Wellcare Pt D jump from 16.70 to $54

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montanagirl
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Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.

Seems to me this happened last year too with Walmart Humana, a jump to $54 that I saw on the SSA notice. So I switched to Wellcare. IIRC I could have gone to a cheaper Walmart Humana plan but it required actually opting out or you're stuck. I can't find the thread here from last year.

Did this happen to anyone else? Is this some kind of marketing game they play? It may have been buried in the piles of paper the Part D plans send out,

Or Is SSA making some mistake here?
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Munir
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Munir »

My Wellcare Wellness Part D monthly premium only went up a couple of dollars for 2021.
kaneohe
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Re: Wellcare Pt D jump from 16.70 to $54

Post by kaneohe »

montanagirl wrote: Wed Oct 14, 2020 9:43 am .........................

Seems to me this happened last year too with Walmart Humana, a jump to $54 that I saw on the SSA notice. So I switched to Wellcare. IIRC I could have gone to a cheaper Walmart Humana plan but it required actually opting out or you're stuck. I can't find the thread here from last year.

...........................................
what did you mean by "required actually opting out?" Last yr I switched from the Walmart Humana to a cheaper Humana because of the price jump. Thinking of switching to a cheap Wellcare this yr.
diy60
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Re: Wellcare Pt D jump from 16.70 to $54

Post by diy60 »

montanagirl wrote: Wed Oct 14, 2020 9:43 am I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.

Seems to me this happened last year too with Walmart Humana, a jump to $54 that I saw on the SSA notice. So I switched to Wellcare. IIRC I could have gone to a cheaper Walmart Humana plan but it required actually opting out or you're stuck. I can't find the thread here from last year.

Did this happen to anyone else? Is this some kind of marketing game they play? It may have been buried in the piles of paper the Part D plans send out,

Or Is SSA making some mistake here?
You can change Part D annually during open enrollment. I suspect it is common to do so. Spouse's Wellcare went from $15 to $16 for next year, it is a small dollar change but still represents over 7% increase. Pay attention to any abnormal increase in premiums and change to another plan as needed. Good luck.
jj
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Re: Wellcare Pt D jump from 16.70 to $54

Post by jj »

Welcare Pt D went from $14.70 to $15.30 here
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neilpilot
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Re: Wellcare Pt D jump from 16.70 to $54

Post by neilpilot »

jj wrote: Wed Oct 14, 2020 11:17 am Welcare Pt D went from $14.70 to $15.30 here
I have no idea what you're plan is, since there's more than one flavor of "Welcare Pt D". Not to mention state/local differences. This is what our plans in TN have announced:
  • My WellCare Medicare Rx Select (Part D) plan will increase from $19.40 to $23.90.

    My DW's WellCare Wellness Rx (Part D) plan will increase from $14.20 to $15.70.
mhalley
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Re: Wellcare Pt D jump from 16.70 to $54

Post by mhalley »

What is most likely happening is they are trying to upsell you. I got the notice that my part d coverage was going up a similar amount last month. (Envision, now Elixer) $14.60 to $35 I believe. Yesterday I received a letter stating that the insurance was going up but that if I wished I could go with the other plan they offered and it would be $15.60 per month, but I had to change plans, either by sending in the letter or enrolling at Medicare.gov They are hoping that a lot of people won’t bother with the hassle of changing the plan.
I am going to change my plan just because I think this is underhanded.
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montanagirl
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Re: Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

mhalley wrote: Wed Oct 14, 2020 4:02 pm What is most likely happening is they are trying to upsell you. I got the notice that my part d coverage was going up a similar amount last month. (Envision, now Elixer) $14.60 to $35 I believe. Yesterday I received a letter stating that the insurance was going up but that if I wished I could go with the other plan they offered and it would be $15.60 per month, but I had to change plans, either by sending in the letter or enrolling at Medicare.gov They are hoping that a lot of people won’t bother with the hassle of changing the plan.
I am going to change my plan just because I think this is underhanded.
Upsell via Medicare?? That does seem to be what they're doing, and Walmart Humana did the same thing in 2019.

EDIT: So I got the Wellcare notice PDF that it's going up to 15.70 and filed an appeal at SSA. Which is what I did last time. Exactly.

