DQOTD: How Can My Part D Premiums be $0???

[Midpack]

We have the lowest benefit plans, because we have ZERO ongoing Rx needs. Just the occasional Rx for vaccines, colonscopy, etc. DW has Part D with Aetna, costs her $5.20/mo. But for some reason my Part D premiums with Wellcare have dropped to $0 for 2024, and I just got my statement showing $0 for 2025. I am active, confirmed via chat with a Wellcare rep, and we have had claims filed with them - and gotten discounts (all we really want from Part D).


My Wellcare premium history:
2019 $17.10/mo
2020 $13.70/mo
2021 $15.30/mo
2022 $12.90/mo
2023 $11.10/mo
2024 $0/mo
2025 $10/mo

What am I missing? Am I unwittingly going to lose Part D coverage at some point in the future staying with Wellcare - paying nothing?

Irony? I do pay a $12.90/mo IRMAA penalty...

 

[ShokWaveRider]

Same for us. $0 renewal and all our drugs are covered.

 

[MichaelB]

We have the lowest benefit plans, because we have ZERO ongoing Rx needs. Just the occasional Rx for vaccines, colonscopy, etc. But for some reason my Part D premiums with Wellcare have dropped to $0 for 2024, and I just got my statement showing $0 for 2025. I am active, confirmed via chat with a Wellcare rep, and we have had claims filed with them - and gotten discounts (all we really want from Part D).

DW has Part D with Aetna, costs her $5.20/mo

My Wellcare premium history:
2019 $17.10/mo
2020 $13.70/mo
2021 $15.30/mo
2022 $12.90/mo
2023 $11.10/mo
2024 $0/mo
2025 $10/mo

What am I missing? Am I unwittingly going to lose Part D coverage at some point in the future staying with Wellcare - paying nothing?

Irony? I do pay a $12.90/mo IRMAA penalty...

My guess is your cost is the deductible. The policy has an actuarial value, 3/4 of that is paid by Medicare, and the 1/4 part you pay is the cost sharing when you use it.

 

[audreyh1]

Yeah, I think a lot of us are wondering exactly this!

Same IRMAA penalty.

DH switched to WellCare for 2024. He has no regular prescriptions, just the occasional one off. His premium is $0.50 per month. It was good this year no expensive surprises.

I ended up with aetna for 3 months - just this month started Medicare. I have one regular prescription which made quite a difference to my options. It’s a generic but I guess a tier 2 drug. For me it turned out to be a wash total cost wise, so I went with the plan that was most convenient in terms of my current close pharmacy having the lower price. However if monthly premiums go up as much as expected, the situation will likely completely change. I’ll be researching later this month. I’m waiting for us to receive premium notices first.

My only guess is that Wellcare has been playing some kind of strategic long game. Are they deliberately going after aetna for example? Who knows.

 

[Midpack]

And a corollary - DW has recently taken on an asthma inhaler long term if not permanent, and it's pricey - works out to $724/year and it's NOT covered by her Aetna low cost Part D. So she has been researching better Part D plans, and BC/BS is the only provider who will cover the inhaler. However, the premium for that plan is $130/mo with a $590 deductible. So her choice is:

Pay $786.40/yr staying on her current low cost plan - $724/yr for inhalers plus $62.40/yr ($5.20x12) Part D plan.
OR
Pay $1,694/yr with the better coverage BC/BS plan - $134/yr for inhalers ($724-$590) plus $1560/yr ($130x12) new Part D plan.

Makes no sense to me...

 

[Gotadimple]

And a corollary - DW has recently taken on an asthma inhaler long term if not permanent, and it's pricey - works out to $724/year and it's NOT covered by her Aetna low cost Part D. So she has been researching better Part D plans, and BC/BS is the only provider who will cover the inhaler. However, the premium for that plan is $130/mo with a $590 deductible. So her choice is:

Pay $786.40/yr staying on her current low cost plan - $724/yr for inhalers plus $62.40/yr ($5.20x12) Part D plan.
OR
Pay $1,694/yr with the better coverage BC/BS plan - $134/yr for inhalers ($724-$590) plus $1560/yr ($130x12) new Part D plan.

