Part D Medicare

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littlebird
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Part D Medicare

Post by littlebird »

A friend, recently widowed, whose spouse always handled the insurance, has Part D Medicare from AARP. She is an insulin dependent diabetic and has several other conditions that require medication. She is paying copays of many hundreds of dollars per prescription for many of these medications, with her insurance.

I am unable to help her, since my situation is so different ( extremely inexpensive former-employer-provided insurance) and I paid little attention to it when Part D was instituted and ever since. Is this truly how much it costs? Is there something ( not too onerous, as she is truly debilitated by her illnesses) that she should be doing? It doesn’t seem right to me.
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HueyLD
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Re: Part D Medicare

Post by HueyLD »

If she does not know how to research the formularies online, she may want to enlist the help of an insurance broker.
Ron
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Re: Part D Medicare

Post by Ron »

When Medicare Open Enrollment opens - (Starts October 15, 2020 - Ends December 7, 2020), she should look for a Part D plan that will cover most/all of her prescription needs, using the link https://www.medicare.gov/plan-compare/# ... &year=2020 . Note: change the link to the new 2021 link when it's available early October.

I've been on Medicare Part D for 8+ years and I've changed my plan 4-5 times over that period, due to formulary changes along with Part D premium costs.

It's an exercise you need to do each year assuming unlike you, she's responsible for selection/payments for the Part D (and even Part B) program.

- Ron
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GerryL
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Re: Part D Medicare

Post by GerryL »

Advise your friend to seek help from her state SHIP program (see https://www.medicare.gov/contacts). The volunteers there can offer objective advice to navigate her choices. And, from what I understand, they will help run the Part D search for her when open enrollment opens if she is not comfortable doing that for herself. (You can actually play with it any time, but the 2021 plans are probably not available yet.)

She will need to have the names and dosages of all of her medications handy.
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cheese_breath
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Re: Part D Medicare

Post by cheese_breath »

If she is "paying copays of many hundreds of dollars per prescription for many of these medications" she's most likely (1) enrolled in the wrong plan, (2) insisting on the brand name when a generic in available, (3) using a non-participating pharmacy, or (4) some combination of the other three. She's stuck with her current plan for the rest of the year, but the solution may be as simple as finding out the answers to these questions. DW uses eleven different prescriptions on her Part D plan including diabetes insulin, and Eliquis is the only one with copay over $100.

2021 Part D open enrollment starts in mid October, so she will be able to change her plan for 2021 then. And she might be able to get her insulin for $35 copay in 2021.

https://www.cms.gov/newsroom/press-rele ... es-seniors
The surest way to know the future is when it becomes the past.
Big Dog
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Re: Part D Medicare

Post by Big Dog »

besides running the prescriptions thru the Medicare site as suggested above, another option is to consider purchasing her insulin from a Canadian pharmacy. There are several BH threads on that topic which you can find with the Search box.

Also check GoodRx and Costco.
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dodecahedron
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Re: Part D Medicare

Post by dodecahedron »

HueyLD wrote: Mon Sep 14, 2020 5:13 pm If she does not know how to research the formularies online, she may want to enlist the help of an insurance broker.
Highly recommend this strategy. I consider myself fortunate to have an extremely astute and ethical insurance broker who stays up to date on all the ins and out of the various Part D and Medigap plans as well as a free state plan (EPIC) in my state that can kick in if costs become very high. (It does not cost me anything extra to use his services. By law his compensation comes from the insurance carriers.)
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GerryL
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Re: Part D Medicare

Post by GerryL »

cheese_breath wrote: Mon Sep 14, 2020 6:07 pm If she is "paying copays of many hundreds of dollars per prescription for many of these medications" she's most likely (1) enrolled in the wrong plan, (2) insisting on the brand name when a generic in available, (3) using a non-participating pharmacy, or (4) some combination of the other three. She's stuck with her current plan for the rest of the year, but the solution may be as simple as finding out the answers to these questions. DW uses eleven different prescriptions on her Part D plan including diabetes insulin, and Eliquis is the only one with copay over $100.