Maybe not necessary, I don't know. I don't get why it showed the number they tried to fob off on me in 2019. :confused
Last edited by montanagirl on Wed Oct 14, 2020 4:28 pm, edited 3 times in total.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by jebmke »

mhalley wrote: Wed Oct 14, 2020 4:02 pm What is most likely happening is they are trying to upsell you. I got the notice that my part d coverage was going up a similar amount last month. (Envision, now Elixer) $14.60 to $35 I believe. Yesterday I received a letter stating that the insurance was going up but that if I wished I could go with the other plan they offered and it would be $15.60 per month, but I had to change plans, either by sending in the letter or enrolling at Medicare.gov They are hoping that a lot of people won’t bother with the hassle of changing the plan.
I am going to change my plan just because I think this is underhanded.
Same thing happened to me last year. I always buy the cheapest I can find since I don’t use it.
When you discover that you are riding a dead horse, the best strategy is to dismount.
mhalley
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Re: Wellcare Pt D jump from 16.70 to $54

Post by mhalley »

Medicare is not doing the upselling, it is Wellcare. Medicare just reports what Wellcare tells them.
Good Listener
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Good Listener »

I have Value Script from Wellcare. My premium in NJ is going from 15.70 to 16.30 per month. Ad they added Costco as a preferred pharmacy, which I can walk to.

Question: I haven't started social Security yet. If you have your part D deducted from your SS payment, then I didn't realize it's a big deal to change plans and that it continues from the same company and plan automatically. Now have to reauthorize payments every year.. Maybe it's best to just pay y credit card like I do now?
Big Dog
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Big Dog »

jj wrote: Wed Oct 14, 2020 11:17 am Welcare Pt D went from $14.70 to $15.30 here
Mine was $13.70 to $15.30. Regardless, Aetna is now cheaper, so I'll switch.

Everyone should get in the habit of participating in Open Enrollment every fall. Plans come and go. Formularies change. Copays change. Network pharmacies change.

Put your meds into the medicare link and find an appropriate plan for next year.

https://www.medicare.gov/plan-compare/# ... 21&lang=en
Lalamimi
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Lalamimi »

Pt D is not taken from SS, only Medicare A/B.
kaneohe
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Re: Wellcare Pt D jump from 16.70 to $54

Post by kaneohe »

Lalamimi wrote: Wed Oct 14, 2020 8:21 pm Pt D is not taken from SS, only Medicare A/B.
apparently you can request that Pt D be taken from SS
https://www.medicare.gov/Pubs/pdf/11400 ... remium.pdf

"If you ask to have your Medicare drug plan’s premium
withheld from your Social Security payment (called “premium withhold”), there
are some important things to know about how it works in different situations."
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Re: Wellcare Pt D jump from 16.70 to $54

Post by neilpilot »

Good Listener wrote: Wed Oct 14, 2020 7:51 pm
Question: I haven't started social Security yet. If you have your part D deducted from your SS payment, then I didn't realize it's a big deal to change plans and that it continues from the same company and plan automatically. Now have to reauthorize payments every year.. Maybe it's best to just pay y credit card like I do now?
If you have Plan D premiums deducted from your SS and change plans, the deduction moves to the new plan’s underwriter seamlessly, so long as you select SS deductions when you select the plan using the online Medicare site.
rivercrosser
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Re: Wellcare Pt D jump from 16.70 to $54

Post by rivercrosser »

My Wellcare premium went down slightly for 2021 but they changed my Brilinta from a tier 3 to a tier 4. I may be able to get an exemption because I've been on it since May. If not I might switch to a Clearspring plan. You have to do your homework or have a good broker that does it for you.
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celia
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Re: Wellcare Pt D jump from 16.70 to $54

Post by celia »

OP, Maybe your preferred pharmacy changed. By continuing to use the same one as in the past, possibly you are increasing your costs by not using the "new" preferred pharmacy. Check out your best option on Medicare.gov, as others suggest.
LifeIsGood
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Re: Wellcare Pt D jump from 16.70 to $54

Post by LifeIsGood »

MyWellCare Value Script (PDP) plan went from $16.20 to $17.00/month.
Seasonal
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Seasonal »

kaneohe wrote: Wed Oct 14, 2020 10:52 am
montanagirl wrote: Wed Oct 14, 2020 9:43 am .........................

