Medicare Plan D [Tale of Woe]

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lucky3
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Medicare Plan D [Tale of Woe]

Post by lucky3 »

This is my first year under original Medicare with an AARP Plan F Supplement, Part D will Silver Script. All was going well unti Iwnet to refill a 90 day supply of medicine which last time cost me $60...this time $241.....yes, I entered the dounut hole....over the $2800 allowance before the year ended. Anyway to avoid this dounut hole by getting another plan? I have the option to switching. I'm ok with the Medicare and AARP Plan F but the PartD will drive me nuts since I take several maintenance drugs. Any options?

Lucky3
technovelist
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Re: Medicare Plan D Tail Of Whoa!

Post by technovelist »

Have you checked prices at Costco or another relatively inexpensive pharmacy?
In theory, theory and practice are identical. In practice, they often differ.
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cheese_breath
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Re: Medicare Plan D Tail Of Whoa!

Post by cheese_breath »

My wife also goes into the donut hole about this time every year. Her last two refills were donut hole refills. Basically, we just plan for it and tough it out. Although I do try to get her more expensive meds refilled on the first day the refill is allowed and spread out the cheaper ones in the hope that maybe we will be able to sneak one more expensive on in while she is still one the stage 1 copay. Sometimes it works, sometimes it doesn't
The surest way to know the future is when it becomes the past.
dolphinsaremammals
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Re: Medicare Plan D Tail Of Whoa!

Post by dolphinsaremammals »

I hit the donut hole and then catastrophic coverage every year. The donut hole $ is somewhat mitigated by paying almost nothing for most prescriptions I have once I'm in catastrophic coverage.

When I'm in catastrophic coverage, I refill as often as possible. I have not sat down and calculated out if doing this saves money, since it may be offset by taking longer to go into catastrophic coverage the following year.

I believe the donut hole is supposed to shrink every year and finally disappear. Yes, I just lifted this off the AARP website: "Because of the Affordable Health Care Act of 2010, the doughnut hole will gradually narrow until it disappears in 2020." What that means is that the initial coverage charges apply in what used to be the donut hole, I think. Somewhat unclear. Then one goes into catastrophic coverage.
dolphinsaremammals
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Re: Medicare Plan D Tail Of Whoa!

Post by dolphinsaremammals »

cheese_breath wrote: Although I do try to get her more expensive meds refilled on the first day the refill is allowed and spread out the cheaper ones in the hope that maybe we will be able to sneak one more expensive on in while she is still one the stage 1 copay. Sometimes it works, sometimes it doesn't
I am not sure this works. My head is not wrapped around it. I do know they don't treat refills as quantum events. When a prescription is refilled at the edge on the donut hole, you pay a smeared out amount.
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cheese_breath
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Re: Medicare Plan D Tail Of Whoa!

Post by cheese_breath »

dolphinsaremammals wrote:
cheese_breath wrote: Although I do try to get her more expensive meds refilled on the first day the refill is allowed and spread out the cheaper ones in the hope that maybe we will be able to sneak one more expensive on in while she is still one the stage 1 copay. Sometimes it works, sometimes it doesn't
I am not sure this works. My head is not wrapped around it. I do know they don't treat refills as quantum events. When a prescription is refilled at the edge on the donut hole, you pay a smeared out amount.
You misunderstand. I mean fill them as soon as the next one is allowed throughout the year, every year. It probably won't help the first year, but it might enable you to get an extra refill before the donut hole the second or third year. That's why I said sometimes it works, sometimes it doesn't. Probably works better with 30 day refills than 90 day refills.
The surest way to know the future is when it becomes the past.
Ron
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Re: Medicare Plan D Tail Of Whoa!

Post by Ron »

dolphinsaremammals wrote:I hit the doughnut hole and then catastrophic coverage every year. The doughnut hole $ is somewhat mitigated by paying almost nothing for most prescriptions I have once I'm in catastrophic coverage.
Same situation here.

