Mrs. Martian is preparing to move onto Medicare in December. She has signed up for Parts A and B, and is going to sign up for Medigap Plan G through UHC/AARP. That leaves what to do about Part D - drug coverage.
The Medicare.gov section for comparing Part D plans is really slow and buggy. Bottom line is that, after we plugged in all her regular meds into their comparison tool, every single option cost more per year than buying directly from Cost Plus Drugs (which she already does because Cost Plus Drugs is cheaper than out Aetna insurance copays). This is only the copays after deductible is met, not including premiums and deductibles.
It seems to me that she (and I when I sign up next year) should just get a low premium high deductible plan for catastrophic medication expenses, like if we suddenly need one of the $10k/month drugs. Maybe we would re-evaluate in the future when our drug expenses go up (she is at around $650/year through Cost Plus Drugs, I am maybe $100/year).
Plan D is by far the most complicated part of Medicare. I welcome comments from the more experience of you as to the soundness (or lack thereof) of my reasoning.
I would recommend contacting your state’s State Health Insurance Program and consult with an advisor about what would work best for you. It’s free (your tax dollars at work), trained advisors can plug all the variables and suggest your best way forward.
I agree that the official Part D sites are useless but I’ve gotten very good information and guidance from my SHIP. The good news is you can switch your Part D plan every year during the fall open enrollment, depending on what drugs you use and the formulary of your plan.
This locator will give contact information for your state SHIP.
I had no issues last year with the Medicare.gov site when comparing drug plans, but remember the total costs they show are for a year (or the remainder of the year, depending when you look).
I agree about checking costs, including GoodRx. I found one of my drugs was cheaper at Costco if I just used the cash price.
My wife dropped me from her employer sponsored prescription drug coverage when I turned 65.
I didn’t sign up for part D until 3-4 months later, and because of that uninsured period, I will be paying a $4+ per month penalty in perpetuity.
Im in PA if that makes a difference.
That’s been my experience as well, and I’ve used that site for six years.
Last year it offered me a plan which cost a total of 12 bucks premiums for the year, six dollars for me and six dollars for my wife. I thought that couldn’t be correct, so I went to the local SHIP office. The woman there used the same site and found the same plan. At least, it certainly looked like the same site to me.
Signing up for Part D was by far the most exhausting, puzzling, and incomprehensible part of getting onto Medicare. (We have AARP/UHC for the whichever letter of the alphabet soup that is Medicare applies).
At the moment we don’t need much in the way of drugs so it doesn’t really matter. But we concluded that even if we DID check on how particular options cover particular drugs, it seemed that plan benefits can change substantially from year to year, so we might sign up for a Plan D that had good coverage for a particular drug only to have it later change.
We finally both went with Wellcare. Our premium of $.50/month just went to $00/month. There is a very high deductible.
We’ve had our most helpful experience working with pharmacists, after getting prescriptions of testosterone and Prolia, both of which are insanely expensive, but so far it seems you can usually find a way to work the system through generics or how it is prescribed.
When we did our original navigation of the Medicare system, SHIP was not helpful in Hawai’i, alas. They tried - the reps were dedicated, called back, and did want to help, but they are extremely oriented toward Medicare Advantage, not toward supplemental plans, probably because the majority of folks here can’t afford supplemental plans.
So I guess all I’m saying is - I can’t provide helpful advice, but I sympathize.
I just checked the medicare.gov page again and they have added 2025 pricing, so their drug prices are now consistent between sections and easier to use.
Mrs. Martians annual drug costs if we buy without Part D are $675 from Mark Cuban’s Cost Plus Drugs and $1275 if we buy at our local Walgreen’s using GoodRx.
The cheapest Part D plan (annual premium+drugs) is Aetna at $1425, second is UHC at $2167.
Wellcare plans are essentially zero premium and $590 deductible.
The plan right now is to continue buying from Cost Plus Drugs (we are very happy with them) and get a Part D plan in case she is hit with a new uber-expensive drug (catastrophic coverage). A Wellcare plan seems appropriate because they are essentially free.
The only question is how much risk there is of a catastrophic need that is not in the Wellcare formulary but is in one of the more expensive plans. That may be an unanswerable question.
When I was going to be eligible for Medicare I talked to my current health care provider, Federal BCBS, about how my existing policy would work with Medicare. One of the things we discussed was that it would be best if I switched from my existing Standard coverage to Basic, which was cheaper but did have different prescription coverage. It was not a Part D policy, and it was suggested that I look into one as an alternative. I can’t remember who I talked to about them, but eventually decided to just stick with the coverage provided by my Basic plan.
Interestingly enough, this year the prescription coverage on my Basic FEHB was converted to include a Part D. No significant premium increase, and the coverage seems to be about the same. In fact, the price of my mail-order prescriptions which had been a flat $20 for a 90-day supply dropped to $15.
Well one thing is many of the more expensive plans don’t have a deductible–so your $590 deductible is replaced essentially by an $49.17/month or so additional premium.
I’m on Wellcare after I got bounced from Aetna after CVS bought them. Premium is like 40 cents a month, and two of my drugs have no co-pay while one has $15 for 3 months. That one suddenly jumped a few years ago, but my doctor was able to put me on an equivalent drug with the current cheap copay. But that’s not always possible.
It might be worth checking if some of her drugs have generic versions. Not all doctors care. And check the pharmacy. The one I used to go to was not in the plan, and if I had continued with it my costs would have gone up a lot.
One drug I take is much cheaper at Costco with GoodRX, so you can pick and choose which to buy through Plan D and which to go outside.
I haven’t used the site for a while, since I just renew with my current plan, but it was more confusing than any other Medicare site, but still not too bad.
All her drugs are already generics. They all show with substantial co-pays on Wellcare, to the point where it is cheaper to just buy the drugs directly from Cost Plus Drugs. The Wellcare co-pays are generally higher than Aetna or UHC.
Of the three plans I looked at Wellcare (essentially free) and Aetna ($50/month) both had $590 deductibles, you have to go to the $90/month UHC plan to get zero deductible.
OK, figured out the problem - I was looking at the wrong Wellcare plan (Classic vs. Value Script). With Wellcare Value Script two of her drugs are zero copay and excluded from deductible; one is $5/month excluded from deductible (that’s about the same as Cost Plus Drugs). Two are Tier 4 and unfortunately have no alternative; one is way cheaper at Cost Plus Drugs even after the deductible is met, the other roughly the same.
A sixth drug show as not covered on the Medicare page, but as Tier 4 prior approval on the formulary, so even if approved likely less at Cost Plus Drugs.
As an addendum, You shouldn’t just look at your copay. You should also consider how much your insurance company is going to pay on their side. if it’s considerable, you could get thrown into ‘the gap’ (a.k.a. the doughnut hole). There, your copay goes up. Sometimes waaaay up. Don’t ask me how I know.
Also, I take one drug, Farxiga, that would be around $500.00 for a 30 days supply, even at Cost Plus Drugs, which I can get from a Canadian pharmacy for Just over $100 for a 90 days supply.
You should look into it. My doctors office gave me the names of a couple of legitimate pharmacies they have dealt with.