300% Increase in Part D Plan for 2025

[sengsational]

Do some insurers just change existing plan premiums and coverage to take advantage of the customer's inertia?

That crossed my mind. My mom thought she had to stay with the same policy and way overpaid last year. I advised her and my sister to shop part D every year.

 

[gianmatt]

Always amazes me how these types of decisions are made without consideration of the possible consequences. The thought process seems to always assume that these things are static and won't change in response. Like just about everything else "somebody's got to pay for it".

Who said they didn't consider the consequences? Of course they knew what would happen.

The general tone of threads like these is "if I get a benefit, then it's fine if someone else is paying for it. If I don't get a benefit, then no, why should I have to pay for it?" I could turn it around and say "I'm healthy - why should I have to pay for your heart surgery?"

 

[MBSC]

MBSC I have two questions.

If I can get my Wellcare for $0 in 2025 was I being overcharged at $0 in 2024?

Do some insurers just change existing plan premiums and coverage to take advantage of the customer's inertia?

1) You should ask for a refund.

2) Everyone should review their Part D options every year. Technically, the plan changes their bid but the result is what you describe. Premiums are calculated after CMS gathers all bids and determines the total cost to the Part D program.

Also, more Part D plans will be non-commissionable in 2025. Some brokers will not show them and put you in a higher total cost plan.

What is the Wellcare Value Script 2025 cost in South Carolina ??

Premium $0.00
Deductible $590 Tiers 3-5
Preferred Retail
Tier 1: $0.00
Tier 2: $5.00
Tier 3: 25%
Tier 4: 37%
Tier 5: 25%
Out of Pocket Limit: $2,000 (for drugs on formulary)

 

[RetMD21]

1) You should ask for a refund.

2) Everyone should review their Part D options every year. Technically, the plan changes their bid but the result is what you describe. Premiums are calculated after CMS gathers all bids and determines the total cost to the Part D program.

Also, more Part D plans will be non-commissionable in 2025. Some brokers will not show them and put you in a higher total cost plan.

It's a good system for some of us but it is beyond the capabilities of some of the old folks. It looks like it will be harder to get help.

I'll let you know if I get that refund

 

[pb4uski]

I'm not sure you can draw a straight line from SilverScript cost increases to the Inflation Reduction Act.

In my opinion, you should start shopping for other Part D plans. Have you looked into WellCare recently ?? What kind of Rx are you buying ?

I think you probably can make that connection. For other insurance we know that lower deductibles result in higher premiums. We see it in car insurance and ACA plans and since expected claims is the starting point for premium prices, it makes sense that lower deductibles from making the donut whole smaller would result in higher premiums.

I agree to shop around and take advantage of the market seeking equilibrium in pricing for the change in deductible Effectively, since the deductible is mandated, all else being equal premiums would increase by the increase in claims spread out over all policyholders.

 

[pb4uski]

Always amazes me how these types of decisions are made without consideration of the possible consequences. The thought process seems to always assume that these things are static and won't change in response. Like just about everything else "somebody's got to pay for it".

Agree, but unlike other insurances where the policyholder can make a value judgement between premiums and different deductibles you don't have those choices with Part D since coverage is mandated.

I think it is good that the donut hole is shrunk... it was a particularly unfair feature of Part D... but it means that we all share in the cost of shrinking the donut hole and so be it. That's what insurance is all about... spreading cost across a population.

 

[Koolau]

In this case, I'm not so certain these were unknown consequences. If all else is equal, then surely reducing a max OOP means something else has to give.

Devil's in the details, but this could be a reasonable give-take overall. Of course, politicians will boast of the benefits to voters, and never mention that it shifts the burden somewhere else.

Is there any data on how much of a hit pharmaceutical companies will take because of these statutory changes? I ask for two reasons. I wonder if pharma stock prices will be affected. I also wonder what Pharma companies will do to compensate for any losses in revenue.

 

[Marc]

Wellcare went down to zero in Texas, too. But, I have just gone over the materials they sent me, and then I went to their drug list on their website, and I have lots of questions.

Drug list online still just shows the 2024 formulary. Materials show Tier 6 "select" going away in 2025. So, for my Tier 6 drug, Jardiance, how do I find out its cost or even which tier for 2025?

I also have a simple 2024 question; I am $12 below the donut hole. If I refill Jardiance will it be a lot more than $33 since I am entering donut hole?

thanks,

Marc

 

[zl55lz]

Wellcare went down to zero in Texas, too. But, I have just gone over the materials they sent me, and then I went to their drug list on their website, and I have lots of questions.

Drug list online still just shows the 2024 formulary. Materials show Tier 6 "select" going away in 2025. So, for my Tier 6 drug, Jardiance, how do I find out its cost or even which tier for 2025?

I also have a simple 2024 question; I am $12 below the donut hole. If I refill Jardiance will it be a lot more than $33 since I am entering donut hole?

thanks,

Marc

I believe the Part D details and fomularies are supposed to come out in mid-Oct?