OTOH, my wife hardly uses any drugs and if she does, she gets them at Wally-world for a few $$$.

I can't really complain. My retirement health plan (not a plan, but they give you $X a year and you buy your own) still covers our policies and deductible/co-pays along with Part D expenses. OTOH, it's not adjusted for inflation (hasn't been for many years) so somewhere down the line (assuming we live that long) we'll have more out of pocket expenses.

- Ron
S&L1940
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Re: Medicare Plan D Tail Of Whoa!

Post by S&L1940 »

technovelist wrote:Have you checked prices at Costco or another relatively inexpensive pharmacy?
Much comment here about Costco being reasonable and possibly less costly than your Part D provider at full price
When I came close to the doughnut hole I found that my local pharmacy (yes they still exist) would be less expensive for an asthma med than using my Part D insurer.
Don't it always seem to go * That you don't know what you've got * Till it's gone
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midareff
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Re: Medicare Plan D Tail Of Whoa!

Post by midareff »

I'm in the donut on my last fills. I was able to avoid it last year but not this one. My internist just advised using 2 OTC Nexium instead of one 40 mg script. About $100 for 90 days vs. $300. That should help next year.
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dm200
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Re: Medicare Plan D Tail Of Whoa!

Post by dm200 »

I am on a Medicare Cost plan (much like Medicare Advantage) with the drug benefit. So, I am also faced with a potential "donut hole" issue/risk. Until the middle of last year, I had been taking only a few, lower cost prescriptions. Then, I was prescribed an expensive medication that I can refill every 90 days. My cost is about $84, but the "actual" cost is about $700 - so that can put me close to donut hole this year - depending on what other prescriptions I get. For this medication, the 90 day supply is actually 180 pills - 2 pills per day. The nature of this medication (as prescribed by my physicians) is such that it can be skipped on a particular day. Also, some days, again perfectly in accordance with my prescribing physicians) I can take just 1 pill. There are actually some medical reasons (I will not go into that discussion) for taking less at times, so I am actually using the 180 pills over about 4 months. I have, so far, refilled every 90 days. That is 3 times in 2014 so far. I can actually wait until after January 1, 2015 to refill the prescription - BUT (since the refill date is in 2014) I plan to see if I will stay under the donut hole by refilling in 2014. That would then give me some slack in 2015 - if I am hit with an unexpected high prescription.
penumbra
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Re: Medicare Plan D Tail Of Whoa!

Post by penumbra »

This is one of those areas where there is no one-fits-all answer. I have had SilverScript this year as well. The main thing is to be lucky enough to have problems for which generic drugs are the answer. Many providers tend to use brand names when simpler generics are just fine, but it's hard for a lay person to know that. I'd suggest going over your med list with your physician with these issues in mind. Some generics even are more expensive thru your plan that you can get thru Costco without insurance. I've confirmed that several times. Another factor is getting prescriptions for larger doses, and cutting pills in half. This works with most, but not all, meds. For my particular meds, I've found SilverScript not to be worth having at all for next year; note that their co pays are going up appreciably for 2015. If you have to pay a large IRMAA, the value of the plan is not there. For these issues, as for most others, you have to be your own advocate and really check things out.
dolphinsaremammals
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Re: Medicare Plan D Tail Of Whoa!

Post by dolphinsaremammals »

1530jesup wrote: When I came close to the doughnut hole I found that my local pharmacy (yes they still exist) would be less expensive for an asthma med than using my Part D insurer.
I get my prescriptions filled at RiteAid. They automatically check for the cheapest way to fill each time. Usually it's plan D, but sometimes they send me into the aisles to get an OTC product, and sometimes they use a couple of oddball little plans I would never have known about.

There have been news articles about the prices of generics going up substantially (surprise!) :twisted: I pay something like $300 for one.
mur44
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Re: Medicare Plan D Tail Of Whoa!

Post by mur44 »

The only way to choose an OPTIMAL Part D plan is to use Drug Plan Finder
at MEDICARE.GOV and enter all the drugs you are taking. The
Plan Finder will list all the plans that are available to you
in the order of lowest total annual cost to highest.
The top three plans can be compared after making sure that
all your medications are covered without any significant
restrictions.

