Risks of not signing up for Medicare Part D and using GoodRx instead?

[early-morning]

I'm currently on Medicare Part D. The premium is minimal but the Part D IRMAA is not. What are the risks of dropping Medicare Part D and using GoodRX for prescriptions instead? For example, Atorvastatin (generic Lipitor) is not even covered by my inexpensive Part D drug plan (Aetna SilverScript). GoodRx however has a coupon for this prescription for $10.00 for a months supply. My drug plan has a $445 deductible and $19 co-pay. Add to that my premium ($7/mo) plus my IRMAA surcharge and the out-of-pocket adds up. I understand that if I deny Part D coverage then later want to get it I have to pay a stiff penalty. So this is a big decision. What are your thoughts?

 

[HF63]

Depends on the kind of meds you take and any health issues that you might face in the future. I have no medicare and just pay for for what I need using Good Rx or I can also get them from Mexico or Canada.


Most folks will have a problem doing this way but works for me.

 

[youbet]

I'm currently on Medicare Part D. The premium is minimal but the Part D IRMAA is not. What are the risks of dropping Medicare Part D and using GoodRX for prescriptions instead? For example, Atorvastatin (generic Lipitor) is not even covered by my inexpensive Part D drug plan (Aetna SilverScript). GoodRx however has a coupon for this prescription for $10.00 for a months supply. My drug plan has a $445 deductible and $19 co-pay. Add to that my premium ($7/mo) plus my IRMAA surcharge and the out-of-pocket adds up. I understand that if I deny Part D coverage then later want to get it I have to pay a stiff penalty. So this is a big decision. What are your thoughts?

To me, the real purpose of Part D is to save your retirement if and when you need a bunch of expensive drugs to stay alive. Without a Part D plan, you never qualify for "catastrophic coverage" and therefore could be subject to spend a big chunk of your FIRE portfolio on drugs before welfare kicks in. I pick my plan looking at the low dollar details (such as your example above) but my real target is protection if and when I need a bunch of very expensive drugs.

 

[Scrapr]

To me, the real purpose of Part D is to save your retirement if and when you need a bunch of expensive drugs to stay alive. Without a Part D plan, you never qualify for "catastrophic coverage" and therefore could be subject to spend a big chunk of your FIRE portfolio on drugs before welfare kicks in. I pick my plan looking at the low dollar details (such as your example above) but my real target is protection if and when I need a bunch of very expensive drugs.

At the end of my wife's treatment for cancer we tried a last hope drug (Keytruda) She did 4 or 5 doses. Dr/Nurse/whatever said it was $20k per. A friend had used it & it saved her life. But she went to Seattle every 6 weeks for a dose. This went on for a couple years

 

[aja8888]

My wife needs expensive drugs to offset the effects of advanced COPD. One drug retails at around $2000/month. We pay $40 for it. GoodRx cost for that drug is 20 times the $40.

Yeah, let's switch from Part D (at $17.20 month premium) to a coupon....right!

 

[MichaelB]

To me, the real purpose of Part D is to save your retirement if and when you need a bunch of expensive drugs to stay alive. Without a Part D plan, you never qualify for "catastrophic coverage" and therefore could be subject to spend a big chunk of your FIRE portfolio on drugs before welfare kicks in. I pick my plan looking at the low dollar details (such as your example above) but my real target is protection if and when I need a bunch of very expensive drugs.

I agree. One positive aspect about Plan D is one can change plans yearly. Enroll now in the lowest cost plan, and if a chronic condition happens that requires expensive medicines, change and plans to cover it.

 

[Sunset]

I'm currently on Medicare Part D. The premium is minimal but the Part D IRMAA is not. What are the risks of dropping Medicare Part D and using GoodRX for prescriptions instead? For example, Atorvastatin (generic Lipitor) is not even covered by my inexpensive Part D drug plan (Aetna SilverScript). GoodRx however has a coupon for this prescription for $10.00 for a months supply. My drug plan has a $445 deductible and $19 co-pay. Add to that my premium ($7/mo) plus my IRMAA surcharge and the out-of-pocket adds up. I understand that if I deny Part D coverage then later want to get it I have to pay a stiff penalty. So this is a big decision. What are your thoughts?

