Where I live (Illinois) according to our agent, there was only one supplement that would allow me to switch without underwriting and that was Blue Cross. So that’s who I am going with as I now have a pre existing condition (who doesn’t at this age?). The supplement came to $170 (around there) a month so after having Obamacare years ago, quite affordable.
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Staying in the Blue Cross Blue Shield (Plan-G) - age category when enrolled. In 2021 for us, at age 65 it was $176/mo; age 66-69 it was $194/mo; age 70 and above $215/month. We are now age 68 and for 2025 we will be paying $207/month - we each got a letter. Last year we each paid $199/month. In Alabama, being in this plan also means that $30/month goes towards a gym that you choose, and we have this membership through a hospital wellness that has good facilities near us.
Welp! My husband lost his job in Oct, and I lost my job in Febuary. But 2023 was a very good year for us, and shows on our taxes. So now Medicare wants the penalty supplement from us. We are going to appeal due to loss of income, but wondering if anyone has heard of anyone else doing this process. We cannot afford the extra 200/month they want from us.
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Go to the Bogleheads forums - I have seen several discussions about this, with some people being successful in situations like yours.
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And don’t forget that IRMAA is based off your tax records 2 years in the past. So, you will have at least 2 years of the adjustment.
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@sdl0625 I did this when both my husband and I stopped working due to his cancer and then death. Complete the following form and make an in person appointment at your local Social Security office. I was approved on the spot and was surprised how easy it was.
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Yes, absolutely appeal. H did that when he retired a few years back and our income went from highest ever (he had a golden parachute) to next to nothing. It took some diligence, but he didn’t have to pay IRMAA.
Now that we’re living off investments, we need to keep an eye on capital gains to keep below the IRMAA fee threshold.
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My husband’s former employer, the one that offered retiree healthcare has decided to spin us off that. They are giving us a stipend to purchase healthcare on the exchange. Healthcare that will cost us plenty and not cover hardly anything.
The good news is that husband will transition to Medicare in September. I have another year but have very few medical needs and will also receive the stipend until I transition to Medicare. Hopefully 
None of my husband’s medications are covered. One is Humira and the other 2 are generic, one a statin and another.
I guess he will have to take another immune suppressant because there is no other option. That’s not my question.
Has anyone used good rx or mark cubans drug plan? Both are listed for good prices. Well better prices.
This has been very stressful for me and I have spent hours and hours on the phone trying to figure this out. Every time I find a new piece of the pie. Anyways, thanks if you have any information about the websites for cheaper medications.
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Contact the drug company to find out what savings programs they have for people in your H’s situation. My BIL gets his expensive meds (not biologics) covered in full by the manufacturer. https://www.humira.com/humira-complete/cost-and-copay?cid=ppc_ppd_ggl_humira_complete_humira_cost_assistance_financial_assistance_exact_ushum220266&gbraid=0AAAAADK9cCGdGe1BRIgYyNH4mfUdB9WbJ&gclid=CjwKCAiA9bq6BhAKEiwAH6bqoHorqSi1wKLVAQDwrLhHPuNLnve1yDi_7WcEd5T9Ry-z5NOskUAhLRoC8F4QAvD_BwE&gclsrc=aw.ds
Statins are inexpensive, and GoodRx has excellent prices for that type of drug. We used GoodRx for H’s niacin last year (it’s a $0 copay this year on his Part D plan) - it’s easy to use. Mark Cuban’s pharmacy has excellent prices for the drugs that they cover - they have a narrower formulary.
Good news is that once he’s on Medicare, he can hopefully get Humira through Part B (no cost after the annual deductible of a couple hundred dollars if you have a Supplement). My Medicare friends on Enbrel get it done as outpatient (which is covered under Part B) & have saved a lot as a result compared to pre-Medicare copays. He should definitely consult SHIP and/or a Medicare broker when the time comes to make sure he picks the best plan option for his situation.
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I haven’t used GoodRX myself, but I have a good friend who saved thousands of dollars a month using it!
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We are very aware of the drug co pay assistance programs. We will reach out again but there’s a top number of what dollar amount they will cover and without any insurance that covers the drug we will exceed that amount before he transitions to Medicare. We still have more calls to make but the fact remains that the particular drug he has been on is not part of the formulary for any healthcare plan in our area.
The good news is that there is an alternative drug that is covered. We have to call his rheumatologist to see which option works best. We already know that his current medication is not covered for Medicare so he was going to transition to another drug then.
I know you are trying to be helpful but I’ve spent hours and hours on this. To find out that one place said it was covered but when I got into the particulars it isn’t. Call after call. To find out a bunch of dead ends.
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You can check SingleCare in addition to GoodRx. I know people who have saved more with that program than GoodRx - it depends on the drug & the pharmacy.
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Singlecare and Good Rx are the same at the pharmacy as an insurance plan would be. You hand them the card and they give you the price. You can’t use them with insurance or medicare, so the amount is not going toward a deductible or max out of pocket. Some pharmacies don’t take one or both. All you can do is try it. Most pharmacies are happy to run the prescription thru both ways, with insurance or with the discount cards.