Makes no sense to me...

It makes perfect sense. In your state, the only plan to offer "broader coverage" (meaning lower copays or more drugs covered) is BCBS and they know it. With BCBS your out of pocket is $590 less, but your premiums are $1497.60 more for the lower co-pay. That's why you have to do the math and pay attention to potential co-pay costs, deductible costs, AND premium charges.

 

[audreyh1]

And a corollary - DW has recently taken on an asthma inhaler long term if not permanent, and it's pricey - works out to $724/year and it's NOT covered by her Aetna low cost Part D. So she has been researching better Part D plans, and BC/BS is the only provider who will cover the inhaler. However, the premium for that plan is $130/mo with a $590 deductible. So her choice is:

Pay $786.40/yr staying on her current low cost plan - $724/yr for inhalers plus $62.40/yr ($5.20x12) Part D plan.
OR
Pay $1,694/yr with the better coverage BC/BS plan - $134/yr for inhalers ($724-$590) plus $1560/yr ($130x12) new Part D plan.

Makes no sense to me...

I think a lot of folks are seeing the aetna premium jump up $35 monthly which is the highest jump currently allowed? Still cheaper I suppose.

 

[CardsFan]

Yeah, I have the same WellCare plan. $0 in 2020, and $0 in 2025. Plus my two maintenance scripts are no cost as well.

DW has a different set of scripts. In 2024, Cigna made the most sense. A quick look today, and WellCare may be best for next year. We will see what it looks like after the 15th.

 

[Midpack]

I think a lot of folks are seeing the aetna premium jump up to $35 monthly which is the highest jump currently allowed? Still cheaper I suppose.

Just in. DW's Aetna premium is jumping from $5.20/mo in 2024 to $40.20/mo in 2025 - she's in another room researching as I type. Aetna says they are combining two tiers into one, hers and a more expensive plan (obviously). So she will check her options when Part D open enrollment begins 10/15. Even at $40.20/mo it's a much better deal than the BC/BS plan she found.

 

[audreyh1]

I think all the Part D info online is for 2025 as of today, 10/1. It’s just you can’t enroll until 10/15.

 

[audreyh1]

I think a lot of folks are seeing the aetna premium jump up $35 monthly which is the highest jump currently allowed? Still cheaper I suppose.

I finally checked for my county.

Aetna Silverscript premium going up $35 to $44.80 per month and none of my pharmacies listed as preferred and my drug price higher. Several other plans are now cheaper.

Meanwhile Wellcare is $0 premium, and my drug prices lower than this year. DH had been paying $0.50. Now it’s $0.

 

[2017ish]

...

What am I missing? Am I unwittingly going to lose Part D coverage at some point in the future staying with Wellcare - paying nothing?

Irony? I do pay a $12.90/mo IRMAA penalty...

Wait--IRMAA penalty applies even with a $0 premium? I always thought it was a multiplier of the underlying premium. (New to medicare 1/1/2025.) Where would I find the best explanation of how this happens?

 

[audreyh1]

Wait--IRMAA penalty applies even with a $0 premium? I always thought it was a multiplier of the underlying premium. (New to medicare 1/1/2025.) Where would I find the best explanation of how this happens?

No, it’s a fixed amount. Both Part B and Part D IRMAA are fixed amounts determined by each IRMAA level.

Monthly premium for drug plans

Learn about monthly fee (premium) Medicare drug plans charge and automatically deducting premium from Social Security payment.

www.medicare.gov

 

[ERD50]

My guess is your cost is the deductible. The policy has an actuarial value, 3/4 of that is paid by Medicare, and the 1/4 part you pay is the cost sharing when you use it.