I don't think it's worth it. As part of the idea is, that it saves you from expensive costs. My relative had cancer drug injections, the monthly prescription cost was $70,000 for a while

So OP if you didn't even use part D, it would cost you "premium ($7/mo) plus my IRMAA surcharge"

Which seems to me pretty cheap insurance for future expensive drug costs.

I know a guy who was late signing up by 1 yr for part D, didn't understand the rules, so he pays a penalty of $3/mo forever.
What would be the penalty if you skipped part D for 10 yrs ?
Do they even allow a person to signup after skipping so many years ?
Of course you'd have to pay until signup for whatever expensive drug you needed.

 

[Ian S]

I'm currently on Medicare Part D. The premium is minimal but the Part D IRMAA is not. What are the risks of dropping Medicare Part D and using GoodRX for prescriptions instead? For example, Atorvastatin (generic Lipitor) is not even covered by my inexpensive Part D drug plan (Aetna SilverScript).

That's odd, I have the cheap Silverscript Smartrx plan and it covers my atorvastatin.

 

[youbet]

That's odd, I have the cheap Silverscript Smartrx plan and it covers my atorvastatin.

Formularies and tiers vary from plan to plan significantly and change every year. That's why annual Part D shopping is such a pita.

 

[travelover]

I just carry a cheap ($7/month) Part D insurance and use GoodRx for most drugs, though the plan does cover a statin for free, which would cost me $6 a month through GoodRx. My local Costco will not allow me to use GoodRx since they have it on record that I have Medicare Part D, yet Fred Meyer pharmacy freely takes GoodRx or my Part D coverage. I've never understood why, but a pox on Costco for that.

 

[JARON46]

Our local Kroger pharmacy lets us use whatever is cheaper GoodRX or Medicare D plan, usually GoodRX is cheaper

 

[audreyh1]

So if you drop your Part D plan Medicare will stop charging you for the Part D IRMAA?

I suppose they will as they seem to know which Part D plan DH is on.

We won’t do it. DH’s total Medicare insurance plus supplements plus IRMAA is still less that what he paid for pre-Medicare insurance with a considerably lower Part B deductible. He’s not taking any drugs so Part D deductible and copays aren’t coming into play yet.

 

[Ian S]

Formularies and tiers vary from plan to plan significantly and change every year. That's why annual Part D shopping is such a pita.

I understand that but the OP appears to have the same Aetna SiverScript plan as mine (under $7 per month.) Maybe the formulary varies from one part of the country to another but it still seems odd since the Part D plans I've had all seem to cover atorvastatin.

 

[Walt34]

I am so glad that 19 years ago I opted for the high-end prescription plan even though at the time I was taking one low cost prescription. That can, and did, change dramatically. Had I not made that choice years ago our options in retirement would now be severely curtailed. DW's father made the opposite choice and later on paid dearly for that mistake.

"You pays your money and takes your chances."

 

[audreyh1]

I am so glad that 19 years ago I opted for the high-end prescription plan even though at the time I was taking one low cost prescription. That can, and did, change dramatically. Had I not made that choice years ago our options in retirement would now be severely curtailed. DW's father made the opposite choice and later on paid dearly for that mistake.

"You pays your money and takes your chances."

That must have been back before Part D existed. Some Medigap plans included drug coverage. DF’s did.

Nowadays you can change Part D plans every year, so you aren’t stuck by your initial choice.

 

[Sunset]

I just carry a cheap ($7/month) Part D insurance and use GoodRx for most drugs, though the plan does cover a statin for free, which would cost me $6 a month through GoodRx. My local Costco will not allow me to use GoodRx since they have it on record that I have Medicare Part D, yet Fred Meyer pharmacy freely takes GoodRx or my Part D coverage. I've never understood why, but a pox on Costco for that.

