Medicare Prescription Drug Plans?

[mountainsoft]

My mom is 71, has Medicare A and B, but no drug coverage. So far she has just paid for meds out-of-pocket, but since her stroke she now needs Eliquis that costs over $400 per month. So, in an effort to reduce her expenses, I am starting to look at Medicare Prescription Drug Plans.

Using the medicare.gov web site and her list of medications, the lowest cost options appear to be AARP MedicareRX Preferred, Envision RX Plus, and AARP MedicareRX Saver Plus.

Does anyone have any experience with any of these? By the time you pay the monthly premiums, copays, etc. do you really save much over the cash price?

 

[kaneohe]

I didn't know the details about the other Rx or the Eliquis so I just left the default settings on Eliquis and got $113/mo including the mo. premium.
I believe your mom will also pay a penalty because she didn't have coverage since she started Medicare.

 

[MBSC]

I didn't know the details about the other Rx or the Eliquis so I just left the default settings on Eliquis and got $113/mo including the mo. premium.
I believe your mom will also pay a penalty because she didn't have coverage since she started Medicare.

+1

Unless she qualifies for a Special Enrollment Period (SEP), the next Part D annual enrollment is 10/15/17-12/7/17 for a 1/1/2018 start date so you have time to research this and may need to re-enter the data when 2018 plans are available since the best plan can change each year.

The Medicare.gov site will not include the Late Enrollment Penalty (LEP). It is 1% per month since she lost creditable drug coverage or turned 65, whichever came later. The 1% is calculated on the "average Part D premium" ($35.63 in 2017) not the premium of the chosen plan. So, a six year penalty in 2017 is an additional $25.70 ($25.65 rounded to the nearest $0.10).

 

[Richard4444]

When I signed up for a medicare prescription drug plan, I called medicare and was pleasantly surprised to find that person extremely helpful. She asked what meds I am taking, did the computer scan thing on her end, and then told me what is the lowest cost for me. I asked her why she is recommending an insurance company (thinking she must be paid, etc) and she replied that this is a service the government just does. And I found that to be true. Yes, I did the online thing myself as well, and she was correct. Just a suggestion.

Rich

 

[athena53]

I believe your mom will also pay a penalty because she didn't have coverage since she started Medicare.

Right. Also from the Medicare.gov site:

"Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($35.63 in 2017) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The national base beneficiary premium may increase each year, so your penalty amount may also increase each year."

So, for enrollment in 2017, her monthly premium will be $25 or so higher than it would have been if she'd had continuous coverage. When I retired 3 years ago and DH, who'd been on my company plan, signed up for Medicare, he was able to avoid the surcharge by showing that he'd had continuous "creditable" coverage since he'd turned 65 11 years earlier.

I turn 65 next year and am on only one prescription which seems to have zero competition, so I suspect the premiums won't be worth it (I just got a 6 month supply for $335). I fully intend to get prescription coverage, probably with a very high deductible.

 

[MichaelB]

I turn 65 next year and am on only one prescription which seems to have zero competition, so I suspect the premiums won't be worth it (I just got a 6 month supply for $335). I fully intend to get prescription coverage, probably with a very high deductible.

DW only uses one prescription, and she can get it filled via GoodRX for less than any insurance plan. So, when she turned 65, we just enrolled her in the plan with the lowest monthly premium ($14).

 

[athena53]

DW only uses one prescription, and she can get it filled via GoodRX for less than any insurance plan. So, when she turned 65, we just enrolled her in the plan with the lowest monthly premium ($14).

I've checked GoodRx and another discount prescription site with a name I can't remember- neither was any help. This is a brand name with no generic alternative. Delicacy forbids me from going into details but I swear it's a punishment to Women of a Certain Age who haven't given up sex.

 

[mountainsoft]

Unless she qualifies for a Special Enrollment Period (SEP), the next Part D annual enrollment is 10/15/17-12/7/17 for a 1/1/2018 start date so you have time to research this and may need to re-enter the data when 2018 plans are available since the best plan can change each year.

Hmm... I hadn't seen that. Good to know, though I don't understand why medical plans always have limited enrollment periods like that. It seems like it would be a massive work load for workers during that time, and slow the rest of the year.

