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Part D Have I got this right?
11-23-2016, 11:03 AM
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#1
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Mar 2011
Posts: 8,410
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Part D Have I got this right?
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)
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Living well is the best revenge!
Retired @ 52 in 2005
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11-23-2016, 11:09 AM
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#2
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Moderator
Join Date: Dec 2007
Location: Eastern WV Panhandle
Posts: 25,340
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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.
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When I was a kid I wanted to be older. This is not what I expected.
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11-23-2016, 11:13 AM
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#3
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Mar 2011
Posts: 8,410
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Quote:
Originally Posted by 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.
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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.
__________________
Living well is the best revenge!
Retired @ 52 in 2005
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11-23-2016, 11:16 AM
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#4
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jun 2002
Location: Texas: No Country for Old Men
Posts: 50,021
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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.
__________________
Numbers is hard
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11-23-2016, 11:32 AM
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#5
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2006
Posts: 5,350
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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.
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11-23-2016, 11:37 AM
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#6
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Thinks s/he gets paid by the post
Join Date: Feb 2012
Posts: 1,477
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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.
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11-23-2016, 11:43 AM
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#7
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Full time employment: Posting here.
Join Date: May 2013
Posts: 756
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I'm 10 years away - can you not add it later? You have to commit now and that lasts forever?
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“Believe me, my young friend, there is nothing - absolutely nothing - half so much worth doing as simply messing about in boats.” ― Kenneth Grahame, The Wind in the Willows
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11-23-2016, 11:50 AM
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#8
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Thinks s/he gets paid by the post
Join Date: Jan 2006
Posts: 4,172
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Quote:
Originally Posted by 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.
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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.
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11-23-2016, 11:56 AM
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#9
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Moderator
Join Date: Apr 2012
Location: San Diego
Posts: 14,212
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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.
__________________
Retired June 2014. No longer an enginerd - now I'm just a nerd.
micro pensions 6%, rental income 20%
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11-23-2016, 12:29 PM
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#10
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Recycles dryer sheets
Join Date: Mar 2016
Posts: 178
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Quote:
Originally Posted by marko
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?
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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.
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11-23-2016, 12:31 PM
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#11
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jun 2002
Location: Texas: No Country for Old Men
Posts: 50,021
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Quote:
Originally Posted by FIREmenow
I'm 10 years away - can you not add it later? You have to commit now and that lasts forever?
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You can add it later but you will pay a late enrollment penalty for each month you delay:
Quote:
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.
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https://q1medicare.com/q1group/Medic...79&frompage=11
__________________
Numbers is hard
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11-23-2016, 12:50 PM
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#12
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Thinks s/he gets paid by the post
Join Date: Jan 2014
Posts: 1,181
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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.
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11-24-2016, 05:47 AM
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#13
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Mar 2011
Posts: 8,410
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Quote:
Originally Posted by 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.
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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!!
__________________
Living well is the best revenge!
Retired @ 52 in 2005
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11-24-2016, 08:18 AM
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#14
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Moderator Emeritus
Join Date: Apr 2011
Location: Conroe, Texas
Posts: 18,727
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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.
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*********Go Yankees!*********
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11-24-2016, 08:20 AM
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#15
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Thinks s/he gets paid by the post
Join Date: Dec 2015
Location: Santa Paula
Posts: 4,076
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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
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Retired Jan 2009 Have not looked back.
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12-04-2016, 09:49 PM
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#16
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Thinks s/he gets paid by the post
Join Date: Feb 2012
Posts: 1,477
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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.
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12-05-2016, 08:21 AM
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#17
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Full time employment: Posting here.
Join Date: Sep 2010
Location: Orlando, Fl
Posts: 950
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Quote:
Originally Posted by 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.
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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.
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"Some people describe themselves as being able to see things as a glass half full. For some, the glass is half empty. Me? I can't even find the f***king glass."
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12-05-2016, 08:31 AM
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#18
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Thinks s/he gets paid by the post
Join Date: Mar 2010
Location: Kerrville,Tx
Posts: 3,361
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Quote:
Originally Posted by 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.
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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.
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12-05-2016, 10:28 AM
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#19
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Thinks s/he gets paid by the post
Join Date: Feb 2012
Posts: 1,477
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Quote:
Originally Posted by meierlde
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.
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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.'
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12-05-2016, 11:53 AM
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#20
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,140
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Quote:
Originally Posted by TrvlBug
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.'
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Wow - that sounds like a racket!!!
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