Seems to me this happened last year too with Walmart Humana, a jump to $54 that I saw on the SSA notice. So I switched to Wellcare. IIRC I could have gone to a cheaper Walmart Humana plan but it required actually opting out or you're stuck. I can't find the thread here from last year.

...........................................
what did you mean by "required actually opting out?" Last yr I switched from the Walmart Humana to a cheaper Humana because of the price jump. Thinking of switching to a cheap Wellcare this yr.
As I recall, last year Humana jumped in price, but also introduced a new plan that was approximately identical to the older cheaper plan. All you had to do was switch to the new plan.
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Watty
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Watty »

Even if your price does not change much you should be sure to also use the Medicare website to enter your prescriptions to see what those will be next year under your plan. Sometime the formulary will change and the price you pay for one of your prescriptions will go up in price so it may make sense to change plans.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by scifilover »

This year I am with Mutual of Omaha. This was their first year offering Plan D and I guess it wasn't good for them because they discontinued my plan. They do offer an alternative plan, but the total cost is more than double.

Just went through MyMedicare.gov to see what 2021 has in store. Lots of other plans are available at a cost similar to what my costs are for 2020. However, every single plan has quantity limits on one or more drugs forcing monthly trips to the pharmacy rather than quarterly. I'm not sure I see the rationale for these limits. In most cases the limits are on tier 1 or 2 generic drugs. When delivered to the consumer, they arrive in prepackaged 30 pill bottles, so the pharmacy really has no more work for 3 bottles rather than one.

MyMedicare.gov is very valuable since it remembers what drugs you had last year, and allows you to easily change or add new drugs.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by cheese_breath »

I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
The surest way to know the future is when it becomes the past.
Bcdkgf
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Bcdkgf »

Munir wrote: Wed Oct 14, 2020 10:18 am My Wellcare Wellness Part D monthly premium only went up a couple of dollars for 2021.
Mine did too, however, some of my maintenance drugs went to tier 2. So Wellcare is not the best option for 2021.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Magruder »

Both the Medicare website and my employer's HRA (Health Reimbursement Account) offers Aetna's Silverscript Smart RX plan at $7.10 per month and zero co-pays for DW and my six Tier 1 and 2 drugs via mailorder for an total annual cost of $85.20 each!

The Aetna Silversript website shows a $57 co-pay for the two Tier 2 drugs, altho their formulary lists those two drugs as being Tier 1! Who and what to believe?

Guess I'll just stay with Envision come Elixir, but switch to the same old plan with the new name.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by vested1 »

Too bad we have to go through this every year. My Wellcare Wellness (PDP) increased $2.90, no big deal, but it appears that they cancelled their contract with CVS, which is no longer a preferred provider. They have zero deductibles for tier 1 and tier 2 but are still charging me a deductible on my only tier 2 drug. It hasn't been worth the effort for the $11 copay every 3 months, mainly because they messed up the rest of my orders and payments multiple times this year, which lead me to issue a Medicare complaint, and I don't want to even call them at this point. This was partially CVS's fault as they mess up every order.

I'll have to verify if Wellcare provides 90 day mail order with my local grocery store pharmacy or with Walmart if I stay with Wellcare. Wellcare, CVS, and Aetna were all mixed up in a contentious merger in 2019/2020 which was a headache if the customer had any problems. They were all pointing the finger at each other when I called.

