@Sabaray, I’m so sorry you and your H are facing this challenge. Be sure to take care of yourself, too – being a caregiver is no easy task.
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I don’t want to get too off topic from our retirement thread, but please know I appreciate everyone’s good wishes. Let’s get back to Medicare and Wellcare and Advantage plans!
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There was a NYT article in June about the high price of drugs due to the middle man (Pharmacy Benefit Manager PBM) negotiating high prices to their benefit. Also in the article it mentions Mark Cubans pharmacy - does anyone know anyone who has used it to see how it works and if it is really costs considerably less than what you would get from your own pharmacy?
I haven’t used it, but I have checked prices. On some drugs, the savings are amazing. It depends on the medication.
I just got on the website and put in my prescriptions and they total much, much less than what I will be paying for Part D anywhere, I think. I do have a lot of meds so I’m likely more expensive than most. I think I need to do a little research on what the downside would be to drop Part D and just go with paying CostPlus directly since I do not see any Medicare Part D insurance offerings on their website.
Do not drop Part D! You’ll end up with a penalty down the road if you do need to use it. Just get the cheapest Part D. You can have Part D but not use it for your meds.
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Yes, I just read this and realize that the late penalty is still in place even if you originally took part D. However, this article says keep Part D (maybe a low monthly price with copays/coshares) and fill your pricey drugs directly with CostPlus. Exactly what you said. Cost Plus Drugs Might Save Medicare Members Money — With a Catch - NerdWallet
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Are you allowed to drop part D? I have SilverScript. No idea if it is paid by part D or by the employer’s retirement package. I rarely need prescription medications.
I have SilverScript Plus and it is going up a lot - but I do have a lot of prescriptions.
No, do not drop Part D.
I went into the 2025 Part D calculator and discovered Wellcare will not be my best option - apparently they priced my expensive brand drug so I would have to pay just under $2000 for the year. Plus the much higher premium! There’s a Cigna plan that’s considerably cheaper - about 70% the total cost. Also in looking at the details, if I do my 90 day generics via mail order but my 90 day brand name via Walgreens, I save a little more. (All my meds are ongoing, once or twice a day depending.)
(Also that brand name is not covered by CostPlus.)
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I don’t know if this will help others but I’ve found that the estimated drug costs aren’t correct. I was comparing a plan that included one of my drugs with another that didn’t. The calculator told me that the price of the drug without insurance was over $1000/yr making the plan that didn’t cover it look much more expensive from a total cost perspective. The plan that did cover it was going to end up charging me a copay that resulted in the annual cost being about $340. But my insurance that I have now doesn’t cover it and I pay for it out of pocket so I know that it really costs about $30/mo without insurance so it’s really about $360 per year. That’s a big error and it’s making one plan look much better than another when it really isn’t.
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Is the limit $2000 per drug or total OOP for the year?
My understanding is that total out-of-pocket costs for all prescriptions cannot exceed $2000 for 2025. Premiums are in addition. That cap can be adjusted for inflation in future years.
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As long as the drug you take is in their formulary. Has to be a covered prescription.
The devil is in the details
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So, we aren’t old enough yet to qualify for Medicare, but is the Part D (prescription) always with your supplemental insurance company? Or can those be two different private insurance companies?
I’m guessing it’s the latter.
Which part is the one you are supposed to, “marry,” and which one is the one you are supposed to, “date.” I think I read that lingo on here. Or is it choosing the Part B component that is so important? Ack! This stuff intimidates me
It’s confusing, but once you figure it out, it makes more sense.
Medicare Part C is Medicare Advantage. These plans are run by private insurance companies who can limit networks and make decisions as to whether or not something is covered (or covered with hoops to jump through). These plans can be changed annually during the Medicare Open Enrollment period. Sometimes the plan includes Part D, but not always. Note: There are widely varying thoughts on Advantage plans vs Supplemental plans, so you really have to look into it based on your own circumstances and plans available to you.
Medicare Parts F-N plans are known as Medicare Supplement plans. Medicare Parts A and B cover a certain amount, and supplemental plans help cover the gap. Each of the parts covers different amounts. Part G is considered the richest plan available to new enrollees (F is closed to new enrollees), covering everything after the small Medicare Part B annual deductible (currently $240) is met. As long as the doctor accepts Medicare & as long as a procedure is covered by Medicare, a Supplement covers it without question. These plans can usually not be changed without undergoing underwriting … but that’s not true in certain states (so you have to look at state rules, too). Supplemental plans do not include Part D.
Part D is a bear. The annual enrollment period is separate from the Medicare annual enrollment period. Prices and formularies can and do change annually. Prices for drugs under a particular plan vary by pharmacy, and sometimes one of your drugs is less at one pharmacy but another of your drugs is more at that pharmacy. You can always pay cash, use GoodRx or use something like CostPlus if it’s less … but those options won’t count toward the Part D deductible. There must be at least two drugs in each category covered by a plan, but those might not be the ones you want/need (although you can attempt to get a waiver to cover what you need). You don’t know what you might need in terms of new drugs during the year, so it is a crapshoot - but you can change plans the following year. It’s scary because of the unknown. And yes, you can use a different insurance company for part D than for your Supplement (or Advantage, if it doesn’t include Part D).
Drugs that are administered in a hospital type setting are covered under Part B. Sometimes a drug is available as an infusion or in a method you can administer at home. Infusion? Covered by Part B (so could be $0 if you have Part G & met your $240 deductible). At home? Covered by Part D & could cost a lot (and possibly not even be covered by that plan). My friend with ankylosing spondylitis gets his Enbril (or its equivalent). by infusion for this reason.
There are some really great videos on YouTube that explain things. I watched a bunch before talking with Medicare brokers. You don’t have to buy through a broker. You can go on Medicare.gov & get pricing (and sign up). I find our broker to be very knowledgeable and helpful, but YMMV.
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Oh, my goodness!! This is super helpful. I have copied and pasted into a note for reference in the future. Thank you for taking time to type all that out.
What is a typical monthly cost for a rich/robust Part G??
Note that the supplement plans have different names depending upon the state. Here in MA we only have one types A & B.
It varies by state (and zip code). You can go to the Medicare site and check your rates without making a login. Just enter your zip code and answer a couple questions. Say 65 for age, M/F, smoker/nonsmoker - choose a letter (G for most robust) - and your companies/rates will pop up. Of course, rates will rise annually, and they will (usually) rise based on age. You can’t predict future rates. Here is a video that explains about the different Medigap companies (in one particular state - everything varies by state) and how they work: https://m.youtube.com/watch?v=j66oGQqz2Mc. (I checked rates at various ages on the Medicare site to see how they differ through the years. Some that start low are really high by age 80.)
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