This method ensures that you have the LOWEST ANNUAL COST
for the prescription plan.

You may visit your local SHIP (State Health Insurance assistance
Program) counselor for free and unbiased counseling:

https://shipnpr.shiptalk.org/findcounselor.aspx


Disclosure: I am a Certified Volunteer Medicare Counselor
Lafder
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Re: Medicare Plan D [Tale of Woe]

Post by Lafder »

http://www.goodrx.com is a pretty accurate site to check for the best med pricing. In general Costco and Sam's Club are lowest but not always.

lafder
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fandango
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Re: Medicare Plan D [Tale of Woe]

Post by fandango »

I have found the drug plan finder to be inaccurate.

Always call the drug provider and double check with a "live" customer service rep.

Express Scripts costs on the Medicare web site was off by over $2000.
scifilover
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Re: Medicare Plan D [Tale of Woe]

Post by scifilover »

FYI, if you are a regular user of Walgreen's Pharmacy, and wait a bit till more providers have their plans and prices out, Walgreen's can tell you which plan available in your area has the lowest total cost for you given the medications you take.

Also, this year was Wellcare's first year in the Plan D market. They came in with a very low price, and as I expected it only lasted for one year. I too will have to move our Plan D coverage to a different carrier.
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dm200
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Re: Medicare Plan D [Tale of Woe]

Post by dm200 »

Very related "donut hole" Medicare question -

I know that the amount actually paid by the Medicare recipient varies greatly depending on the exact plan the recipient is enrolled in. My question is about the "full price/cost" that is used by Medicare to determine entry into and exit from the "donut hole". Is that dollar amount the same or different for the exact same drug, dosage and number of days?
MikeRes
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Re: Medicare Plan D [Tale of Woe]

Post by MikeRes »

dm200 wrote:Very related "donut hole" Medicare question -

I know that the amount actually paid by the Medicare recipient varies greatly depending on the exact plan the recipient is enrolled in. My question is about the "full price/cost" that is used by Medicare to determine entry into and exit from the "donut hole". Is that dollar amount the same or different for the exact same drug, dosage and number of days?
This is one of the most annoying and unfair aspects of Plan-D.
Medicare does not determine nor assign the "full price/cost" of a medication.
The "full price/cost" of a medication (my plan refers to it as the Retail Price) is assigned by the Plan-D insurance provider.

Each provider can have their own price.
When I say "assigned by the provider" I mean that these numbers are made up and do not necessarily bear any resemblance to reality, nor to the insurers real cost of the medication.
These inflated/imaginary "retail prices" are however used to calculate when you have reached the donut hole at which point your out of pocket price increases considerably.

You can get a better idea of what you estimated monthly expenses will be for Plan-A, Plan-B and Plan-D by using the Medicare Plan Finder web site:
https://www.medicare.gov/find-a-plan/qu ... eSupport=1
This website will give you your expected monthly cost by pharmacy and will show you when you can expect to reach the donut hole.
It will then show you what your expected monthly costs will be, by month, until you exit the donut hole.

The Medicare.gov web site can be very valuable in helping you choose your medicare plans,
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Munir
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Re: Medicare Plan D Tail Of Whoa!

Post by Munir »

mur44 wrote:The only way to choose an OPTIMAL Part D plan is to use Drug Plan Finder
at MEDICARE.GOV and enter all the drugs you are taking. The
Plan Finder will list all the plans that are available to you
in the order of lowest total annual cost to highest.
The top three plans can be compared after making sure that
all your medications are covered without any significant
restrictions.

This method ensures that you have the LOWEST ANNUAL COST
for the prescription plan.

You may visit your local SHIP (State Health Insurance assistance
Program) counselor for free and unbiased counseling:

https://shipnpr.shiptalk.org/findcounselor.aspx


Disclosure: I am a Certified Volunteer Medicare Counselor
+1.