+1
I agree, it makes Costco a LOT less attractive to me than Sam's for drugs, or even Walmart.

 

[Bamaman]

At the current rate of prescription usage, I will never meet my deductible.

I pay $17 a month for a bottom line Part D with a $420 deductible per year. In case of some catastrophic medical condition I might have, I keep it.

 

[Sarah S]

I understand that but the OP appears to have the same Aetna SiverScript plan as mine (under $7 per month.) Maybe the formulary varies from one part of the country to another but it still seems odd since the Part D plans I've had all seem to cover atorvastatin.

I have the plan too. Atorvastatin coverage varies by pharmacy here from free ( mailorder and cvs) to 19 dollars a month at “standard pharmacies” ( Walmart and a few other local ones) to uncovered ( other local ones they consider out of network)

 

[audreyh1]

I see - so you need to use the preferred providers which might include mail order, otherwise you’ll be paying some higher copay.

Makes sense.

When we signed up for the super cheap Silverscript Part D plan I checked which pharmacies were preferred, and CVS and HEB were included, so I knew we had local access if needed.

 

[Happyras]

+1
I agree, it makes Costco a LOT less attractive to me than Sam's for drugs, or even Walmart.

I use Costco and they always check for me if GoodRx is better than the cheap Aetna I have to pay for with my very high IRMAA adder.

I would ask to see a manager and ask why they would not choose the best coverage or coupon. Lately, I am finding the new Aetna plan (CVS based) is paying fully for everything except the Zetia. GoodRx is high for this one, but Aetna covers all but $20 some bucks on this $500 drug. I can't or won't take statins!

 

[ncbill]

I'm currently on Medicare Part D. The premium is minimal but the Part D IRMAA is not. What are the risks of dropping Medicare Part D and using GoodRX for prescriptions instead? For example, Atorvastatin (generic Lipitor) is not even covered by my inexpensive Part D drug plan (Aetna SilverScript). GoodRx however has a coupon for this prescription for $10.00 for a months supply. My drug plan has a $445 deductible and $19 co-pay. Add to that my premium ($7/mo) plus my IRMAA surcharge and the out-of-pocket adds up. I understand that if I deny Part D coverage then later want to get it I have to pay a stiff penalty. So this is a big decision. What are your thoughts?

It's not that stiff a penalty for those paying IRMAA surcharges.

David Belk says don't buy any Part D plan until you need expensive drugs:

https://truecostofhealthcare.org/part-d-case-study/

 

[Ian S]

David Belk says don't buy any Part D plan until you need expensive drugs:

https://truecostofhealthcare.org/part-d-case-study/

That's not always the case. I have a Part D plan that costs me under $7 a month. I am on three generic drugs which are covered under my plan with no copay and no deductible. These three common drugs alone would cost me around $22/mo through Goodrx. So my "junk" Part D plan saves me over $15/month.

 

[ivinsfan]

As a PSA I want to remind anyone on Medicare and currently in the VA health care system that between VA coverage and GoodRX part D is not really necessary.

 

[travelover]

I use Costco and they always check for me if GoodRx is better than the cheap Aetna I have to pay for with my very high IRMAA adder.

I would ask to see a manager and ask why they would not choose the best coverage or coupon. Lately, I am finding the new Aetna plan (CVS based) is paying fully for everything except the Zetia. GoodRx is high for this one, but Aetna covers all but $20 some bucks on this $500 drug. I can't or won't take statins!

When I printed out the GoodRx coupon for Costco it said right on it that it is not good for anyone covered by Medicare or other Federal government plans. I pushed it and got GoodRx to call the pharmacy and it was all for nothing. Some Costcos just won't budge. No problem, I just go down the street to Fred Meyer for my prescriptions.