2021 Part D open enrollment starts in mid October, so she will be able to change her plan for 2021 then. And she might be able to get her insulin for $35 copay in 2021.

https://www.cms.gov/newsroom/press-rele ... es-seniors
Yes. What often happens also is that someone picks a Part D plan and never goes back during open enrollment each year to determine whether a different plan is now a better option. And sometimes, perhaps for convenience, couples pick the same plan for both individuals even though their needs are very different.
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cheese_breath
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Re: Part D Medicare

Post by cheese_breath »

Ron wrote: Mon Sep 14, 2020 5:48 pm When Medicare Open Enrollment opens - (Starts October 15, 2020 - Ends December 7, 2020), she should look for a Part D plan that will cover most/all of her prescription needs, using the link https://www.medicare.gov/plan-compare/# ... &year=2020 ....
She could use it as a test right now. Input her current medications, process for different pharmacies, and compare the results to her current plan. And OP can help if she's not computer literate.
The surest way to know the future is when it becomes the past.
kaneohe
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Re: Part D Medicare

Post by kaneohe »

Big Dog wrote: Mon Sep 14, 2020 6:08 pm ...............................................

Also check GoodRx ........................
I have a low end pt D plan but it has been ok for my needs in the past. This wk I needed to get a new drug which is not covered by my plan. Medicare.gov said $375 for a month. I got it for $144 at Wagreens.

Later I ran across an Optum AARP site that suggested about $80 and then GoodRx for about $57. I have never used GoodRx and you need to print out a coupon for GoodRx but will be exploring those soon. You get a member card for Optum and can get the same from GoodRx but supposedly using the online coupons for GoodRx is cheaper than using the member card.

For the longer term as others have mentioned,it is worth using the medicare.gov online tool to see if whether paying a bit more for monthly membership will make the plan coverage better for your specific Rx.
neilpilot
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Re: Part D Medicare

Post by neilpilot »

GerryL wrote: Mon Sep 14, 2020 6:49 pm

Yes. What often happens also is that someone picks a Part D plan and never goes back during open enrollment each year to determine whether a different plan is now a better option. And sometimes, perhaps for convenience, couples pick the same plan for both individuals even though their needs are very different.
I know several couples who have the same Part D plan for years and never once compared other plans using a list of their maintenance prescriptions. Even the first year of enrollment.

They've simply responded to AARP advertising on the media, or picked an insurer they know & like or the one that they use for Part B.
cashmoney
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Re: Part D Medicare

Post by cashmoney »

littlebird wrote: Mon Sep 14, 2020 4:41 pm A friend, recently widowed, whose spouse always handled the insurance, has Part D Medicare from AARP. She is an insulin dependent diabetic and has several other conditions that require medication. She is paying copays of many hundreds of dollars per prescription for many of these medications, with her insurance.

I am unable to help her, since my situation is so different ( extremely inexpensive former-employer-provided insurance) and I paid little attention to it when Part D was instituted and ever since. Is this truly how much it costs? Is there something ( not too onerous, as she is truly debilitated by her illnesses) that she should be doing? It doesn’t seem right to me.


She is probably in the Gap Coverage where she is paying 25% of the cost.Some insulin pens and other drugs prescribed to type 2 diabetics can cost up to 1000.00.Good news for next year is that many MAPD plans and some Part D plans will participate in the Part D Senior Savings Model that will cover most insulins at 35 copay through all phases of part D . https://innovation.cms.gov/innovation-m ... ings-model

Until then she should she if the doctor can give her samples ( if they prescribe it they usually have samples),prescribe lower cost alternatives or hook her up with a patient assistance program.Some insulins are now OTC at Wal Mart and there is always Goodrx

disclaimer I am a licensed agent.
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littlebird
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Re: Part D Medicare