I'm thinking of switching to Aetna Silver Script because the premium is less than half of the new rate at Wellcare, but Aetna only has no deductibles for tier 1, and they use CVS. Two strikes, one to go.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Seasonal »

vested1 wrote: Thu Oct 15, 2020 11:01 am Too bad we have to go through this every year. My Wellcare Wellness (PDP) increased $2.90, no big deal, but it appears that they cancelled their contract with CVS, which is no longer a preferred provider. They have zero deductibles for tier 1 and tier 2 but are still charging me a deductible on my only tier 2 drug. It hasn't been worth the effort for the $11 copay every 3 months, mainly because they messed up the rest of my orders and payments multiple times this year, which lead me to issue a Medicare complaint, and I don't want to even call them at this point. This was partially CVS's fault as they mess up every order.
They are still listing CVS, at least for the NY mail order pharmacy for 2021: https://wellcare.com/en/New-York/Member ... e-Pharmacy
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montanagirl
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Re: Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

cheese_breath wrote: Thu Oct 15, 2020 9:43 am I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
I went to the wellcare web site today and there is no cost increase message and chat help said there is no info for 2021 yet fwiw
Big Dog
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Big Dog »

vested1 wrote: Thu Oct 15, 2020 11:01 am Too bad we have to go through this every year.
I was thinking just the opposite; IMO annual Open Enrollment for Part D is a positive. It's guaranteed issue.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by cheese_breath »

montanagirl wrote: Thu Oct 15, 2020 11:17 am
cheese_breath wrote: Thu Oct 15, 2020 9:43 am I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
I went to the wellcare web site today and there is no cost increase message and chat help said there is no info for 2021 yet fwiw
Wellcare sent me a package about three weeks ago describing the changes from my current coverage.
The surest way to know the future is when it becomes the past.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Bcdkgf »

cheese_breath wrote: Thu Oct 15, 2020 11:46 am
montanagirl wrote: Thu Oct 15, 2020 11:17 am
cheese_breath wrote: Thu Oct 15, 2020 9:43 am I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
I went to the wellcare web site today and there is no cost increase message and chat help said there is no info for 2021 yet fwiw
Wellcare sent me a package about three weeks ago describing the changes from my current coverage.
We received that same pamphlet. Instead of saying what the exact changes were, it just said that there changes in tiers, formulary, and preferred retail pharmacies . The pamphlet said to go to their website to see what changes there will be for 2021. We had to wade thru the Wellcare muddy website to find the changes. MyMedicare.gov was a lot easier to use to find out that information.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by cheese_breath »

Bcdkgf wrote: Thu Oct 15, 2020 11:58 am
cheese_breath wrote: Thu Oct 15, 2020 11:46 am
montanagirl wrote: Thu Oct 15, 2020 11:17 am
cheese_breath wrote: Thu Oct 15, 2020 9:43 am I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
I went to the wellcare web site today and there is no cost increase message and chat help said there is no info for 2021 yet fwiw
Wellcare sent me a package about three weeks ago describing the changes from my current coverage.
We received that same pamphlet. Instead of saying what the exact changes were, it just said that there changes in tiers, formulary, and preferred retail pharmacies . The pamphlet said to go to their website to see what changes there will be for 2021. We had to wade thru the Wellcare muddy website to find the changes. MyMedicare.gov was a lot easier to use to find out that information.
Just be careful with Medicare.gov right not. From my looking for plans for myself and DW, it appears a lot of the information is incomplete. But that's not unusual this early in the process.
The surest way to know the future is when it becomes the past.
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montanagirl
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Re: Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

cheese_breath wrote: Thu Oct 15, 2020 12:48 pm
Bcdkgf wrote: Thu Oct 15, 2020 11:58 am
cheese_breath wrote: Thu Oct 15, 2020 11:46 am
montanagirl wrote: Thu Oct 15, 2020 11:17 am
cheese_breath wrote: Thu Oct 15, 2020 9:43 am I don't understand all the commotion. Prices change every year. My Wellcare went up to $54 too. I'll just change to a different plan in 2021.
I went to the wellcare web site today and there is no cost increase message and chat help said there is no info for 2021 yet fwiw
Wellcare sent me a package about three weeks ago describing the changes from my current coverage.
We received that same pamphlet. Instead of saying what the exact changes were, it just said that there changes in tiers, formulary, and preferred retail pharmacies . The pamphlet said to go to their website to see what changes there will be for 2021. We had to wade thru the Wellcare muddy website to find the changes. MyMedicare.gov was a lot easier to use to find out that information.
Just be careful with Medicare.gov right not. From my looking for plans for myself and DW, it appears a lot of the information is incomplete. But that's not unusual this early in the process.
Yes Medicare is all wet. I called wellcare and the premium is going down a dollar.

