300% Increase in Part D Plan for 2025

[fh2000]

I am in California. I am not taking any prescription drugs.

Wellcare monthly premium will increase from $0.4 to $17.40.
I see

Cigna Healthcare Assurance Rx (PDP)​

Monthly premium: $1.80.
Looks like I will switch to Cigna

 

[shotgunner]

Looking at the Medicare site today. This plan from WellCare seems to be my best choice not only for 0 dollar premium but lowest out of pocket cost for my formulary.

 

[marko]

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

So is this a state by state thing? My 2024 Wellcare was $0.50 a month but is now going to $12.50. Why the difference between us?

 

[audreyh1]

Yes, medical insurance is always state by state and even county by county in terms of pricing.

 

[audreyh1]

Well I looked. My Aetna premium would go up $35 a month.

Wellcare drops to $0 monthly for our county plus much cheaper cost on the one regular drug I take.

 

[Texas Proud]

I just got my update and my Wellcare is going from $0.50 to $0.00...

However, the deductible is going up like $45 to $50 (do not remember and do not want to go look)... and the copays have doubled!!!

SOOO, until I max the $2000 I will be paying more in 25 than 24...

 

[audreyh1]

The deductible goes up every year. All the plans have the same increased deductible.

My copays went down. All my pharmacies are listed as preferred in network now. So monthly drug cost dropped.

 

[RetMD21]

I looked at the Medicare website. My plan still has a $0 premium but a drug has been moved to a lower tier so my projected drug cost is $0. I guess it depends on an individual's drugs but all the other plans had both a monthly premium and higher drug costs. One had a lower deductible but only by about the amount a one month's premium. I can't complain.

 

[Marc]

My Jardiance went from $11/month under WellCare in 2024 to the $2,000 max in 2025. It is a good thing that Jardiance is one of the "negotiated" CMS drugs for 2026, it will be capped at $197/month per negotiation results.

 

[audreyh1]

My Jardiance went from $11/month under WellCare in 2024 to the $2,000 max in 2025. It is a good thing that Jardiance is one of the "negotiated" CMS drugs for 2026, it will be capped at $197/month per negotiation results.

I guess you have to use another plan for 2025?

 

[zaqxsw]

Ohio:
Our WellCare premium is $0/mo. My drug (3) costs are $0/mo. with one(1) more going up from $3/mo. to $5/mo. DW drug (3) costs are $0/mo.

Amazing!

 

[MichaelB]

I wouldn’t be surprised to see changes in formularies for many of the Plan D providers. It’s a way to lower their expected costs so they can lower the premium or keep it low while also lowering the TOOP. They have to inform, but last year I found it very difficult to compare the WellCare formulary.

 

[Marc]

I guess you have to use another plan for 2025?

I ran all plans and all came to just below $2,000 plus premiums for year.

 

[Marc]

I wouldn’t be surprised to see changes in formularies for many of the Plan D providers. It’s a way to lower their expected costs so they can lower the premium or keep it low while also lowering the TOOP. They have to inform, but last year I found it very difficult to compare the WellCare formulary.

Last year WellCare had a Tier 6 "select" which were drugs priced at $11/month. They got rid of Tier 6 for 2025.

 

[Texas Proud]

My Jardiance went from $11/month under WellCare in 2024 to the $2,000 max in 2025. It is a good thing that Jardiance is one of the "negotiated" CMS drugs for 2026, it will be capped at $197/month per negotiation results.

Mine was much higher... The first 90 days was the big deductible... and the 3rd or 4th was like $300 or more... when I hit the donut hole...

I wish it was only $11 per month...

 

[Murf2]

I’ve got a question about something I don’t understand. Yeah, another one!


Look at the plans on Medicare.gov. $0 monthly premium, two prescriptions that are $0 each monthly. The total of premium + prescriptions $24 annually.

I’m not complaining. I’m just curious where this number comes from.

Murf

 

[MBSC]

For Jardiance, Northwest Pharmacy, a CIPA certified Canadian pharmacy, has it for $185 +$10 shipping for 90 days, or $780/yr plus $0 Wellcare plan as a placeholder. It may be less expensive elsewhere.

 

[Montecfo]

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.

Agree. There is no "magic" here. In my experience selecting medical insurance plans, we were always told, for example, that the low cost increases for Medicare resulted in higher costs for regular commercial plans. Someone has to pay.

Here it is even simpler: max OOP capped, so premiums rise on those who were not generating the cost. They need more people to pay as close to that $2000 as possible to make the numbers work. The people who were generating the cost get a large subsidy from everyone else.

