Anyone not get Medicare Part D?

[Wade Lippman]

I am currently paying $86 a month for Medicare part D (medications...) I don't use much, and have found that anything expensive is actually cheaper with GoodRX than with my Medicare. I am thinking of just abandoning the part D and relying on GoodRX. The advantage plans without part D look like they give better coverage on medical.

Has anyone done that? Is there a big downside to it that I am missing?

[Lisa Starr]

I have an Advantage plan with drug coverage included. My mother had traditional Medicare with a Supplement, but no Part D, as at that time she took no prescription drugs. Things have now changed, but as she hasn't had Part D plan since becoming eligible for Medicare, there is a surcharge for enrolling "late". For her, the answer was to switch to an Advantage plan that includes Drug Coverage.

I know this doesn't really address your question, but I think you need to determine if dropping Part D now will mean a surcharge later if you want to re-enroll.

[Jim Becker]

Lisa brings up a good point...there are caveats when you make some kinds of changes "now" that can affect how things work/cost "later". Be sure you are comfortable with them since at the current time medications can be a substantial burden if they suddenly come into play. Discount programs like GoodRX are great for a lot of common things, but may or may not cover some of the more unique and expensive medications that are commonly used for certain conditions at this point. So be sure you examine everything is excruciating detail!

[Jamie Buxton]

When I signed up for Medicare I was taking no meds at all, so I did not sign up for part D. A few years later I signed up with Kaiser, and their plan required that I take part D. For quite a few years now, my cost for part D has included a penalty for signing up late. They even call it a penalty. I suspect my long-term cost would have been lower if I just signed up for part D at the beginning.

[Bob Turkovich]

First of all, you need to realize that Medicare plans and costs vary from state to state so one person's experience may not apply to yours.

https://www.retireguide.com/medicare/coverage/state/


My personal experience (in Michigan) is as follows:


I have a Medical Supplement plan for additional medical coverage (i.e., not an Medical Advantage Plan). I have Plan D coverage for prescriptions.

I pay $15/mo. for the Plan D coverage.

I currently have 6 daily prescriptions that I take. Using the Plan D coverage for these drugs costs me $16 total for a 90 day supply. The $16 cost is for one prescription - the other 5 are free. This is obviously dependent upon which drugs you take. My experience in talking with others is that drugs that are more common and been around longer are usually considered Tier 1 and are cheaper or fully covered.

Where the cost can be a factor is on some of the "one-time" treatments (ex., rash ointment). In these cases I have found Good Rx to offer significant savings.

My spouse has had the same experience as I.

I use an agent to help me find which Plan D provider is the lowest cost for my prescriptions. I have changed providers 4 times in the last 5 years. The agent's fee is included in the monthly cost for the plan.

[Mike Henderson]

My Part D plan is about $11 a month. Medicare has a web site where you can find the cost of all plans in your area. You do need to enter the medications you're taking. I think this is the web page (https://www.medicare.gov/plan-compare/?utm_campaign=pn-cmsoe2021&utm_source=Google&utm_medium=Search&utm_content=pn-10152021_MedicareBrand_V3&gclid=Cj0KCQjww4OMBhCUARIsAILndv79ci4mkWqSGgK73cR5 7xOH55RjUQrI9JKOUlx7JZ9Oz3R-kb7USMEaAoBYEALw_wcB#/?lang=en&year=2022).

I've switched plans several times over the years.

Mike

[Bill Dufour]

Talk to an insurance broker who does medicare. It is free to you. Like travel agents used to be a thing. They know the ins and outs of all the plans in your area. Make sure to ask your doctors first what plans they accept as full payment.
Give the agent a list of all meds you take. My wife saved about 400 a month but is paying 150 more in drugs. So a good a savings. You can switch every year if things change for you like new meds, specialist doctors etc.
Bill D

PS my plan is $20 copay on 90 days of meds. It is often cheaper to pay full cost for generic drugs.

[Michael Weber]

Until my ex employer dropped retiree medical coverage last year I was blissfully ignorant of the pitfalls of choosing Medicare options. I eventually chose a supplement plan before looking at part D coverage. That’s when the real insanity began. Every option, and there were dozens of them, was different. Without ability to see into your future drug needs it would be impossible for one to know which was the better decision. Monthly premiums, deductibles, co-pays, “Tier” coverage all are different. I studied many “plan details” before making still mostly uninformed decisions. One for myself and a different one for my wife. Because of yearly changes in plans neither of use will stay with the same plan next year and I assume that it’s likely a change will occur nearly every year. The number of people/companies/institutions profiting is impressive. For the first time in my life I totally understood the desire for single payer medical coverage. At the very least part D coverage should have limited options and standardized coverage just like the limited and standardized medical supplement plans.

[Brian Elfert]

There is a penalty for not enrolling in Medicare part D when you initially sign up for Medicare. They don't want people waiting to enroll until they need prescription drugs. The premiums from folks who don't need prescription drugs goes to pay for drugs for those who need them.