The Medicare.gov site will not include the Late Enrollment Penalty (LEP). It is 1% per month since she lost creditable drug coverage or turned 65, whichever came later. The 1% is calculated on the "average Part D premium" ($35.63 in 2017) not the premium of the chosen plan. So, a six year penalty in 2017 is an additional $25.70 ($25.65 rounded to the nearest $0.10).

I saw the penalty somewhere but hadn't seen how to figure out what it would cost. Thanks for breaking it down.

I still haven't been able to figure out if the prescription drug plan will end up saving money over just paying cash, especially with the late penalty. I see different results for the same plan on Medicare.gov depending on the screen I'm looking at, or maybe I just don't understand what each price refers to.

 

[mountainsoft]

DW only uses one prescription, and she can get it filled via GoodRX for less than any insurance plan.

I checked GoodRX and their quoted price is only $14 less than what I paid at the same store. Even if I could really get that price, it's not much of a discount on a $420 drug. I tried to use a SimpleCare card my mom already had, but the pharmacy said the discount is already applied to the price.

 

[Souschef]

Be aware of the "doughnut hole" in drug coverage. My wife takes 6 meds and she just hit it. The normal $45 drug went up to $150 per month.
It will stay there until she reaches $4950 OOP!
Needless to say, she will not get there in 2017.

 

[athena53]

Good to know, though I don't understand why medical plans always have limited enrollment periods like that. It seems like it would be a massive work load for workers during that time, and slow the rest of the year.

Both that and the penalty are to avoid or penalize "adverse selection"- people waiting to buy coverage till you actually have a need for it. The system needs a good representation of currently-healthy people to keep the premiums low. DH was allowed to start Medicare in May but it was because he'd been covered on my plan and I'd quit my job. That's the type of special event that will let you enroll outside of the open enrollment period.

 

[MBSC]

I still haven't been able to figure out if the prescription drug plan will end up saving money over just paying cash, especially with the late penalty. I see different results for the same plan on Medicare.gov depending on the screen I'm looking at...

You get different results on different pages because of the default settings. The initial results default to "Lowest Remainder of the Year Costs" which is unrealistic since she probably is not eligible to enroll at this time. This is why it is best to wait until 2018 plans are posted and the "Remainder of the Year Costs" reflect 2018 annual costs.

For the AARP Preferred plan, the Part D comparison tool estimates "remainder of the year costs" at $444 ($76.10/month premium + $35 Tier 3 copay *4 remaining months in the year) before penalty using the default values for Eliquis and a Walmart pharmacy.

The comparison tool includes the "donut hole" in the annual cost estimate. This is illustrated by choosing "compare plans" after the initial results are displayed.

The monthly cost for the first 9 months are $111.10 ($76.10 premium + $35 Tier 3 copay). It indicates the donut hole is reached in the 10th month ($189.82) and months 11 and 12 are $231.97 each. This gives a 2017 annual cost of $1653.76 ($137.81/month) before penalty. Part D is a good deal in this scenario even with a penalty.

If her other medications are filled under Part D, she will hit the donut hole earlier in the year and pay the higher Eliquis cost for additional months. This is why some continue to fill generics outside Part D.

 

[kaneohe]

................................

The comparison tool includes the "donut hole" in the annual cost estimate. This is illustrated by choosing "compare plans" after the initial results are displayed.

The monthly cost for the first 9 months are $111.10 ($76.10 premium + $35 Tier 3 copay). It indicates the donut hole is reached in the 10th month ($189.82) and months 11 and 12 are $231.97 each. This gives a 2017 annual cost of $1653.76 ($137.81/month) before penalty. Part D is a good deal in this scenario even with a penalty.

If her other medications are filled under Part D, she will hit the donut hole earlier in the year and pay the higher Eliquis cost for additional months. This is why some continue to fill generics outside Part D.

Appreciated the detailed explanation.........have never used the "compare plans" feature so wasn't aware it would show the donut hole when used mid-late in the yr.

Usually when I check very late in yr when new plan info is available, if I click on the name of a plan, a very detailed display comes up showing the costs for each month of the year. I've never come close to the donut hole, but I assume that the increased cost from that would would show up as the months went by.

 

[marko]

I just started Medicare in June and signed up for Part D via Walmart (Humana).
$17 a month. So far so good. Seems to be at least as good as my old BCBS plan.