It would be nice if we could vote on these things.

 

[MichaelB]

Agree. There is no "magic" here. In my experience selecting medical insurance plans, we were always told, for example, that the low cost increases for Medicare resulted in higher costs for regular commercial plans. Someone has to pay.

It would be very interesting to see evidence to support this conclusion. It doesn’t reflect how insurance markets work.

Here it is even simpler: max OOP capped, so premiums rise on those who were not generating the cost. They need more people to pay as close to that $2000 as possible to make the numbers work. The people who were generating the cost get a large subsidy from everyone else.

If there were just one plan for everyone this might be the case. There are hundreds of plans, though, and as attested to by posts in this thread, some of them are falling in cost or have zero premium. “Spreading the cost around” won’t work in a competitive environment. The additional user cost for the lower OOP is being paid for by those same users.

It would be nice if we could vote on these things.

Let’s all join efforts to keep election politics out of our civil discussions.

 

[Marc]

I wonder if the 300% increase for Aetna is due to financial issues at parent CVS? If so, this may really backfire if they lose a lot of business to WellCare (assuming WellCare still makes a profit on each new customer).

 

[audreyh1]

I wonder if the 300% increase for Aetna is due to financial issues at parent CVS? If so, this may really backfire if they lose a lot of business to WellCare (assuming WellCare still makes a profit on each new customer).

They chose to raise the monthly premium $35 which is the max increase allowed in a year per the new rules. Someone calculated that for them it was a 300% increase.

 

[Sarah S]

Aetna no longer has the supersaver plan in my area. I only see the choice plan which is 50 something a month. I am in Massachusetts.

 

[gianmatt]

Just pay attention to the details. I used the free Wellcare plan this year, and I'm taking a Tier 4 medication which Wellcare is dropping in 2025. I have to switch to another provider. Luckily it will only be $18/month.

 

[Koolau]

I just got my Part D info for the year. My premium went from about $40 to (wait for it) $0.00. Say what?

I did notice an increase in deductible of about $50/year total and reduced % coverage on tier 3 from (I pay) 14% to now I pay17%. I'm sure I'll hit the $2000 OOP max, so I don't suppose any of this matters that much to me.

 

[Montecfo]

It would be very interesting to see evidence to support this conclusion. It doesn’t reflect how insurance mrts work.

That's how it worked when I was evaluating insurance plans over 15-20 years. Understand this is the medical service provider pricing approach. Insurance has pricing as defined above as one input plus expected utilization, overhead and insurer profit. But since company demographics changed slowly, medical services pricing was the common and key input.

It would be explained this way, for example, with graphics: overall medical cost pricing ising 8%. Medicare and Medicaid were 25% of the market and those allowed increases were 2%. The remaining 75% of the market will bear an increase of 10% to cover the expected overall increase. (.75*.1 + 2%*.25= 8%). This is how private insurance pricing would rise at a rate above the average cost increase.

If there were just one plan for everyone this might be the case. There are hundreds of plans, though, and as attested to by posts in this thread, some of them are falling in cost or have zero premium. “Spreading the cost around” won’t work in a competitive environment. The additional user cost for the lower OOP is being paid for by those same users.

Yes some will be lower due to drugs covered and changes the subsidy from Medicare (of which there were some to keep costs from rising too much at uh this time. But analysis I am reading makes it clear the cap and other changes from IRA are driving higher premiums:

"According to KFF, the estimated average enrollment-weighted monthly premium for Medicare Part D stand-alone drug plans is projected to be $48 in 2024, up 21% from 2023. There is considerable variation of premium growth across plans, with some well below the average 21% increase and others above it. The increase is driven by higher expected plan costs to provide the Part D benefit in 2024, including the new limit on enrollees’ out-of-pocket spending."

"The question now is whether the tradeoff involved of a $2,000 cap on spending and other limits in co-payments is worth an average increase in premiums of roughly $8 a month."

$2,000 Cap On Out-Of-Pocket Drug Costs To Help Millions Of Medicare Beneficiaries

20% of adults over 65 forgo their prescriptions due to cost. The IRA’s $2,000 cap on annual out-of-pocket drug costs helps alleviate the issue for Medicare beneficiaries.

www.forbes.com

To your point, there are other plan design steps an insurer can make to mitigate higher costs, such as more mandated generics, requiring pre-approval, etc. But reducing utilization via pre-approval reduces the usefulness of the insurance. It is not pain free to the customer.