PS: A recent thread deals with similar issues:

http://www.bogleheads.org/forum/viewtop ... 2&t=147237
dolphinsaremammals
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Re: Medicare Plan D [Tale of Woe]

Post by dolphinsaremammals »

MikeRes wrote: This is one of the most annoying and unfair aspects of Plan-D.
Medicare does not determine nor assign the "full price/cost" of a medication.
The "full price/cost" of a medication (my plan refers to it as the Retail Price) is assigned by the Plan-D insurance provider.

Each provider can have their own price.
When I say "assigned by the provider" I mean that these numbers are made up and do not necessarily bear any resemblance to reality, nor to the insurers real cost of the medication.
These inflated/imaginary "retail prices" are however used to calculate when you have reached the donut hole at which point your out of pocket price increases considerably.
Is this actually correct? I assumed each insurance company negotiated a price with the manufacturer, and that's why the prices differ. I agree that Medicare itself seems to have no input on the prices.
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dm200
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Re: Medicare Plan D [Tale of Woe]

Post by dm200 »

MikeRes wrote:
dm200 wrote:Very related "donut hole" Medicare question -

I know that the amount actually paid by the Medicare recipient varies greatly depending on the exact plan the recipient is enrolled in. My question is about the "full price/cost" that is used by Medicare to determine entry into and exit from the "donut hole". Is that dollar amount the same or different for the exact same drug, dosage and number of days?
This is one of the most annoying and unfair aspects of Plan-D.
Medicare does not determine nor assign the "full price/cost" of a medication.
The "full price/cost" of a medication (my plan refers to it as the Retail Price) is assigned by the Plan-D insurance provider.

Each provider can have their own price.
When I say "assigned by the provider" I mean that these numbers are made up and do not necessarily bear any resemblance to reality, nor to the insurers real cost of the medication.
These inflated/imaginary "retail prices" are however used to calculate when you have reached the donut hole at which point your out of pocket price increases considerably.

You can get a better idea of what you estimated monthly expenses will be for Plan-A, Plan-B and Plan-D by using the Medicare Plan Finder web site:
https://www.medicare.gov/find-a-plan/qu ... eSupport=1
This website will give you your expected monthly cost by pharmacy and will show you when you can expect to reach the donut hole.
It will then show you what your expected monthly costs will be, by month, until you exit the donut hole.

The Medicare.gov web site can be very valuable in helping you choose your medicare plans,
Thanks. Add this to the "bizarre and confusing" aspects of Medicare Part D!
MikeRes
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Re: Medicare Plan D Tail Of Whoa!

Post by MikeRes »

mur44 wrote:The only way to choose an OPTIMAL Part D plan is to use Drug Plan Finder
at MEDICARE.GOV and enter all the drugs you are taking. The
Plan Finder will list all the plans that are available to you
in the order of lowest total annual cost to highest.
The top three plans can be compared after making sure that
all your medications are covered without any significant
restrictions.

This method ensures that you have the LOWEST ANNUAL COST
for the prescription plan.

Disclosure: I am a Certified Volunteer Medicare Counselor
A minor corrective note.
The Medicare Plan Finder (https://www.medicare.gov/find-a-plan/qu ... /home.aspx) will give you "the LOWEST ANNUAL COST for the prescription plan" ONLY at the time you visit the website.
The insurance providers are free to change their price and their formulary AT ANY TIME, and there is nothing you can do about it!

What it boils down to is that the Medicare Plan Finder is your best bet at getting the best estimate at what your total annual cost might be - just don't count on it to match reality.
Despite the imperfections just mentioned, the Medicare Plan Finder is an excellent, if not the best tool for helping you choose a Medicare plan.

When you are signing up for Plan-D you are NOT entering into a contract with your selected insurance provider.
You are merely promising to pay your selected insurance provider a fixed premium per month for the next 12 months even if they unilaterally change the drugs they cover and the price you pay for them.
The only way to change this is to write your congress critter.
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