I'm not following this. I'm in a similar boat, I currently pay $9.90/month, and my 2 generic drugs are zero added cost to me. For 2025, I see a $0 plan, with $0 cost to me for my 2 generic drugs. So I pay nothing towards any deductible either.

So how does the ins co make money? Does their data tell them that the average person needs some non-zero cost drugs, and the ins co pockets some of the deductible, and some of the amount above the deductible (you pay more for the drugs than they do?)? So it works out on average for them?

If that's the case, seems almost the opposite of most insurance. They don't profit on fixing my car for example, they profit from all the people paying in a year, and NOT needing their services.

Or.... does the govt subsidize a portion of this, and that's why the ins can offer it at zero cost to the consumer? Or all/some of the above?

 

[RetiredHappy]

Wait--IRMAA penalty applies even with a $0 premium? I always thought it was a multiplier of the underlying premium. (New to medicare 1/1/2025.) Where would I find the best explanation of how this happens?

IRMAA is income based (MAGI). If you stay under IRMAA first tier, don't pay for Medicare Part D. Drug plan (Plan D) price varies based on which plan that you select.

 

[MichaelB]

I'm not following this. I'm in a similar boat, I currently pay $9.90/month, and my 2 generic drugs are zero added cost to me. For 2025, I see a $0 plan, with $0 cost to me for my 2 generic drugs. So I pay nothing towards any deductible either.

So how does the ins co make money? Does their data tell them that the average person needs some non-zero cost drugs, and the ins co pockets some of the deductible, and some of the amount above the deductible (you pay more for the drugs than they do?)? So it works out on average for them?

If that's the case, seems almost the opposite of most insurance. They don't profit on fixing my car for example, they profit from all the people paying in a year, and NOT needing their services.

Or.... does the govt subsidize a portion of this, and that's why the ins can offer it at zero cost to the consumer? Or all/some of the above?

Yes, as I pointed out in my post, Plan D costs are subsidized. CMS pays around 3/4 of the actuarial cost of the policy and states pay some as well. Pharma companies and PBMs also pay “rebates” to insurers. All these are factored into the premium, and in your case that payment is enough to cover the entire cost.

 

[gianmatt]

What Wellcare has done is to drop a number of expensive drugs from coverage. They don't care about your inexpensive meds. They do care about the $2K/month specialty tier drug. Some of those people now need to switch to another company's plan because Wellcare will no longer cover the drug in 2025.

I think we all know that the insurance companies know very well how to make a profit.

 

[CardsFan]

What Wellcare has done is to drop a number of expensive drugs from coverage. They don't care about your inexpensive meds. They do care about the $2K/month specialty tier drug. Some of those people now need to switch to another company's plan because Wellcare will no longer cover the drug in 2025.

I think we all know that the insurance companies know very well how to make a profit.

Or, put another way:
WellCare has decided to target a specific market. Those with no, or low cost, scripts.
Kinda like Walmart vs Neiman Marcus. Both can exist and be profitable. They just serve different markets.

 

[ShokWaveRider]

Or, put another way:
WellCare has decided to target a specific market. Those with no, or low cost, scripts.
Kinda like Walmart vs Neiman Marcus. Both can exist and be profitable. They just serve different markets.

And that is OK with us.

 

[CardsFan]

And that is OK with us.

Exactly!

 

[Lstansbury]

My guess is your cost is the deductible. The policy has an actuarial value, 3/4 of that is paid by Medicare, and the 1/4 part you pay is the cost sharing when you use it.

I thought it was, at least in part, because Wellcare received a bigger stipend from Medicare due to its focus on dual eligibles on the other side of its business? ... And is making a marketing move to grab share this year. As an agent, I'm not sure on this one. But it has caused more phone calls and questions than the "advantage plan or Medicare supplement?" Conundrum for new to Medicare folks. I know the deductible is at the highest point, and not all the plans are at the 590. So they are definitely covering themselves there as well. Thanks for any additional insights you have to share!