The cola statement from Medicare is kinda useless. I was hoping it was right about part B not changing but no. 😐
vested1
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Re: Wellcare Pt D jump from 16.70 to $54

Post by vested1 »

Seasonal wrote: Thu Oct 15, 2020 11:12 am
vested1 wrote: Thu Oct 15, 2020 11:01 am Too bad we have to go through this every year. My Wellcare Wellness (PDP) increased $2.90, no big deal, but it appears that they cancelled their contract with CVS, which is no longer a preferred provider. They have zero deductibles for tier 1 and tier 2 but are still charging me a deductible on my only tier 2 drug. It hasn't been worth the effort for the $11 copay every 3 months, mainly because they messed up the rest of my orders and payments multiple times this year, which lead me to issue a Medicare complaint, and I don't want to even call them at this point. This was partially CVS's fault as they mess up every order.
They are still listing CVS, at least for the NY mail order pharmacy for 2021: https://wellcare.com/en/New-York/Member ... e-Pharmacy
I live in SC, so the preferred pharmacies may be different than NY. The costs are pretty steep for not using a preferred pharmacy.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by nisiprius »

mhalley wrote: Wed Oct 14, 2020 4:02 pm What is most likely happening is they are trying to upsell you. I got the notice that my part d coverage was going up a similar amount last month. (Envision, now Elixer) $14.60 to $35 I believe. Yesterday I received a letter stating that the insurance was going up but that if I wished I could go with the other plan they offered and it would be $15.60 per month, but I had to change plans, either by sending in the letter or enrolling at Medicare.gov They are hoping that a lot of people won’t bother with the hassle of changing the plan.
I am going to change my plan just because I think this is underhanded.
1) Me, too.

2) In my case, it's worse than that. It's not just a premium and deductible increase, it's also a steep and undisclosed increase in the price I would have to pay before meeting the deductible.

In my case, they sent me material disclosing that if I did nothing, I would be transitioned from Envision RxPlus to "Elixir RxSecure at a higher premium and deductible," but if I filed paperwork I could continue in "Elixir RxPlus." The premium for RxPlus would be about $14/month, about the same as last year. If I did nothing I would be automatically enrolled in RxSecure at about $35/month.

Here's what was not disclosed. During the initial period (until the $445 deductible was met), the out-of-pocket cost for 90-day supplies of two "preferred generic" prescription at my local pharmacy--which is in their "preferred" network--was going to be

$48.40 under the the RxSecure plan they would default me into
$6.00 under the RxPlus plan I'm in and need to file paperwork to stay in.

I gave 'em fifteen minutes listening to music on hold to find out if there was some mistake in the information on the medicare.gov website before shrugging, hanging up, and enrolling in a plan with estimated total annual costs of $86.40, compared to $606.48 for Elixir RxSecure (default) or $195.60 for Elixir RxPlus.

Yes, even at $606.48 I would be grateful that I need to pay so little. But, jeez, sneaking me into a $606 plan when the plan I am already on would only be $195 is... infuriating.

Idiots. They could so easily have kept me as a customer, all they had to do was not tick me off.

P.S. Just to be clear... because this is a puzzling detail... I went through something similar a couple of years ago, and they kept explaining to me patiently that "you need to pay the full price until you have paid your deductible," and I kept explaining patiently to them "but your 'full price' is $40 a month and your competitor's 'full price' is $4/month, at the same pharmacy which is a preferred pharmacy in both networks."
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Lalamimi »

Thanks for the heads up. I see we can switch back to a SilverScript for $7.30 each. (had a plan with them for $24 in 2019) WellCare Wellness going up to $17.80, so a very good savings. We each take a Tier 1 drug which are $0. Gladly use GoodRX if something is prescribed that is higher. Used it twice this year.
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Re: Wellcare Pt D jump from 16.70 to $54

Post by kaneohe »

scifilover wrote: Thu Oct 15, 2020 9:41 am .........................................................