I opted to not shift to Walmart itself for my Rx...I really like my pharmacist, so I pay a small copay (~$7) which is fine with me. If I went to Walmart my copay would be something like $1.

 

[Blue Collar Guy]

Yeah there is a penalty for not taking the part D right away. I know this as my mother got some disturbing letter stating she was not enrolled in a qualifying plan. Turns out everyone was wrong, her union plan is qualifying and she didnt need Part D. Then you need to research her medicines which I think is also wacky. Different plans cover different prescriptions for different prices. But since you did the work do a cost analysis. If its close let her take part D, the penalty will only get bigger ever year she waits.

 

[tu2008]

https://www.goodrx.com/eliquis/savi...antity=60&days_supply=&label_override=Eliquis

Eliquis has a savings card program that reduces copay to 10 bucks per month. I dont know if medicare coverage would interfere with eligibility in the program.

 

[jebmke]

I start Medicare in January. Signing up for Medigap next week. I only use one generic script + maybe once a year an antibiotic. When I met with SHIP, they suggested just getting the cheapest Rx plan available just to maintain coverage.

But realistically, I doubt such a plan would cover anything for me so it would just be reserving a place to avoid the penalty later if I start needing more Rx.

I can get an Rx plan for about $17/month. Is it really worth it just to avoid a penalty down the road or am I missing something else?

 

[Sarah S]

The penalty is 1 percent of a baseline amount that changes yearly per uncovered month forever I believe . that could add up to a good amount extra each month afer a couple of years especially if the baseline rises

It is my understanding too that after the initial medicare enrollment period you can only change once a year. What if you unexpectedly acquire a need for an expensive drug? I retired taking one medication. Total yearly cost 5.32. Then half way through the second year I needed another drug- generic, no alternative- 600 a month.

 

[REWahoo]

I can get an Rx plan for about $17/month. Is it really worth it just to avoid a penalty down the road or am I missing something else?

It is insurance and like any insurance, not having it is a risk. Add in the financial penalty in premium cost Sara S describes and your risk only magnifies. Enroll when you can do so without penalty.

 

[FIRE'd@51]

................. or am I missing something else?

Yes, no matter how healthy you are (or think you are), you could be diagnosed with something that requires a very expensive drug. If you don't have Part D, you would be on the hook to pay for it yourself until the next open enrollment. IMO, $17 a month is pretty cheap catastrophe insurance.

 

[Bamaman]

My wife takes 14 prescriptions, including two controlled substances, and I have gone be Medicare's analysis of our state's insurance companies. In comparison with last year's p!ans, I question the info provided. Most of her meds are $4 at Wal-Mart and only two were expensive. But with terrible arthritis, spinal stenosis and stomach problems, we just have to keep Part D even though it is not paying that much.

I am type II diabetic on an insulin pump. And Medicare Part B pays 80% of my supplies and vials of insulin ($255 each.). Although out of pocket meds are low, I am not about to be caught without Part D. Type II diabetics have pressure very high incidence of heart issues and most at one time end up with cardiac surgery. I am trying to be proactive in my healthcare.

 

[Walt34]

I can get an Rx plan for about $17/month. Is it really worth it just to avoid a penalty down the road or am I missing something else?

That $17/month number can change, literally in a heartbeat.

When I retired I was taking one prescription medication. Now I'm on seven, two of them combined are $1k/month. YMMV.

 

[jebmke]

Yes, no matter how healthy you are (or think you are), you could be diagnosed with something that requires a very expensive drug. If you don't have Part D, you would be on the hook to pay for it yourself until the next open enrollment. IMO, $17 a month is pretty cheap catastrophe insurance.

Thanks. I was sort of leaning that way. It isn't a big number in the scheme of things and does cover a catastrophic situation if things suddenly change.

 

[Sunset]

Thanks. I was sort of leaning that way. It isn't a big number in the scheme of things and does cover a catastrophic situation if things suddenly change.

Good idea, sort of like fire insurance, not something you want to buy after the fire starts

 

[Sunset]

I have found the medicare website fantastic for comparing part D plans.

I know a fellow that looked it up and SURPRISE, he is going to save $5,000 next year (based on his current drugs taken). Yes it is estimated he will pay $2,000 / yr, but that is better than over $7,000

Imagine all the people who don't bother to try to compare. . .