Post by littlebird »

Thank you everyone who responded. Given my friend’s condition, I think a specialty insurance agent would be the best idea. I consulted my very plugged-in neighbor and got a referral for my friend. Thanks again. I didn’t even know there were such agents. :beer
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celia
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Re: Part D Medicare

Post by celia »

She needs to be sure her drug plan insurance is being billed. Knowing the "rules" also helps: https://www.medicareinteractive.org/get ... d-coverage

After she has paid $6,350 out-of-pocket during the year, she will be out of the "donut hole" and remaining meds will usually be 5% of the "contracted cost (contract between the drug plan and the drug manufacturers).

She can call the drug plan (the number is on her drug card) to ask them questions. She should also be getting Explanation of Benefits in the mail which tells which phase she is currently in. If she isn't getting them, her insurance isn't being billed!
vested1
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Re: Part D Medicare

Post by vested1 »

cheese_breath wrote: Mon Sep 14, 2020 6:07 pm If she is "paying copays of many hundreds of dollars per prescription for many of these medications" she's most likely (1) enrolled in the wrong plan, (2) insisting on the brand name when a generic in available, (3) using a non-participating pharmacy, or (4) some combination of the other three. She's stuck with her current plan for the rest of the year, but the solution may be as simple as finding out the answers to these questions. DW uses eleven different prescriptions on her Part D plan including diabetes insulin, and Eliquis is the only one with copay over $100.

2021 Part D open enrollment starts in mid October, so she will be able to change her plan for 2021 then. And she might be able to get her insulin for $35 copay in 2021.

https://www.cms.gov/newsroom/press-rele ... es-seniors
This may be true of insulin, but none of your reasons apply to us. There is no generic after 21 years on the market for the drug my wife takes for her arthritis, which keeps her out of a wheelchair. The manufacturer ensured that no generic is available by going to court repeatedly, and by paying a fortune for lobbying. The cost of the drug went up 9.5% in 2020.

We are out of the donut hole by the end of February every year since she went on Medicare, with around 2k copay in January and over $900 copay in February, with a copay of $297 every month from March to December, just for this drug. Her other prescription copays are about $87 every 3 months, so her prescription copays alone are $6,248 a year on top of all the other copays and premiums.

Combined premiums for our Medicare plans are $530 a month. Non-prescription copays so far this year are over $1,000, and we're pretty healthy. We have zero premium Medicare Advantage available where we live but the co-pays are much higher for prescriptions and specialists, plus the requirement to go through underwriting if you ever want to transfer to a non Medicare Advantage plan, so we avoid Medicare Advantage plans as the premium for Part B doesn't go away, even with the Advantage plans.

I always do the research to find the Plan D provider and the medigap provider who offers the lowest cost and best coverage for each category, which I'll have to do again in a month, just like every other Medicare subscriber should do. The best advice is as you and others have said; do your due diligence every year and don't assume you are on the best Medicare plan available for your circumstances.
cashmoney
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Re: Part D Medicare

Post by cashmoney »

celia wrote: Mon Sep 14, 2020 11:05 pm She needs to be sure her drug plan insurance is being billed. Knowing the "rules" also helps: https://www.medicareinteractive.org/get ... d-coverage

After she has paid $6,350 out-of-pocket during the year, she will be out of the "donut hole" and remaining meds will usually be 5% of the "contracted cost (contract between the drug plan and the drug manufacturers).

She can call the drug plan (the number is on her drug card) to ask them questions. She should also be getting Explanation of Benefits in the mail which tells which phase she is currently in. If she isn't getting them, her insurance isn't being billed!

The Troop is $ 6,350 but because while in the coverage gap the drug manufacturers and pdp carrier are subsidizing almost 75% typically the OOP cost to the pdp subscriber is about $3,000.00 before they get to catastrophic 5% stage

Best way to monitor utilization of your part d is to register account online and track in real time or call pdp carrier for an up to date total.
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