Just went through MyMedicare.gov to see what 2021 has in store. Lots of other plans are available at a cost similar to what my costs are for 2020. However, every single plan has quantity limits on one or more drugs forcing monthly trips to the pharmacy rather than quarterly. I'm not sure I see the rationale for these limits. In most cases the limits are on tier 1 or 2 generic drugs. When delivered to the consumer, they arrive in prepackaged 30 pill bottles, so the pharmacy really has no more work for 3 bottles rather than one.

MyMedicare.gov is very valuable since it remembers what drugs you had last year, and allows you to easily change or add new drugs.
How does the quantity limit show up when using medicare.gov? I've never seen a limit show up?
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Re: Wellcare Pt D jump from 16.70 to $54

Post by nisiprius »

Lalamimi wrote: Thu Oct 15, 2020 2:31 pm Thanks for the heads up. I see we can switch back to a SilverScript for $7.30 each. (had a plan with them for $24 in 2019) WellCare Wellness going up to $17.80, so a very good savings. We each take a Tier 1 drug which are $0. Gladly use GoodRX if something is prescribed that is higher. Used it twice this year.
I didn't try to make a very detailed analysis. One thing I noticed about the Silverscript plan is that the "preferred generic" drugs cost $0/month in the "initial coverage phase," but "generic" drugs cost $19. Some of the other plans have a higher premium, and maybe cost $1/month for "preferred generics," but only $6/month for "generics."

At the moment all my drugs are "preferred generics" and Silverscript is the cheapest plan. But if at some point this year I need a "generic" prescription, it is possible that it might cost more than than the next three or four plans. However, the savings of around $90 on the premium would pay for some of that difference. But the insurance plans have the statistical information and I don't, so I'm just going to do the obvious thing and choose the cheapest based on the drugs I am taking now.

The big thing, really, is the catastrophic coverage. I could easily pay for the drugs I take now without any insurance. But if, heaven forbid, I end up needing some $5,000/month drug, it's fairly important to me to only need to pay 5% of that!
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.
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Munir
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Munir »

Nisiprius, are you referring to Humana or Wellcare? I am not familiar with the names you mentioned of the various programs in the plan you were criticizing.
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montanagirl
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Re: Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

Munir wrote: Thu Oct 15, 2020 4:01 pm Nisiprius, are you referring to Humana or Wellcare? I am not familiar with the names you mentioned of the various programs in the plan you were criticizing.
I think it's aetna. Very low cost!

Found it at Medicare.gov
scifilover
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Re: Wellcare Pt D jump from 16.70 to $54

Post by scifilover »

kaneohe wrote: Thu Oct 15, 2020 3:29 pm
scifilover wrote: Thu Oct 15, 2020 9:41 am .........................................................

Just went through MyMedicare.gov to see what 2021 has in store. Lots of other plans are available at a cost similar to what my costs are for 2020. However, every single plan has quantity limits on one or more drugs forcing monthly trips to the pharmacy rather than quarterly. I'm not sure I see the rationale for these limits. In most cases the limits are on tier 1 or 2 generic drugs. When delivered to the consumer, they arrive in prepackaged 30 pill bottles, so the pharmacy really has no more work for 3 bottles rather than one.

MyMedicare.gov is very valuable since it remembers what drugs you had last year, and allows you to easily change or add new drugs.
How does the quantity limit show up when using medicare.gov? I've never seen a limit show up?
Once you have added all your drugs and have a response that shows you the drug plans for you in your state, within the area for each quote, there is a little line that says "View drugs and their costs." This takes you to another page which shows you the actual costs on the plan you are considering for each drug. At the bottom of this page there is an area showing "Other Drug Information" This includes plan requirements such as Prior Authorization, step therapy, and quantity limits. It is important that when you entered your drugs you chose the actual number of pills you typically get.
kaneohe
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Re: Wellcare Pt D jump from 16.70 to $54

Post by kaneohe »

scifilover wrote: Fri Oct 16, 2020 7:06 am
kaneohe wrote: Thu Oct 15, 2020 3:29 pm
scifilover wrote: Thu Oct 15, 2020 9:41 am .........................................................

