sure that if you enter that drug into Well Care site, it will show you the cost as you pass through the remainder of this year.

I would go to another pharmacy with the GoodRx coupon.

Might also check into the price for Costco's program if you are a Costco member. I have found that

1) Medicare Part D is usually the most expensive option
2) Good RX is usually better but Good RX pricing varies a lot by Pharmacy
3) Costco's price for Costco members is usually lower than 1 and 2 above

 

[ShokWaveRider]

I have Aetna Part D. I have paid premiums up front $110 + $100 in Copays for 2023. I take 4 Drugs (Cholesterol, Reflux and BP). So far this year the plan has paid $7.02 and we are all done for the year as I get 90 days.

So I have paid $220 and Aetna has paid $7.02. I would be better off with Good RX and no Part D. It is an absolute con! Being forced to get something that we do not use.

 

[bobbyr]

I have Aetna Part D. I have paid premiums up front $110 + $100 in Copays for 2023. I take 4 Drugs (Cholesterol, Reflux and BP). So far this year the plan has paid $7.02 and we are all done for the year as I get 90 days.

So I have paid $220 and Aetna has paid $7.02. I would be better off with Good RX and no Part D. It is an absolute con! Being forced to get something that we do not use.

I am new to Medicare, and glad to see what I agree is bogus...I have used Good RX so far. Aetna provides nothing beneficial as far as I can tell.

Related question, I got flu and RSV vaccine from Kroger and it said $0 out of pocket, but it also showed on the receipt that I saved $90 on the flu shot and $350 or so on RSV. Am I going to see a bill down the road or do I assume Medicare covered it all?

 

[Rianne]

Wellcare just told me on a chat I can get the Shingrix vaccination for no charge because I'm in tier 3. I'm going tonight. Wellcare is so cheap $8/month and my generics are covered. If they don't cover a drug, they do offer alternatives.

 

[Car-Guy]

I am new to Medicare, and glad to see what I agree is bogus...I have used Good RX so far. Aetna provides nothing beneficial as far as I can tell.

Lucky you. We have Aetna too and it's paid off better than any slot machine I've ever seen for years now. The DW needs some rather expensive drug injections on a frequent basis plus the usual health care cost that many seniors see. We have an annual 3k OOP Max which we blow past early each year. So after that we pay zero for any/all office visits and injections. W/O insurance we'd be paying "a lot".

 

[CRLLS]

Wellcare just told me on a chat I can get the Shingrix vaccination for no charge because I'm in tier 3. I'm going tonight. Wellcare is so cheap $8/month and my generics are covered. If they don't cover a drug, they do offer alternatives.

Not to disagree with WellCare, my understanding is that Shingrix is covered for those with Part D for no cost at all or having to meet a deductible starting in 2023 forward. I got one a month ago and going back for my 2nd in November. \ I haven't looked, but not received a bill.

 

[mf15]

I can't seem to find a explanation as to why Good Rx many times can be cheaper for a drug than Part D insurance. Any thoughts. Seems that something very strange going on with the system.
Oldmike

 

[bobbyr]

Lucky you. We have Aetna too and it's paid off better than any slot machine I've ever seen for years now. The DW needs some rather expensive drug injections on a frequent basis plus the usual health care cost that many seniors see. We have an annual 3k OOP Max which we blow past early each year. So after that we pay zero for any/all office visits and injections. W/O insurance we'd be paying "a lot".

I confess to very limited sample size on this (started medicare 2 months ago and some weird scripts needed due to eye surgery)

 

[Car-Guy]

^^^^^
I sincerely hope you never need to see the other side of the "medical/drug cost" coin.

 

[CardsFan]

^^^^^
I sincerely hope you never need to see the other side of the "medical/drug cost" coin.

Amen. I have not seen it myself, and hope never to see it, BUT, that is why I buy INSURANCE. And why I price it out every year for my KNOWN meds. We can't predict the unknown, but we can shop our plan every year. So, at worst case, if you are prescribed a drug not well covered well by your current plan, you are stuck with that plan only for a year.

It sounds like many here want their plan to pay more than they do, all the time. Sorry, not how insurance works. And an $8/month plan does not cover you the same as a $75/month plan.

Is the system perfect? No, far from it. But it is not as broken as some feel.

 

[omni550]

Not to disagree with WellCare, my understanding is that Shingrix is covered for those with Part D for no cost at all or having to meet a deductible starting in 2023 forward. I got one a month ago and going back for my 2nd in November. \ I haven't looked, but not received a bill.

Correct, Medicare is covering both Shingrx shots for free under the 2023 Inflation Reduction Act, effective 1/1/23, for anyone covered by a Part D plan .

https://www.aarp.org/politics-socie...nflation-reduction-act-questions-answers.html

omni

 

[Car-Guy]

Not to disagree with WellCare, my understanding is that Shingrix is covered for those with Part D for no cost at all or having to meet a deductible starting in 2023 forward. I got one a month ago and going back for my 2nd in November. \ I haven't looked, but not received a bill.

I just got back today from get my "premium grade" (Over 65) flu shot and they tried to get me to take the Shingles shot too. They said it was two shots to be taken 6 months apart. Looks like you are getting yours ~3months apart. I wonder why the difference?

 

[REWahoo]

I just got back today from get my "premium grade" (Over 65) flu shot and they tried to get me to take the Shingles shot too. They said it was two shots to be taken 6 months apart. Looks like you are getting yours ~3months apart. I wonder why the difference?

...

[The] CDC recommends two doses of Shingrix separated by 2 to 6 months.

 

[Car-Guy]

Well that clears that up... They didn't mention a "range" to me. They just said 6mos.

Thanks

Also, a few folks walked up while I was waiting and asked for a Covid booster... Nope, all out!

 

[GhostofTomJoad]

Talking to my US Senator's Office about the Part D scam. I was told the "Inflation Reduction Act" caps out-of-pocket copays per year at $2,000.00. But how is that enforced? The insurance companies are not going to VOLUNTARILY comply.