Also, due to the new regs I believe the "donut hole" is going away in 2025 so the previous "structure" does not apply.

 

[camfused]

I got my letter from Aetna Silverscript, and sure enough, it is going up by exactly $35. Plus deductible is now doubled, and tier 1 (all my drugs) are going from $0 to $5. Will be shopping around next month when the prices come out.

 

[Koolau]

I got my letter from Aetna Silverscript, and sure enough, it is going up by exactly $35. Plus deductible is now doubled, and tier 1 (all my drugs) are going from $0 to $5. Will be shopping around next month when the prices come out.

Good luck. They're likely all going up because of the new max OOP limits set by gummint. You can't squeeze the Insurance companies and not expect them to react. YMMV

 

[marko]

Got my brother's letter from AARP/United Health. Going up from $34 to $69 a month. Need to do some shopping.

 

[Sue J]

My Wellcare plan (Wellcare Value Script PDP) premium is staying the same as 2024 - $0.00 per month.

Deductible was $545, going up to $590. Tier 1 preferred copay stays at $0.00, Tier 2 preferred copay increasing from $3/30 day to $5/30 day.

DH has the same plan and he has 1 Tier 2 Rx so this increase is minor, $9/90 day vs $15/90 day. But he has started on one of the Tier 6 drugs which would be $578/90 days, up to the $2000 copay. So far he is getting it at no cost through the manufacturer's Patient Assistance Program based on household income. This year we make it under their income limits (400% FPL) but they could change that at any point and he'd have to pay for it.

 

[Sunset]

......

Do some insurers just change existing plan premiums and coverage to take advantage of the customer's inertia?

I know that my FIL was on the same plan for many years, when I finally looked into it, I showed him how he could save well over $2,000 per year by switching.

He didn't know, because he was not computer literate, so without a computer finding out this information is a lot more difficult than using the great medicare.gov website (which I think is wonderful to have to compare plans).

He switched and saved.

 

[RetMD21]

I know that my FIL was on the same plan for many years, when I finally looked into it, I showed him how he could save well over $2,000 per year by switching.

He didn't know, because he was not computer literate, so without a computer finding out this information is a lot more difficult than using the great medicare.gov website (which I think is wonderful to have to compare plans).

He switched and saved.

Some of the old folks can benefit a lot from computer help.

 

[PatrickA5]

Got my Silverscript notice today. Yup, going up about $35. I'll check other plans in October, but I doubt I'll find anything much cheaper. My two prescriptions are generic Tier One types, so probably $5 each (as opposed to free this year).

I personally don't have a problem with the increases if they bring drug prices down - for the ones that can't afford them - to a more reasonable level. $2,000 out of pocket maximum is probably a decent starting point.

 

[ShokWaveRider]

Our Wellcare Value Script has no changes for 2025 $0 premium and all our drugs are covered at no charge.

 

[PatrickA5]

Our Wellcare Value Script has no changes for 2025 $0 premium and all our drugs are covered at no charge.

I'll be on the lookout for that plan!

 

[marko]

FWIW, I spent a half hour online and then on the phone with AARP United Health just now. They have no new information regarding next year until October 1. I'd suspect that other providers have a similar start date.

 

[Jerry1]

FWIW, I spent a half hour online and then on the phone with AARP United Health just now. They have no new information regarding next year until October 1. I'd suspect that other providers have a similar start date.

Correct. I start Medicare on 12/1 and the administrator set up an appointment with me on October 3rd. “Because that’s when they’ll have plans reflecting the new laws.”

DW just got her notice today. The waiting (to shop) is the hardest part.

 

[2retireearly]

Hi. Trying to prepare for my new choice. Question: is Wellcare only mail in/out prescriptions? Or can one still get a prescription filled at a brick and mortar place, for those times you need something asap?

 

[camfused]

^^^ Can do B&M too.

Unless I am missing something, Wellcare seems like the way to go: $0 premium, can use local pharmacy, and if your drugs are in tier 1 ($5/each).

 

[orchid55]

Hi. Trying to prepare for my new choice. Question: is Wellcare only mail in/out prescriptions? Or can one still get a prescription filled at a brick and mortar place, for those times you need something asap?

We have used Wellcare for several years and always pick up the prescriptions at the pharmacy. We travel a lot for business so mail order would not work for us.

 

[Ian S]

Hi. Trying to prepare for my new choice. Question: is Wellcare only mail in/out prescriptions? Or can one still get a prescription filled at a brick and mortar place, for those times you need something asap?

I use a B&M store for all my prescriptions under Wellcare. Locally, there are several preferred pharmacies but CVS is the most convenient and the one I use. $0 premium for me this coming year as before. The main difference affecting me is for one drug I currently pay $2 for a month's supply is going up to $5. Their 2025 pharmacy list isn't out yet but hopefully no surprises there.

 

[Koolau]

My pharmacy benefit (not Wellcare) allows either B&M or mail order. OOP is higher for B&M, so I only use B&M for something like an antibiotic for a UTI or other emergency script. YMMV