Medicare Part D Observations and Dislikes

[ShokWaveRider]

History: This is my first year on Medicare and I purchased the cheapest Part D supplement because all my regular medicines here in Florida are either free at Publix and Winn Dixie or $10 for 90 days at Walmart. Of course the main reason was to avoid the Medicare Part D penalty.

Well I recently needed a one off drug for post operative reasons, and guess what, not covered by my Part D and subject to a $415 deductible.

So basically Medicare Part D does nothing but give the insurance company a free premium. Then they give me the finger, when I actually need/choose to use it. It would be different if it was a regular planned drug.

Anyone else feel cheated here? Why does Medicare continue to panda and give meal tickets to the drug companies?

 

[Spock]

you bought the cheapest policy, you get the least coverage.
Did you check with the policy's formulary list to see if there was a substitute med available?

 

[ShokWaveRider]

you bought the cheapest policy, you get the least coverage.
Did you check with the policy's formulary list to see if there was a substitute med available?

Yes, and that was the generic that was not covered. The point being it was a 1 off. I would understand if it was a regular that I had not told them about. BTW it was recommended to me by Medicare based on my regular drug use. To add insult to injury, they want to put the premium up by 40% this year when I have never used them.

 

[Chuckanut]

Well I recently needed a one off drug for post operative reasons, and guess what, not covered by my Part D and subject to a $415 deductible.

So basically Medicare Part D does nothing but give the insurance company a free premium. Then they give me the finger, when I actually need/choose to use it. It would be different if it was a regular planned drug.

Anyone else feel cheated here? Why does Medicare continue to panda and give meal tickets to the drug companies?

I am in the same boat. After years of not needing expensive meds I now have one I need to take for a while. My cheap plan does not cover much of the cost.

But, I don't feel cheated. I'm glad I haven't needed to get those more expensive meds in the past years. It means I've been relatively healthy. And I hope to return to that situation. However, I may switch plans next year to one that will cover more of my current drug costs, albeit at a greater monthly fee.

I do think that Part D is unnecessarily confusing since the patient has to predict which formulary is best for him/her. Alas, my crystal ball is still broken and my time machine still needs repairs. IMHO, the only variables should be the size of the deductible and the resulting monthly payment. That is something most patients can understand and plan for.

 

[MichaelB]

So basically Medicare Part D does nothing but give the insurance company a free premium. Then they give me the finger, when I actually need/choose to use it. It would be different if it was a regular planned drug.

Anyone else feel cheated here? Why does Medicare continue to panda and give meal tickets to the drug companies?

I don’t think this is cheating. We know insurance only works when the risk pool is spread across the entire population. If only sick people insure, the cost would be much higher, perhaps unaffordable - much like unsubsidized ACA.

Here Medicare requires us to insure, but then gives us a low cost option. For low med users, this is a much better deal. The alternative is everyone in the same risk pool, which would raise your premium cost substantially.

 

[ivinsfan]

Well you guys on minimal part D or any part D, here's a tip to use. When given a RX for something new, insist on a written script. Don't just have it routinely sent to your pharmacy.

I know it's a pain but before you take the script anywhere look on a discount drug site such as GoodRX. Know that price before you process anything go in person and tell the pharmacy the discount price and then tell them to run your insurance price and take the cheaper one. Sometime there are huge differences in price between GoodRX and insurance prices.But your pharmacy will routine just run your insurance price.

It shouldn't be this much of a hassle but it is. I got caught paying an extra 100 bucks once because I needed a certain med in my hand before my DH could get released from the hospital..

 

[REWahoo]

I know it's a pain but before you take the script anywhere look on a discount drug site such as GoodRX. Know that price before you process anything go in person and tell the pharmacy the discount price and then tell them to run your insurance price and take the cheaper one. Sometime there are huge differences in price between GoodRX and insurance prices.But your pharmacy will routine just run your insurance price.

While this was SOP in the past, I think the recently enacted full disclosure law has changed things for the better. I know the past couple of prescriptions I've had filled the pharmacy clerk ran both my insurance and GoodRX and told me the price for each. Didn't have to ask.

 

[mf15]

I have also seen good Rx to be cheaper than insurance for a drug. That being said
there is something wrong with the system.
Oldmike

 

[NoMoreJob]

I also buy the cheapest plan for the reasons you state. I've gone through cancer treatment (surgery and chemoradiation) and a couple of other minor surgeries in the past three years. None of the medications prescribed (and covered under Part D) have been expensive, as a matter of fact they've been very inexpensive....I'm sure I've spent much less on medications than I would have on premiums for a 'better' plan. Maybe I've been lucky or maybe my doctors have been good about choosing medications that are affordable but whatever the reason my experience has been very good.