Medicare is changing in January with a $2000 max per year, and no more donut hole.
My Part B meds have a 20% co-pay and that goes toward medical deductible, not pharmacy. It really sucks for me as I have a very expensive drug (injection) and come Jan I can’t afford the co-pay. The manufacturer can’t help with a co-pay card because I have medicare. I’ve called all the foundations and they are closed to new patients for this condition. And I get to start my $2000 toward pharmacy all over again (except that I’m stocked up on medications for the next 90 days).
I have done nothing but go to doctors in Nov and Dec to get everything tested, tweaked, biopsied, and medicated before the end of the year.
And then I needed a root canal and still need a new crown. And new glasses.
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It really stinks when you have a condition that is helped by a medication you can’t afford.
Where we are coming up is that there is a class of drugs and one of the medications is approved. But that medication doesn’t work well with your condition. More calls to figure out what we can do.
Dental isn’t covered after January. That’s fun
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Is the “alternative drug” a Humira biosimilar? There are several now available, and the most recent one was just approved by the FDA a few months ago, I believe. I’m surprised your
Insurance continued to cover Humira; usually, as soon as a biosimilar becomes available, insurance wants to switch to a cheaper alternative. I looked at Costco pricing, and the biosimilar they sell is $700 compared to Humira’s $7k price for the same dose. The good news is that there is a choice of several biosimilars, the bad news is it might require several tries to find the formulation that would work best.
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I just had to switch my Part D for next year since the plan I have is going from $9 a month to $48 per month. So I enrolled in a plan with a $0 per month premium and my generics will cost $0. The plan does not cover generic Advair but I can get that with GoodRx for about $50. If I wanted a plan that would cover it the premium would be more than $50. So what’s the point of this plan? On my part, the point is I have to have a Part D. But what’s in it for the insurance company?
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DH’s aunt - who is a fairly healthy looking 81 YO has Ovarian Cancer, Stage IV, but is doing pretty well with it. Diagnosed in 2017 and had surgery and other treatments then; had two spots on colon area in 2021 (from outside of colon within her gut), but she is on oral medication that seems to be keeping things ‘at bay’. She takes two pills in the morning and two pills at night. She has a grant that pays for the medication - which otherwise would cost $3,000/month. I think she gets the meds with the grant because she is doing so well with those drugs.
She commented about not affording the med otherwise - uh, no, they have the resources. I told DH, if either of us needed a drug to live that cost $36,000/year (or even double that) we would have the money. This aunt/uncle have had about 7+ different boats (going bigger on sail boats, and then motor boats going bigger and bigger over the years), a ski condo they owned, and now winter in FL for 5 months a year. Very thrifty/cheap in some areas to splurge in other areas.
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Thanks that is definitely something the husband can discuss with the rheumatologist.
The only immune suppressant listed was Enbrel, which works for his PA but not his crohns. He took Enbrel in the past until the diagnosis of Crohns at which time he was switched to Humira on the advice of his gastro. Crohns is a complication of the PA.
I couldn’t find confirmation for remicade but was told that it is approved. That’s because remicade is an infusion and not a medication. Therefore is billed under medical not medicine. It’s all so confusing.
lol this is too much information and I’m sure the husband wouldn’t be thrilled I’m talking about some of his medical diagnoses.
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Maybe at 81 it’s something to think about spending money on medication. My husband has been on this medication for the past 20 years and will be for the rest of his life.
There’s been co pay assistance in the past, there is no reason not to accept help that is offered. Because without, it could have been life changing for our financial health.
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Being on the right medications - be it infusions or other things to control issues (and you hit upon some that are pretty common) - how they do get treated with Medicare supplement and drug plans, and making the conversion from pre-Medicare health insurance plans.
One of our cousins has some similar issues to your DH; she continues to work to do all the travel and lifestyle things - and in two years paying off her mortgage after extensive home addition and added a pool. She is able to work from home (and with her health issues is able to continue to work from home) - she has an excellent CS job. She actually also did have colon cancer and has to schedule around some of her health every day, with things we take for granted. Her own pool is because of needing a private pool.
I know I had some surgeries that once one gets older they don’t want to do. Gyn did a bladder sling type of procedure (he did a variation that is a long name) - so I don’t have an issue many older ladies have with having to wear a pad for exercise or having worse issues as they age – my surgery was in 2011 (when I was 55) - I had met my copays and deductibles that year and qualified for the surgery (it has to do with fullness of bladder and also leaking – I qualified on both bladder test measures).
Over Thanksgiving I shared with a former SIL (now age 67) about Fundiplication (stomach) surgery with hiatal hernia repair – she has had hernia repair and having continued reflux issues and might also have hiatal hernia again. My surgery was when I was 56, 12 years ago. Her son and DIL are both nurses, and she has an attentive NP. Key with that surgery is having two skilled surgeons attending (laproscopic, if nick the spleen or liver, need 4 hands to have it all under control) - my surgery was w/o complications.