Medicare Part D Observations and Dislikes

[JoeWras]

I'm 8 years away from Medicare and have been ignoring it. I figured it was time to start thinking about it now that I'm retired. So, I started reading some of these threads.

I am totally, 100% confused.

Is this normal? Should it be this hard? Am I an outlier? And do we have a FAQ or Pinned Thread that is all about Medicare someone can point me to?

 

[travelover]

I'm 8 years away from Medicare and have been ignoring it. I figured it was time to start thinking about it now that I'm retired. So, I started reading some of these threads.

I am totally, 100% confused.

Is this normal? Should it be this hard? Am I an outlier? And do we have a FAQ or Pinned Thread that is all about Medicare someone can point me to?

Medicare has a really good website. I'd suggest that you start there.

 

[joeea]

I'm 8 years away from Medicare and have been ignoring it. I figured it was time to start thinking about it now that I'm retired. So, I started reading some of these threads.

I am totally, 100% confused.

Is this normal? Should it be this hard? Am I an outlier? And do we have a FAQ or Pinned Thread that is all about Medicare someone can point me to?

"Get What's Yours for Medicare" https://smile.amazon.com/Get-Whats-Yours-Medicare-Maximize/dp/1501124005/

 

[frank]

I ran into the same problem. Purchased the cheapest plan available for part d and did a search on medicare.gov to find out what was the best overall plan. turns out the cheapest was the best plan as everything for me and the wife were covered and generic, so no copays. the middle of the year my wife found that she needed a new prescription for an expensive drug. went to get it filled 415. for the month. I got a good rx coupon for 133. for the same drug. I went back on medicare.gov and found that once I had paid the copay of 415 the drug would have been 40 mo for the rest of the year. it was a tier 4 drug. it also said it wasn't covered. If I had it to do over I would have done what the others on here have suggested. gotten the prescription on paper, checked all the options, espescially medicare.gov and goodrx. then chosen the cheapest route from then on.

 

[H2ODude]

Just flipped through the latest bundle of paper that is sent regularly by Humana, our Part D provider. Says monthly premium is doubling next year, from 30 to $60. Not a burden for us but for those struggling in retirement I'd guess that would hurt.

 

[frank]

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

are the 2020 plans available for viewing already? Where at?

 

[wmc1000]

are the 2020 plans available for viewing already? Where at?

Not yet that I know of. I received my letter from current Part D provider and it showed the increase in deductible for 2020 along with the rate increase. Was $15.50 going to $17.20 per mo.

added: Deductible is for drugs on Tiers 3-5.

 

[grayv]

Is this normal? Should it be this hard? Am I an outlier?

get medicare, a supplement, and a medicare drug plan.

 

[trumpeting_angel]

I'm 8 years away from Medicare and have been ignoring it. I figured it was time to start thinking about it now that I'm retired. So, I started reading some of these threads.

I am totally, 100% confused.

Is this normal? Should it be this hard? Am I an outlier? And do we have a FAQ or Pinned Thread that is all about Medicare someone can point me to?

I just posted a small rant on the other Part D thread that is running concurrently. @JoeWras, it is this complicated. The limited good news is that each state has a SHIP (Statewide Health Insurance Program), where one can theoretically get help. Effectiveness varies by state. My state, not so much.

There are Medicare consultants (fee only) who can figure out the best plan for you. And there are Medicare insurance agencies who can figure out the best plan for you from among the plans that will pay a commission. I went this route and used Boomer Benefits, along with a little research of my own, and have been pleased with the results.

It is ridiculously complex. I’m a recently retired healthcare professional with decades of experience working with health insurance, and due to a truly minor complication I simply couldn’t figure out my Part B and D enrollment without help.

A few months pass, and now I have to look at the changes and use a slide rule, spreadsheets, and a guess which statin my doctor will prescribe before I can re-choose a Part D plan for next year.

 

[JoeWras]

get medicare, a supplement, and a medicare drug plan.

That was my simple plan, but...

It is ridiculously complex. ... A few months pass, and now I have to look at the changes and use a slide rule, spreadsheets, and a guess which statin my doctor will prescribe before I can re-choose a Part D plan for next year.

... This is where I started to lose my confidence. I was watching the discussion on part D, and just how different it is for people. I thought my supplement would handle part D. Guess not? Go to Medicare site and it starts talking about "creditable plans." What? It implies only federal employees and unions have that gravy train, but then, maybe not because it barks out you may lose everything if you screw something up.

So, that's when I backed off, discouraged. By buying part D, I lose things? Grumble.

Quote from the part D section of medicare.gov:

Note

If you join a Medicare Prescription Drug Plan, you, your spouse, or your dependents may lose your employer or union health coverage.

[ First link on: https://www.medicare.gov/drug-coverage-part-d/how-part-d-works-with-other-insurance ]

 

[SumDay]

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..

When I had my knee replaced, several prescriptions were called to my pharmacy upon release from the hospital. One was for generic Celebrex which would have been well over $100. The pharmacist called and helped me through my anesthesia fog to print off a Good Rx coupon for total out of pocket of around $25.

I agree - there is something wrong with the system when you have to play games like this. I'm glad I know how to play, but it shouldn't have to be done. I see lots of people at the pharmacy who wouldn't know how to turn on a computer.

 

[Bamaman]

My wife takes something like 14 prescription medicines, 12 of which are cheap. Her pain management clinic recently received 100's of letters from The State ordering reductions in opioid medicines 1/3, and the only drug that fits their orders is Embeda. The drug is so expensive, virtually no pharmacies stock it and it has to be ordered in. She went from a $200 a month drug to a $1250 a month drug with a $265 cost to us.