 

[ivinsfan]

While this was SOP in the past, I think the recently enacted full disclosure law has changed things for the better. I know the past couple of prescriptions I've had filled the pharmacy clerk ran both my insurance and GoodRX and told me the price for each. Didn't have to ask.

One can hope.I needed to do 3 Goodrx at two different pharmacies and had to ask both times.

 

[travelover]

I've found GoodRx can save a bunch on pet meds, too. So get a prescription from the vet rather than just getting pet meds from the vet.

 

[joeea]

I purchased the cheapest Part D supplement

Well I recently needed a one off drug for post operative reasons, and guess what, not covered by my Part D and subject to a $415 deductible.

So you say the cheapest supplement isn't always best?

I'm shocked and chagrined. Mortified and stupefied!

So basically cheap crap insurance supplement does nothing but give the insurance company a free premium. Then they give me the finger, when I actually need/choose to use it. It would be different if it was a regular planned drug.

Fixed it for you. There's a lesson in there somewhere.

 

[Mr._Graybeard]

History: This is my first year on Medicare and I purchased the cheapest Part D supplement because all my regular medicines here in Florida are either free at Publix and Winn Dixie or $10 for 90 days at Walmart. Of course the main reason was to avoid the Medicare Part D penalty.

Well I recently needed a one off drug for post operative reasons, and guess what, not covered by my Part D and subject to a $415 deductible.

So basically Medicare Part D does nothing but give the insurance company a free premium. Then they give me the finger, when I actually need/choose to use it. It would be different if it was a regular planned drug.

Anyone else feel cheated here? Why does Medicare continue to panda and give meal tickets to the drug companies?

You could have opted for a more expensive Part D plan, and the drug might have been covered. But then a big chunk of that $415 would have gone toward premiums.

 

[audreyh1]

This scenario won’t bother me as I don’t see a way to figure out the coverage for one-off drugs in advance anyway. Not only that but coverage can change from year to year! Shopping for more comprehensive and expensive part D plans only makes sense if you are taking more expensive drugs regularly. And then as drug needs change, and as coverages change, you have the open enrollment period each year to switch. There is probably always going to be part of the year where coverage is not optimal.

As Mr. Graybeard said, you probably saved enough in premiums already to cover part of that expensive drug.

 

[harllee]

At least we have Part D now. I remember when my mother (she is almost 90 now) fist went on Medicare there was NO prescription coverage at all. A real hardship. Personally I am grateful for Part D.

 

[CRLLS]

I guess I don't understand how it can be "not covered" and at the same time be applied to the "$415 deductible". I thought if it wasn't covered, it wasn't covered. Period. No benefit and no application to the deductible. Am I missing something?

 

[ShokWaveRider]

I guess I don't understand how it can be "not covered" and at the same time be applied to the "$415 deductible". I thought if it wasn't covered, it wasn't covered. Period. No benefit and no application to the deductible. Am I missing something?

I guess I was not as clear as I should be. The Total Cost of the drug was not covered for the discounted Co-Pay, hence the whole cost would go to deductible. Perhaps I should have said it was a Tier 4 drug? I am as confused as you are, it should not be this complicated.

 

[Chuckanut]

If one buys drugs using Good RX then payment does not go towards meeting the deductible. Correct?

 

[ivinsfan]

If one buys drugs using Good RX then payment does not go towards meeting the deductible. Correct?

I don't know my DH uses VA and doesn't have a drug plan, but his regular Medicare supplement offers discounts on common drugs.

 

[meierlde]

Note that part d starts with a 415 deductable on at least some meds (some plans exclude generics from the deductable, and since 80% of prescriptions are generic, this may be worthwhile)

 

[jimbee]

If one buys drugs using Good RX then payment does not go towards meeting the deductible. Correct?

That's how it has worked for me with employer insurance and ACA insurance.

 

[wmc1000]

BTW in 2020 the part d deductible increases from $415 to $435 on the lowest cost plans.

 

[Animorph]

One good thing is that you can change your Part D plan every year. I can't know what drugs are not in the formulary until I have to take them, but I can switch plans next year if that's a problem. One-offs will just be hit or miss I guess, though I tried to get a good sized formulary.

Although I didn't select the cheapest plan by premium, I did get one that covered my current drugs for the lowest cost. The negotiated price at the "preferred" pharmacy was far lower than my other options, even when I'm paying the deductible. Better than the cheapest plan and my current costs at Costco, so I'm fine with it.

 

[HFWR]

A refined fish oil prescription went from $9 with a mfg. coupon to $290; won’t accept the coupon now that I’m on Part D. To top that off, I got some muscle relaxers for lower back issues. Express Scripts said I should have gotten pre-approval, plus they sent my GP a nasty gram, saying I was too old to be prescribed that med.

This in month one...

 

[joeea]

I can't know what drugs are not in the formulary until I have to take them

Can't you get a complete list (or at least a link) to the formulary for your plan? I did.