I went to medicare.gov today to compare Part D (prescription) plans. I duly entered the two new drugs I started taking this year and began the comparison between the available plans. If we stay with our current plan (Silverscript Smartsaver) we will pay a total of $178.20 for the entire year, if the website is accurate. However, if we switch to Wellcare Value Script, we will pay a total of $12.00 for the year, using the same pharmacy. I don’t quite believe this, so I’m going to contact SHIP and see if they get the same results.
I ended up with the AARP UHC Plan D here in 2023. Intend the same for 2024. Which plan is run by Walgreens and uses Walgreen’s mail-order pharmacy (OptumRx) for maintenance drugs.
I was amazed to learn that both CVS and Walgreens are considered in-network for this plan. As are the two main grocery store chains in our state: Publix & Winn-Dixie.
I’d have to work very hard to find an out-of-network pharmacy around here.
That doesn’t detract from your point that the same med may have a very different price between pharmacies. So it’s worth it to comparison shop for anything that seems unduly or inconveniently expensive. But with everybody being in-network the OOP differences are pretty muted until you’re looking at a Tier 3.
Open enrollment time approaches. If you don’t want to make any changes to any Medicare Parts or to Medigap, you do nothing, right?
Correct
Just for grins, I did the Part D exercise. Our drug list has one addition from last year.
As I expected, our current plan would charge us a total of $141.90 next year. This is somewhat less than the total charge for this year. This includes premiums and co-pays. This plan is SilverScript SmartSaver.
What I did not expect was that another plan would charge us only for premiums, and there would be no co-pays next year. The premiums are $.50 each per month, for a grand total of 12 bucks for the year. This plan is Wellcare Value Script.
Our pharmacy stays the same. I’m not completely believing this, so I’ve made an appointment with our local SHIP representative. I will see what she discovers when I see her next week.
Mr. Legend is in his third year on Medicare, and he’s never changed anything. When he originally chose a plan, he went with traditional Medicare plus Medigap and Part D, and he’s been happy with the coverage.
He’s under the impression that if he wanted to switch plans now, they could do underwriting, which we assume would mean he would be rejected because of his breathtakingly expensive pre-existing conditions. (Given his state of health and the carefully chosen phalanx of specialists he sees, he doesn’t want an Advantage plan.) Is this true?
This is most likely true. Stay with his current plan is my advice.
This is indeed true, as we switched plans several months ago (because of prohibitively high and ever-increasing premiums). We both had to go through a 30-question survey, which my wife passed without an issue. I had to speak to somebody a couple of days later because I had double-bypass surgery 4 years ago. But since I’ve had no further complications, I was also given the green light.
Yeah, that’s why we started out with medicare supplement insurance and why we’re sticking with it over an advantage plan. I could never pass a re-assessment if I wanted to go from Advantage to supplement plan, with my recent cancer stuff.
Tho this year we did switch over to United Healthcare’s supplement over our regional provider’s supplement as UHC covers more providers and services and costs less. And our regional supplement had so many damn hoops to jump through.
A few years back some scumbag talked my dad into switching from Supplemental to Advantage. Fortunately (and illegally) they didn’t trigger a cancellation of his Supplemental (Medicare was pissed when I talked to them).
The downside is that he was paying for two plans, one of which he couldn’t use. The upside was that once open season came around, I could cancel the Advantage and put him back on Supplemental without any re-evaluation. In the process, I switched him from Mutual of Omaha to UHC, but either would’ve been a vast improvement over his crap Advantage plan.
What’s this “one-time” payment from SS I see in my account? SS online doesn’t explain, nor does googling. It’s the second time this has happened.
Is it an amount that could be a multiple of your Part B or D premiums?
Did you make any payments at the inflated amount? If so, the excess would be refunded to you.
If the entry in your bank account says something like “SSA 310 TREAS,” it may be a correction in your SS payment. I just started receiving SS in January. On Oct. 6, I received a deposit of $9.00. About 10 days later, I received a letter from SS explaining that the $9.00 was to correct a miscalculation & telling me my payment for the rest of the year would be $1.00 more per month.
Maybe Teela your plan gives a kick back of your premium up to a certain amount. that’s a benefit in some plans I think I read.
2025 is the year for my spouse but my curiosity is aroused about what my current provider, Priority Health (PH)/in Michigan offers for Medicare plans. This year they offer 11 bundled or Advantage styled plans and just 4 Original Medicare supplemental plans.
The advantage plans are looking pretty good actually wrt coverages and extras. Clearly those are the products favored or most heavily pushed by PH.
I’m looking at Blue Cross here too, on a quick read their supplemental plans look stronger than their advantage plans.
I’m mostly curious about if certain plans are more prone to greater increases in deductibles co pays etc over time.
Yes, the entry says “SSA TREAS 310”, and I don’t know what’s being corrected. I could go down to the SS office and find out, but I’m tired of dealing with them.
I do know that they are not withholding enough towards my Part B payment, due to a stupid mistake on my part when I filed an IRMAA. They were unable to back out my mistake, and so I’m going to owe them a chunk once we file our tax return for this year.
Reviving this very informative tread.
My situation: I am soon to be 67yrs old. I have had Medicare part A and B since 65. I think it costs me about $138 or so.
Prescription drugs go through my wife’s work health care plan, Anthem, and CVS pharmacy, for which I pay about $5 each time a prescription is filled, so good, so far. Medicare has paid most of my doctor and hospital bills.
Wife lost her job and medical insurance will run out in 3 or 4 months. So, who, what, where, how do I procede with the part of Medicare that pays my prescriptions? It is time for open enrollment but most things I see are obviously sales pitches from insurance companies.
As has been noted upthread a couple of times, a good place to start would be SHIP.
What you need for drug coverage is called Medicare Part D. The only place to get that is from a commercial insurer; there is no government option. The typical plans are on the order of $30/mo/person for the basics. Plus an override for IRMAA if you make too much money.
As a separate matter, the government-provided Parts A & B are far short of a complete medical insurance plan. You can easily find yourself with many thousands of dollars of medical bills after A & B get done paying all they will.
The usual solution to that is a “Medicare supplement” plan, often called a “medigap” plan since it fills in the many gaps in Medicare’s coverage. These are offered by various commercial insurers. These pick up where A & B (& D) leave off. The details vary by state, but all the various types of plans have the same coverage from each insurer by law, then each insurer adds a bit of their own secret sauce on top as a marketing gimmick. Which makes choosing the “best” plan hard.
It’s beyond the scope of this post to explain that in detail, but if you’ve had comprehensive medical insurance with your wife’s job, you won’t have that any more. To the degree this is news to you, you’ve got some studying to do.
This figure is not typical for me. This year my wife and I each paid 36 bucks for the year in premiums. Then we pay 3 bucks per month per prescription. Between us we have six prescriptions; that’s 18 dollars a month, or 216 dollars, plus the 72 dollars in premiums, for a total of 288 bucks for the year. That’s a lot less than 720 dollars for the year.
Obviously, the plans/costs will be different depending on your location and your prescriptions.