I don’t see any recent threads on this topic; forgive me if my searching is failing me. I’m looking at my options for Part D plans for 2027 and I’m a bit flummoxed. I take four maintenance meds that are all available as common generics. The plans on offer vary so wildly I’m not sure what to make of it. One of them costs just over $5/mo in premium and the meds all have $0 copays–making my total outlay for the year less than $65! Yet others would charge much higher premiums and copays, running the annual totals up as high as $2528.40 for both.
To my question: Is there any other metric beyond price, another reason I might want to bump up to a higher offering (like Humana Value Rx vs Humana Basic Rx, for example)? I assume there are differences in formulary but they don’t affect my list of meds, so can I really grasp this brass ring? I can’t predict what I might be prescribed in the coming year (knock wood), but no point in over-insuring.
I’m surprised that you’re able to find 2027 plans right now. Everything I’ve seen tells me that you can shop for new plans beginning October 15. ETA: I just logged onto the Medicare site, and, yes, I can already shop for Part D plans. So thanks for the heads-up!
It’s been my experience that, yes, Part D plans can vary widely in their cost and coverage. And I’ve always chosen the cheapest one; thus far, with no repercussions.
There’s an ongoing discussion about All Things Medicare in the link below. It might be better to participate in that thread, rather than opening a new one.
Earlier this year my wife and I both got COVID. Our doctor recommended that we both do a course of Paxlovid. On my Part D plan, the total cost was $10. On her plan, it was over $700. So yes, Part D coverage can vary dramatically between plans.
Here in FL I’ve had one of those zero dollar premium negligible price plans for a couple years now. And am set up to renew for 2027. Works great, costs substantially nothing.
My impression is they make their money by having seriously high OOP copays / coinsurance prices for the seriously expensive drugs. If you’re not taking anything like that (yet), get that cheapo plan and bet on the come you won’t need something stupid expensive before year end.
Part D plans are also subject to the general Medicare rules about max annual OOP no matter what. I forget what that number is, but less than $5K. If that worst case is tolerable to you, there’s no reason not to go for the cheapest.
It’s worth pointing out any time Medicare is discussed that it is a federal program with uniform federal rules. But each state regulates the medical insurers in their state separately and differently. And as a result each insurer offers 50 unique state-specific versions of each of their basic products, each tuned to the local market conditions and what the state insurance regulator will let them get away with.
So Humana Basic Rx & Human Value Rx here in FL may be significantly different from the plan with the exact same name in your state. As such, any question or any advice really needs to have the state name included.
Whenever I see these sorts of discussions, I am thankful for my retired military medical. My wife and I don’t need any of the Part (alphabet) options, as it picks up the slack and costs me nothing.
This is what I figure. Even if the cheapo plan doesn’t cover Paxlovid or whatever fancy antibiotic I might need, my HSA can absorb the hit until I hit the MOOP.
I’m in NJ, fwiw. But I wasn’t looking for specific plan info, just a general sense on whether the price indicator was truly all there was to this. Coming into this market from a lifetime of shopping among commercial and ACA plans, the straightforward comparisons of Medicare Supplement letter plans and Part D plans is quite jarring!
Remember overall the federal government is paying 75% or so of the costs of the Part D plans:
For 2026, Medicare’s actuaries estimate that Part D plans will receive direct subsidy payments from the federal government for the cost of basic Part D benefits (plus administrative expenses and profits) that average $1,710 per enrollee overall, $522 in reinsurance payments for very high-cost enrollees, and $1,337 in subsidy payments for enrollees receiving the LIS.
So OP, assume your 4 generics that each average $10/month that is $480/year (averaging $20 would be $960/year) while the insurance company got $63 from you and $1710 from the government for a total of $1773 that gives the company a very nice profit on you.
For another thing you should consider look at ratings–some companies have poor customer service.
Medicare.gov makes this easy. You enter in the medications you take and you can compare plans using different pharmacies in your area. It will give you a total cost including premiums. There is also a user star rating for each plan.
Yes, the pharmacy you choose can make a big difference in what you pay. My plan has preferred pharmacies and using one saved a lot of money. I’m on six drugs now, only one has a co-pay at all, and that is like $8 for a three month supply. It is always a gamble about needing an expensive drug, though.