Just went through MyMedicare.gov to see what 2021 has in store. Lots of other plans are available at a cost similar to what my costs are for 2020. However, every single plan has quantity limits on one or more drugs forcing monthly trips to the pharmacy rather than quarterly. I'm not sure I see the rationale for these limits. In most cases the limits are on tier 1 or 2 generic drugs. When delivered to the consumer, they arrive in prepackaged 30 pill bottles, so the pharmacy really has no more work for 3 bottles rather than one.

MyMedicare.gov is very valuable since it remembers what drugs you had last year, and allows you to easily change or add new drugs.
How does the quantity limit show up when using medicare.gov? I've never seen a limit show up?
Once you have added all your drugs and have a response that shows you the drug plans for you in your state, within the area for each quote, there is a little line that says "View drugs and their costs." This takes you to another page which shows you the actual costs on the plan you are considering for each drug. At the bottom of this page there is an area showing "Other Drug Information" This includes plan requirements such as Prior Authorization, step therapy, and quantity limits. It is important that when you entered your drugs you chose the actual number of pills you typically get.
Found it! Thanks.
robertalpert
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Re: Wellcare Pt D jump from 16.70 to $54

Post by robertalpert »

montanagirl wrote: Wed Oct 14, 2020 9:43 am I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.
I'm not finding any of Wellcare premiums being close to $54. Could that $54 be the annual cost of prescription medication copays under the plan?

I currently have Silverscript Choice plan and have been well satisfied. But am considering a move to Wellcare-wellness plan for 2021. I would save a few bucks if my meds remain in the tier-2 level. But at Wellcare, my meds are listed at tier-1 and would represent a couple hundred dollar annual savings. I'm somewhat skeptical about whether their formulary may change and meds migrating to tier-2 level during the next year.

A cautionary note about Aetna Silverscript new Smart plan with premium of about $7 /month. This plan charges the full deductible for Tier-2 and beyond.
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montanagirl
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Re: Wellcare Pt D jump from 16.70 to $54

Post by montanagirl »

robertalpert wrote: Fri Oct 16, 2020 11:29 am
montanagirl wrote: Wed Oct 14, 2020 9:43 am I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.
No it appears to be system error at mySSA.gov. That was the price humana walmart was going to go up to if I'd not changed it a year ago. The number stayed stuck at SSA even though they correctly deducted 16.70 all this year.

So go figure.
Magruder
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Magruder »

robertalpert wrote: Fri Oct 16, 2020 11:29 am
montanagirl wrote: Wed Oct 14, 2020 9:43 am I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.
I'm not finding any of Wellcare premiums being close to $54. Could that $54 be the annual cost of prescription medication copays under the plan?

I currently have Silverscript Choice plan and have been well satisfied. But am considering a move to Wellcare-wellness plan for 2021. I would save a few bucks if my meds remain in the tier-2 level. But at Wellcare, my meds are listed at tier-1 and would represent a couple hundred dollar annual savings. I'm somewhat skeptical about whether their formulary may change and meds migrating to tier-2 level during the next year.

A cautionary note about Aetna Silverscript new Smart plan with premium of about $7 /month. This plan charges the full deductible for Tier-2 and beyond.
Going to Aetna Silverscript's website and entering all of our drugs, I find that drugs labeled Tier 2 at other companies, are actually Tier 1 in the Silverscript Smart RX plan. Before assuming you will pay the full deductible with this plan, enter your drugs and have a look-see.
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plannerman
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Re: Wellcare Pt D jump from 16.70 to $54

Post by plannerman »

When I ran my drugs through the Medicare Part D calculator, one of my drugs in the lowest total price plan was still $100 for a 90 day supply. I have been buying this same drug (same brand, same dosage, same quantity) for $26 using Good RX coupons. As long as this pricing lasts I'm not using my Part D insurance. Anybody else find a similar situation?

plannerman
Last edited by plannerman on Sat Oct 17, 2020 3:52 pm, edited 1 time in total.
Bcdkgf
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Bcdkgf »

plannerman wrote: Fri Oct 16, 2020 8:56 pm When I ran my drugs through the Medicare Part D calculator, one of my drugs in the lowest total price plan was still $100 for a 90 day supply. I have been buying this same drug (same brand, same dosage, same quantity) for $26 using Good RX coupons. As long as this pricing lasts I'm not using my Part B insurance. Anybody else find a similar situation?

plannerman
We also use GoodRx and the Kroger Rx Savings. It is remarkable the difference in prices. Our Kroger RX Saving plan accommodates 5 other family members. We shop accordingly.
SpideyIndexer
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Re: Wellcare Pt D jump from 16.70 to $54

Post by SpideyIndexer »

Has anyone gone from Wellcare to Elixir? Currently in Wellcare Wellness Rx Select (which bought out the Aetna plan I had years ago.) Yes, I have read the complaints about Elixir early in this thread.

