Part D Rx Plans

[Elizrogers]

I did not take the Part D Rx plan when I first started Medicare, so I have 2, I found that the two I used to take are not covered by any plan, at any tier, so I would be paying the total cost. The one I take occasionally, with my Good RX discount card costs $11 for 90 pills. Under Rx plans it runs anywhere from $159-$256 depending on the plan. That is ridiculous. So, I have decided to save the $264 yr, which would be over $2,264 over the next 10 years. And the premiums will go up. If I save that money, I can pay for a lot of drugs.​

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I realize if you have something serious like MS, you may have some very pricey drugs to take, but the chances are low for something like that. I do expect cancer as it runs in my family and I have had a small one removed from a breast gland, but no chemo or radiation was required and it did not spread beyond the gland, which was removed. Of course, chemo and radiation are considered Treatments, not drugs, and covered under Part B, so if I ever do take them Part D won't help. I don't know how they are allowed to penalize you so heavily for not taking this coverage from day one, when you can't use it, effectively forcing people to pay for nothing, just because they fear the unknown future and so may pay someone thousands of dollars and never get a benefit.​

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If I don't start for 10 years, (assume in 10 years I need an expensive drug) it will still only cost about $50/mo for Part D at that time. If a drug is only a couple hundred dollars, I am still going to be ahead by saving that premium all those years and I can't imagine taking a drug that costs thousands of dollars, as I do not intend to go to extremes to prolong life, should I get something catastrophic anyway. Am I wrong or overlooking something? I'm 68 and have no health problems other than orthopedic, so consider the risks of needing ridiculously expensive drugs very slim, and I might not take them even if prescribed, just because I hate drugs. I had a blood clod about 5 years ago and they wanted me to take Xarelto for the rest of my life. I took it for 9 months, which was 3 more than they said I needed to in order to clear out all the pieces of the clot from my system, but then stopped. They could not show me any indications that I might ever have another one, except that I had had the one. It was a fluke, no history in my family, and no indications in my blood or other medical tests to say I'm at risk. Everyone seems to want me to waste money on this plan, "just in case", but I can't wrap my head around paying someone for something I don't expect to ever use and will probably cost me more than any drugs I may ever take.​

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Comments?​

 

[REWahoo]

Comments?

We all make thousands of decisions in life, some good some bad. No way at this point to know how your decision to save a few $ each year will work out.

 

[pacergal]

I believe there is a penalty for not signing up for Part d.
However, I am not on Medicare yet, so I am still investigating.

 

[Midpack]

I believe there is a penalty for not signing up for Part d.
However, I am not on Medicare yet, so I am still investigating.

There is a penalty if you choose to delay signing up for Part D after your initial enrollment period. And that penalty is added to your monthly premium for the rest of your life. As it should be IMO.

https://www.medicare.gov/drug-cover...-drug-coverage/part-d-late-enrollment-penalty

I don’t take any Rx’s so I have an inexpensive Part D with WellCare that started when I began Medicare at 65. But it’s a personal decision we all have to base on our own circumstances.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019 and $32.74 in 2020) 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.

 

[travelover]

........Comments?

Paragraphs are still free.

 

[harllee]

ElizRogers, I would never do what you are doing. I take no prescriptions so I signed up for the least expensive Part D plan available to me, Walmart Human at $13.50 per month. My husband has psoriatic arthritis and takes Humira. It is hugely expensive (thousands per month). We would have a hard time affording the Humira without the Part D insurance. DH still has to pay quite a bit with the Part D but what he pays is only a fraction of the total cost of Humira.

OP everyone makes financial choices and you certainly have the right to make your choice but you asked for comments and my answer is that I would never go without the Part D insurance. For me $13.50 per month is a small amount to pay for peace of mind.

 

[Katsmeow]

Not the choice I made even though when I went on Medicare this year I took exactly once prescription which is a very cheap generic. I took a plan that is $28 a month. Why?

1. Well, there a penalty if you sign up later and you pay that penalty for the rest of your life.

2. Stuff changes. When my mom went on Medicare she didn't take a lot of prescriptions. By the time she died at 94 she was taking a ton of medications because by then she had a lot of very serious health problems that she didn't have when she was younger. I know someone who usually blows through the donut hole early in the year as he takes an expensive medication that is totally necessary. It is for a health problem that he didn't have in his 60s.

I remember when Part D came out and my mother was so thankful because by then medications were really starting to be expensive for her.

I get that sometimes people may choose not to take a particular medication but some medications are very necessary and really expensive. I would not want to be in a situation where I either couldn't afford my medication or I would have to, say, sell my house to pay for it.

Right now I get a cheap Part D plan since I don't take expensive meds routinely. If that changes then the next year I would consider switching to a plan that was better for the meds I was taking.

 

[Bamaman]

Insurance is spreading out the risks amongst millions of people.