She's had 4 major surgeries in a year, and has arthritis all over her body. With the new medicine not being as strong, she wakes up about 2:00 a.m. and has to take breakthrough over the counter pain medicines. She's pretty miserable--and sleep deprived.

Politicians just want to hear opioid prescriptions are down, down down. They don't care about the aging Baby Boomers and their ailments. And they'll never hear about the thousands of previous Pain Management patients taking street heroin and other illegal drugs to take away their pain because they cannot afford insurance AND co-pays/deductibles. Many die from the street meds too.

 

[Chuckanut]

For those of you who have switched Part D prescription coverage....

How did your existing prescriptions move over to your new insurance company? Did you have to get new ones from the Dr? Where they moved automatically? Did you have to do anything to get them moved?

 

[travelover]

..........How did your exciting prescriptions move over to your new insurance company?...........

My doctor won't prescribe exciting drugs. Too bad. Existing prescriptions stay the same, but I inform the pharmacy of the insurance change.

 

[Chuckanut]

I inform the pharmacy of the insurance change.

Right.

What about prescriptions sent by mail via the insurance company's mail-order prescription service? My current insurer, Envision, has its own outlet for drugs sent by mail.

 

[travelover]

Right.

What about prescriptions sent by mail via the insurance company's mail-order prescription service? My current insurer, Envision, has its own outlet for drugs sent by mail.

In that case, you'll need to transfer the prescription just like you'd do if you changed brick and mortar pharmacies.


I recognize it won't be as easy with mail order prescriptions. Your new insurance company should assist with this.

 

[trumpeting_angel]

That was my simple plan, but...



... This is where I started to lose my confidence. I was watching the discussion on part D, and just how different it is for people. I thought my supplement would handle part D. Guess not? Go to Medicare site and it starts talking about "creditable plans." What? It implies only federal employees and unions have that gravy train, but then, maybe not because it barks out you may lose everything if you screw something up.

So, that's when I backed off, discouraged. By buying part D, I lose things? Grumble.

Quote from the part D section of medicare.gov:

Sorry Joe! I was ranting, for sure. I don’t have to do any of those things, unless I want to double check that I have the lowest cost plan for the best benefits. Prices change and benefits juggle around so we old ones have to stay on our toes. Or risk paying more.

I do know that giving-up feeling, though.

You are a prime candidate for Boomer Benefits or a fee-only Medicare consultant. Sounds like there may be some minor complexities for you which, like me, sound so confusing that one wants to burn the Medicare brochures and go live off the grid. Ideally in Sweden.

You aren’t without options. The folks who can explain this do it so well that you won’t even believe you thought it was complicated!

 

[JoeWras]

Sorry Joe! I was ranting, for sure.

No worries at all! That was no rant. Let me show you a few threads around here with rants.

I'm currently "observing and monitoring" since DW and I are still 5+ years away from major decisions on this. I suspect there will be some changes before then, possibly major, so I don't want to burn too many brain cells on what may be an obsolete decision later.

 

[trumpeting_angel]

You should wait a few years! This year’s complaints will have been forgotten and replaced several times over with new issues!

 

[rk911]

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?

nope. our part d plan from BC/BS has saved us bucks each year. my wife has one drug not covered and which would cost hundreds of $ for each refill. for that drug we use https://www.goodrx.com/?gclid=Cj0KC...eWOBIqx5WWbxgntz3IINtjedqthhPsVQaAm-8EALw_wcB which drops the cost to ~$30. the card is free and they claim accepted at most pharmacies. i know Walgreen's accepts it. at the GoodRx website you can enter your drug(s) and get a cost.

 

[Bamaman]

My ex-MegaCorp has changed over to a Medical Savings Acct. type of plan managed by an outside company. My wife and I can each draw $565 a month for all healthcare, deductibles, co-pays and medicine. We have to call in for an up to 90 minute interview to discuss our health issues, medicines and get guidance on what supplement manner to apply for. We'll see how it works.

My wife takes many meds, with only two being very expensive. Insurance pays little or nothing on most of the generics. We're going to get with the local pharmacist and see if we can bypass insurance and just buy'em out of pocket to save $. It may add up over a year to be substantially cheaper.

 

[ivinsfan]

Well I'm getting a little paranoid now. After getting a letter Saturday from Humana telling me my Part D plan will double in price today I get another letter.

The front of it says "Important info about your Part D plan, but no, inside it says ..Not happy with the increase in your Part D costs? Why don't you take a good look at our MA plans which include Part D coverage, we bet that would work better for you.

Why do they seem to be pushing people to MA, and will this be a continuing trend? I can be pretty certain they aren't pushing me towards it because "it's better for you"

 

[Another Reader]

I guess it never occurred to Humana that you might just change your drug plan during open enrollment...

I would probably choose not to do business with a company that blatantly attempts to manipulate me into doing something that is in their best interest and not in mine. That attitude tends to spill over into their other business practices.

 

[mf15]

Yesterday I called Humana about getting a new medigap plan. The rep went on for 20 minutes about MA plans,sending people to my house, could not shut her up. Told her 4 times I only wanted medigap info. For what ever reason they are pushing MA,really hard.
Oldmike

 

[HadEnuff]

I have Humana Part D, for the obvious reasons others have stated:

I only have one maintenance Rx and it's not expensive,
I want to avoid the Part D penalty, etc.

My premium is going to go up and I probably will pay the premium without getting any benefit in return.

Essentially I am willing to self-insure for the occasional Rx, and pay the lowest premium available to avoid a Part D penalty later should my circumstances change.

For someone like me, is their a cheaper alternative than Humana?