If I go to the cheaper Wellness Rx, I save $110 per year if I switch from Costco to CVS or $135 if I switch to mail order.

If I go to Elixir RxPlus I save $135 at Costco or $207 mail order. This is the cheapest plan for me in terms of total annual out of pocket (assuming nothing changes.)

I have a somewhat irrational fear of going with the lowest bidder. However it seems both Elixir and Wellcare are doing rebranding and merging so probably their business practices are similar. I had been paying about $20 per month for the Aetna plan which Wellcare bought out and the Wellcare Wellness Rx Select to which they transferred me will be $28 next year. Wellcare has two cheaper plans so I feel they have been up-migrated me to some extent. But as I said, likely all of the part D providers do they sort of thing. I don't expect them to act as my fiduciary. fiduciary.

Wellcare's mail order pharmacy is CVS Caremark; I don't know who is Elixir's but will find out. The other points to compare is proximity to network pharmacies if I need an Rx in a hurry. Costco (preferred) is pretty close though not sure if I want to deal its parking lot when feeling sick.
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Munir
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Re: Wellcare Pt D jump from 16.70 to $54

Post by Munir »

robertalpert wrote: Fri Oct 16, 2020 11:29 am
montanagirl wrote: Wed Oct 14, 2020 9:43 am I got my 2021 Social Security benefit notice yesterday, and saw where Wellcare Part D was going from 16.70 to over $54.
I'm not finding any of Wellcare premiums being close to $54. Could that $54 be the annual cost of prescription medication copays under the plan?

I currently have Silverscript Choice plan and have been well satisfied. But am considering a move to Wellcare-wellness plan for 2021. I would save a few bucks if my meds remain in the tier-2 level. But at Wellcare, my meds are listed at tier-1 and would represent a couple hundred dollar annual savings. I'm somewhat skeptical about whether their formulary may change and meds migrating to tier-2 level during the next year.

A cautionary note about Aetna Silverscript new Smart plan with premium of about $7 /month. This plan charges the full deductible for Tier-2 and beyond.
Are you sure Silverscript Smart Rx (2021) charges the full deductible for Tier 2 generics?
SpideyIndexer
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Re: Wellcare Pt D jump from 16.70 to $54

Post by SpideyIndexer »

I don't even understand what is meant by "charges the full deductible."

Are you saying that under the Aetna plan you pay full street price, not plan negotiated prices, until the deductible is met? I don't see this when comparing total costs in the government Healthcare.gov website. (It can be strangely difficult to navigate to this from Medicare.gov.) Similar low prices I found in another marketplace website.

What I have found that the drug deductible stage "shared costs" are indeed higher in this plan, but identical for all Tier 2 drugs. As I recall about $19 per month in my area. So it is not optimal for those with many prescriptions in higher Tiers. But one should always compare total cost of drugs + premiums when shopping plans.

Side note, can one even find out the street price of a drug from a pharmacy?

Edit: It seems that the plan in question does NOT cover Tier 2 (generics which are not preferred) until the deductible is met. The majority of the web based tools state this so it is likely true. Applying the deductible to Tier 2 is unusual for 2021 PDPs.

When shopping plans a important piece of the puzzle is the "retail" (no coverage) price of your drugs. That is what you'll pay in the deductible stage, assuming a deductible able in that drug class, and it is the price used to determine how long you stay in the Initial Coverage and Donut Hole stages. Q1Medicare.com has formularies for many plans in one convenient place; otherwise you may have to bounce between providers' websites to get this information. I'm not sure that many of the total cost calculators get these prices correct.
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