My wife has a heavy medication regiment, and the doctors recently put her on a $1,200 per month medicine. Our share was $265 monthly. Thankfully they've put her on an old generation medicine 3 months later and filling in with another cheaper substance.

We're not willing to take the risk. I'm type II diabetic, but my expensive medications are covered on Part B of Medicare 80%.

 

[Elizrogers]

These are good things to consider in making a decision. It's nice to know that some if you are actually being covered by Part D. Thank goodness you have something they like and will cover. I think contributing early even if you aren't taking drugs, so you will have it when/if you need it later makes sense. My concern is that it appears they do not have to cover most drugs, and since no plan covers any drug I have ever taken, I feel like they won't cover anything I may need in the future. As I mentioned, the only two maintenance drugs I've needed, and may again, are not listed on any Part D plan at any tier. So, does anyone know of a plan that pays a percentage of drugs whatever it is, and not just the ones specifically pick to be on their formularies?

 

[REWahoo]

My concern is that it appears they do not have to cover most drugs, and since no plan covers any drug I have ever taken, I feel like they won't cover anything I may need in the future.

I see some seriously flawed reasoning here.

 

[Another Reader]

These are good things to consider in making a decision. It's nice to know that some if you are actually being covered by Part D. Thank goodness you have something they like and will cover. I think contributing early even if you aren't taking drugs, so you will have it when/if you need it later makes sense. My concern is that it appears they do not have to cover most drugs, and since no plan covers any drug I have ever taken, I feel like they won't cover anything I may need in the future. As I mentioned, the only two maintenance drugs I've needed, and may again, are not listed on any Part D plan at any tier. So, does anyone know of a plan that pays a percentage of drugs whatever it is, and not just the ones specifically pick to be on their formularies?

You should call someone like Boomer Benefits and give them a list of drugs you have taken. They can help you find a plan that covers a broad spectrum of drugs, including the ones you have taken. If the drugs are not covered by any drug plan, they will explain why they are not covered.

 

[Elizrogers]

I did check with Health Markets and CareNCare, as well as at Medicare to see what they could find based on two very common drugs that I've used and may again. Zolpidem and Omeprazole. These are generics and very common. There was a range of options. The cheapest ones overall were $34/mo premiums, $435/ann deductible and $4,700 for my portion of cost of drugs annually. I can get one of those for $72 every 2 months the other is $54.13 every 3 months. So, it seems I will do better without insurance, using a prescription discount card. It makes me sad to think that someday there might be a drug I would need that would be less expensive with one of these plans, but it seems from what I can find that you will pay 10 times the actual cost with one on most drugs, and I could not afford my portion anyway. I am trying to live on social security. I wonder how many people have tried to find online, discount cards or other means to get their drugs to compare to what they are paying through their Part D plans. I think if that ever happens and a Part D plan will save me anything, I will still be willing to pay the approx. $50/mo premium for starting so late, which is about what it will be if I wait 10 years. I cannot believe that if I can get these drugs so much cheaper, that insurance companies cannot do better than 10 times that. It sounds like a real racket to me.


Thank you all for sharing your experiences. Insurance is always a gambling game, but there is a very good chance, based on family history and my current health, that I will never have diabetes, high blood pressure, cardiac or pulmonary disease and the Advil is more than sufficient in controlling the arthritis pain. Of course, being retired, I can usually just relax in my recliner on particularly painful days and take nothing. One of the benefits of not "having" to go anywhere or be physically active. Knowing what others are taking expensive drugs for, gives me an idea of what types of things a Rx plan might be beneficial for and what really it will not.

 

[travelover]

I did check with Health Markets and CareNCare, as well as at Medicare to see what they could find based on two very common drugs that I've used and may again. Zolpidem and Omeprazole. .........

Omeprezole is available as an over the counter drug - no prescription needed.

 

[Elizrogers]

Thank you, Travelover. I am aware of the over the counter, but the Rx Zegerid is 40mg Omeprazole and 1100mg Sodium Bicarbonate. Over the counter is only 20mg Omeprazole. I can buy two or three different drugs and mix them to get the right combination, but it's so much easier to just take one pill twice a day. But the Rx can still be gotten for hundreds of dollars less a month with just a Good Rx card, than with the insurance. If you go to the trouble to get it over-the-counter even less need for a Rx plan.

 

[bja1234]

How much is the monthly penalty today? Exactly how is the penalty calculated? Thank you

 

[REWahoo]

How much is the monthly penalty today? Exactly how is the penalty calculated? Thank you

From Medicare.gov:

How much is the Part D penalty?

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019 and $32.74 in 2020) 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.

You can Google up a calculator to assist in figuring out your specific number.

 

[fh2000]

From Medicare.gov:



You can Google up a calculator to assist in figuring out your specific number.

I am learning all these rules since I won't turn 64 and 9 months (time to sign up medicare) until next October.

I understand that the penalty is 1% increase for life for every month you are not in any Plan D. So OP is 68 now, and missed 3 years = 36 months. That is 36% increase if she is to sign up for any plan today.

