Yep…you sure do! You will be billed for anything that your SS doesn’t cover. If your SS covers your Medicare costs including the IRMMA, you won’t get an additional bill.
BUT if SS is not enough, you will get a bill to pay.
And since neither you or your husband is on SS yet…you will get a bill for the total you owe including your IRMMA.
If your 3 months include January, you’ll have a slightly bigger charge on one future bill - this is because the monthly premium will increase in the new year & they will make the adjustment later.
We were billed on DH’s Medicare A/B until he started SS. Since he was ‘backdated’ for coverage (we got official card with A/B in Dec effective the prior Sept 1) we got a statement and a quarterly bill, and then he started drawing SS. They refunded overpayment.
My Medicare A/B started the same time I started SS so I had no separate billing, as they took out the monthly premiums out of SS before my SS payment.
When H started getting spousal SS, they took Medicare B premiums out of his SS. I called to complain that they had also been taking Medicare B premiums from his pension for over a decade! They repaid the payments to his pension and then kept withdrawing from his spousal SS.
I got an email from my broker this week that the changes for next year’s policies will be mailed to me by Sept 30 and I should compare them to current one to see if I can live with them. Last year I did switch because the changes to the Aetna policy would have cost me several thousand dollars more than switching to United Health Care.
Can’t wait to see the price increases for this year.
I’m the person in our marriage who is the planner and does not think that everything will be fine without any planning.
My husband turned 65 in September. Now it’s one month later, the plans for 2026 have come out. He has a plan G with a plan D prescription drug plan
My husband has a tier 5 drug that he takes, Humira. Last year, a plan was picked that included his drug. This year no plan in our area has it as part of his formulary
I figure that he will have to go to a generic which is fine. But what generic, what dosage and what plan will cover what he needs?
It’s so complicated. I know people will tell us to ask his doctor. The doctor isn’t helpful. My husband went last week and since he doesn’t really get all of this and thinks that it will magically work out, the doctor said pick the generic they will cover.
This is such new territory. For so many years, we had good employer based insurance that we took for granted. Things have changed. For Medicare and for employer based insurance also. Last year with an ACA plan, it was difficult to get the drug approved. I suspect it doesn’t work as well and it was still ridiculously expensive.
Would your pharmacist be able to help?
Could ask the pharmacist, the drug must be filled by an online pharmacy. Maybe our local pharmacist can help
I put in a bunch of different medications and dosage and think I found an acceptable alternative.
My husband can call the doctor and we can ask the pharmacist. We also have a call set up with the insurance broker
Of course it’s a different plan than the one he’s currently using.
These are the most similar options to Humira because they are designed to be highly similar to the original biologic drug,adalimumab.
You’ll need to look at the formulary for the drug plan to see if any of these are covered.
I believe CVS is using Hyrimoz.
Thank you so much! That is extremely helpful!
For Medicare part D it seems that you have to enter the correct medicine in the correct dosage and the correct form. Meaning syringe or pen.
He’s on simlandi now but that generic isn’t listed. It’s more complicated than our plans in the past which just substitute the generic.
Again, this was so helpful!
Glad to be of service!
I also just went on Medicare this month. Picked a drug plan that is Aetna which is basically CVS. It was logical pick as it is where I fill my prescriptions and the one med I take was cheapest on this plan. I get the new pricing for January and the premium is double. I’m going to reach out to the agent.
@deb922 my sister takes an immune suppressant drug and had a similar case. Her Dr filed an appeal and she was able to stay on the same drug for another year. He also gave her plenty of samples. Her supplemental and drug plan are through her retirement benefits.
Open Enrollment starts tomorrow. (Oct 15), so you can bypass any agent and easily search for drug plans offered in your zip code.
Note, however, that I have read that some of the early rates/plans may contain errors, so check back a weeks later to see if they have been updated.
Check amazon pharmacy, Costco pharmacy and goodRX prices too. It may be cheaper to go with a plan with a lower (or zero) monthy premium and then pay for a drug on one of those sites
That’s a great suggestion. I’m only on one monthly medication at this time.
We found that Mark Cuban cost plus drugs is a great resource for finding prescriptions at a good price
My husband has a drug (not the Humira) that isn’t on any formulary but is very reasonable on Mark’s website. Less so than the good rx or Costco. I’ve checked all the pricing.
His tier 5 drug is another animal all together. He could ask for an exception, just getting the drug on the formulary isn’t easy so I’d rather go with an option I know is covered.
Luckily, switching Part D plans is seamless, so that’s one less worry.
H has a medical issue right now that is short-term. He was prescribed a muscle relaxer that is not on his Part D formulary. Luckily, Costco’s price is really low. His niacin is on the Part D formulary, but it’s expensive. Again, Costco to the rescue, at less than $12/month. It’s a lot to think about, and I’ll have to train our D in a couple decades so she can help us when we’re old & confused.
I moved one of my meds to the Amazon pharmacy just to see how it would be. Cvs initially said they didn’t get the request so I managed to do a three-way phone call. Got the pharmacist to talk to each other and got the medicine within a day. I don’t think I could switch to Costco pharmacy because if I went to Costco, I’d end up spending an extra $100 on stuff I didn’t need! 
I’ve been on Medicare for several years, grandfathered into the supplemental plan F (HealthNet) so never changing that. My 2025 Plan D company was bought out earlier this year; changed from Cigna HealthCare to HealthSpring. Nothing cost wise changed for 2025 but they sent me a pamphlet of changes for 2026 - $0 premium but instead of fixed copay, they are going to charge percents.
So today being the first day of open enrollment, I went into my Medicare account and looked up 2026 drug plans to see what they were going to charge me. It turns out that my one non-generic expensive medication (Synjardy) isn’t covered by HealthSpring - they want to charge me $9000/year. Yikes.
I am going back to Wellcare Value Script (PDP) - I’ll be bumping up against the $2100 maximum annual drug cost but whew everything is covered. And I finally decided to let them deduct it from SSA benefits instead of paying a bill.
FYI we’re in California.
Are the traditional medicare plans not under the $2000 max OOP? I thought they were.
This year I had United (a medicare advantage plan) and they had some strange accounting method so even though my drugs were tier 3 (and even one tier 4 that I didn’t know was a tier 4) and I paid about $800 OOP. Next year it is a $2100 OOP max but United is changing the accounting and I believe it will be more than the $800 so I told my doctor to find some different drugs. For one, she did. For the other, there is a manufacturer’s program I’m applying for to make them free to me. We’ll see.
The tier 4 drug I was accidentally put on was no cost to me as I’d already met my OOP max so I think tier 4 and 5 are included.
If you use programs like Good RX, those do not count toward the $2000 OOP max, so in the long run those discount cards may not save you money if you are going to hit the OOP max. $2000 is still a lot, but definitely cheaper than $9000.
Oh, and I was on the monthly payment plan that medicare started this year. It was pretty easy to set up and after the first month (and 783 calls to United health and medicare to find out why the first month cost so much), I just pay $65 per month. At the pharmacy, any pharmacy, I pay nothing. If the meds are $500/mo, it is worth setting up the payment plan program.