Taking harllee's example above, he/she is not taking any prescriptions so chose a cheapest plan for $13.5 a month. I consider this just like taking a cheap liability insurance for your vehicle.

If OP has access to such a plan, she will have to pay 36% higher premium, therefore, $18.36 to get in the door for life. Of course, this plan might not cover her current prescriptions, but at least she gets in the door.

Is my math correct above?

 

[bja1234]

Thanks for the calculator. So...if I was born in March 1930 and never had coverage until today the penalty today is $54.10 per month. $649.20 per year doesn't seem so monumental. Sure YMMV, but in the scheme of potential drug cost, maybe coverage until you need it is not that big a deal.....

 

[Midpack]

Thanks for the calculator. So...if I was born in March 1930 and never had coverage until today the penalty today is $54.10 per month. $649.20 per year doesn't seem so monumental. Sure YMMV, but in the scheme of potential drug cost, maybe coverage until you need it is not that big a deal.....

Just a cocktail napkin illustration w/o inflation etc., your breakeven on Part D premiums with the penalty comes up pretty fast (about 6 years) by delaying even with the less than "monumental" penalty. This all assumes you can go to age 89 without needing any prescriptions and you die on schedule. And if you're unlucky and when some affliction hits along with expensive prescriptions, you could take a big $ hit in that one year before you begin Part D. But as you say, you might come out ahead by waiting, I just don't see much advantage.

It's the same argument with all insurance, you could come out ahead by waiting until you have an accident, illness, earthquake or fire, OR you could wish you'd just been in the (risk) pool all along...

 

[Bestwifeever]

.... The one I take occasionally, with my Good RX discount card costs $11 for 90 pills. Under Rx plan it runs anywhere from $159-$256 depending on the plan. That is ridiculous....

You can still use GoodRx regardless of insurance. My Part D is $13.20 a month (I chose the cheapest plan as I take no ongoing prescriptions). A recent prescription for a non-chronic problem was $120 under my insurance. The pharmacist suggested I use GoodRx, which came in at $45, so of course I did, no problem. So GoodRx vs Part D is not an either/or situation.

I can always change to a different Part D every year at no penalty if I am prescribed meds that are not covered under my current plan—if you decide to enroll in Part D at a late date, you will face a cumulative permanent penalty for the years you did not pay for Part D.

Whatever works.

 

[travelover]

You can still use GoodRx regardless of insurance. .........

I seem to recall some pharmacies not accepting GoodRx if you have prescription insurance. Anyone recall that?

 

[audreyh1]

You can still use GoodRx regardless of insurance. My Part D is $13.20 a month (I chose the cheapest plan as I take no ongoing prescriptions). A recent prescription for a non-chronic problem was $120 under my insurance. The pharmacist suggested I use GoodRx, which came in at $45, so of course I did, no problem. So GoodRx vs Part D is not an either/or situation.

I can always change to a different Part D every year at no penalty if I am prescribed meds that are not covered under my current plan—if you decide to enroll in Part D at a late date, you will face a cumulative permanent penalty for the years you did not pay for Part D.

Whatever works.

Thanks - I was wondering about that. For DH we expect to use the cheapest Part D as he has no ongoing prescriptions. Mostly the occasional antibiotic or cream or eyedrops, and these tend to be quite cheap. Seemed like in the past the pharmacy was cooperative about us paying through insurance or directly. In one case a pharmacy even found him a GoodRx coupon!

 

[badatmath]

Yeah well I hope to never use my liability insurance either but I still have some!

 

[MBSC]

From Medicare.gov:

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019 and $32.74 in 2020) 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.

Taking harllee's example above, he/she is not taking any prescriptions so chose a cheapest plan for $13.5 a month. I consider this just like taking a cheap liability insurance for your vehicle.

If OP has access to such a plan, she will have to pay 36% higher premium, therefore, $18.36 to get in the door for life. Of course, this plan might not cover her current prescriptions, but at least she gets in the door.

Is my math correct above?

$18.36 is $13.50+36%. The penalty is not applied to the policy you select. The penalty is 36% of $32.74 (the national base premium for 2020) rounded to $11.80. $11.80+$13.50=$25.30 for 2020. The penalty percentage remains constant once enrolled in Part D but the national base premium fluctuates each year so the person's penalty fluctuates.

That is 36% increase if she is to sign up for any plan today.

Therein lies the problem. Part D open enrollment for 2020 has closed. If a person is told tomorrow they need an expensive Part D covered drug, they would need to pay out-of-pocket or seek help from a non-profit agency for 12.5 months until 1/1/21 extending the penalty.

 

[nwsteve]

I seem to recall some pharmacies not accepting GoodRx if you have prescription insurance. Anyone recall that?

Happened to us. Our Costco told us since we had insurance on file we could not use a GoodRX coupon. I IIRC supposedly some Medicare "rule" per pharmacist