[Mike Henderson]

Until my ex employer dropped retiree medical coverage last year I was blissfully ignorant of the pitfalls of choosing Medicare options. I eventually chose a supplement plan before looking at part D coverage. That’s when the real insanity began. Every option, and there were dozens of them, was different. Without ability to see into your future drug needs it would be impossible for one to know which was the better decision. Monthly premiums, deductibles, co-pays, “Tier” coverage all are different. I studied many “plan details” before making still mostly uninformed decisions. One for myself and a different one for my wife. Because of yearly changes in plans neither of use will stay with the same plan next year and I assume that it’s likely a change will occur nearly every year. The number of people/companies/institutions profiting is impressive. For the first time in my life I totally understood the desire for single payer medical coverage. At the very least part D coverage should have limited options and standardized coverage just like the limited and standardized medical supplement plans.

I don't find choosing a Part D plan that complex, although there is some risk in your choice.

You go to the Medicare Part D web site, enter the drugs you're taking, and it will tell you the lowest cost plan for your situation. The risk you face is that your situation can change over the year. But when open enrollment rolls around, you can go back to the Part D website and get the lowest cost plan for your new situation. Seems like a decent situation to me.

Mike

[Mike Henderson]

Talk to an insurance broker who does medicare. It is free to you. Like travel agents used to be a thing. They know the ins and outs of all the plans in your area. Make sure to ask your doctors first what plans they accept as full payment.
Give the agent a list of all meds you take. My wife saved about 400 a month but is paying 150 more in drugs. So a good a savings. You can switch every year if things change for you like new meds, specialist doctors etc.
Bill D

PS my plan is $20 copay on 90 days of meds. It is often cheaper to pay full cost for generic drugs.

I assume you're referring to Medicare Advantage plans and not traditional Medicare. Note that Medicare Advantage Plans are (almost all) HMOs with the advantages and problems of HMOs. The primary disadvantage of HMOs is the amount of time required to see a specialists and the limitation in the number of, and availability of, specialists (there may be a specialists who is an expert in your condition but if they're not a part of the HMO you may not be able to go to that person - certainly not before going to the in-network specialists. With traditional Medicare, you can go to any Medicare participating provider.) In general, the best physicians will not become part of an HMO or Medicare Advantage plan because they can make a lot more money outside those plans. Those who graduate at the bottom of their Med school class have to go somewhere. (To be fair, there can be some pretty bad doctors in traditional Medicare. The good doctors know who the other good doctors are. Ask.)

You also usually have to get a referral from your primary care physician and that physician is financially incented to limit referrals. Note that the only way these plans can make money (and they're all profit oriented) is to ration care and pay their physicians less. So you ask, "Which physicians will work for less money?"

HMOs and Medicare Advantage plans can work well as long as you're healthy. They tend to fail when you develop an unusual, expensive condition.

You can encounter a problem with moving from a Medicare Advantage Plan back to traditional Medicare. Traditional Medicare pays 80% and most people purchase a supplemental plan to cover the other 20%. When you first sign up for Medicare, those supplemental plan companies have to take you without regard to preexisting conditions. After that initial period, for example, suppose you went with an Advantage Plan for 5 years, and then decided to go back to traditional Medicare, you may have to go through underwriting for a supplemental plan. This may make your supplemental insurance plan cost prohibitive.

The main reason people decide to go back to traditional Medicare is to gain access to physicians which are not part of the HMO or Medicare Advantage Plans. Usually they have developed some expensive condition and are not happy with the service they are receiving from the HMO or Medicare Advantage Plan, or those plans refuse to provide certain treatments which are available in traditional Medicare.

Mike

[I've seen too many horror stories with Medicare Advantage Plans. I'll give one example of Kaiser. A elderly woman had a eye issue (may have been a detached retina, don't remember). She was given a referral to an eye specialists but the specialists didn't have any openings for a month. In a month, she could have been blind in that eye. Her husband had to go nuclear with Kaiser to get her an appointment within a week. If she had traditional Medicare, she could have called any Medicare participating eye specialists until she found one that could have taken her immediately.]

[Stephen Rosenthal]

I assume you're referring to Medicare Advantage plans and not traditional Medicare. Note that Medicare Advantage Plans are (almost all) HMOs with the advantages and problems of HMOs. The primary disadvantage of HMOs is the amount of time required to see a specialists and the limitation in the number of, and availability of, specialists (there may be a specialists who is an expert in your condition but if they're not a part of the HMO you may not be able to go to that person - certainly not before going to the in-network specialists. With traditional Medicare, you can go to any Medicare participating provider.) In general, the best physicians will not become part of an HMO or Medicare Advantage plan because they can make a lot more money outside those plans. Those who graduate at the bottom of their Med school class have to go somewhere.

You also usually have to get a referral from your primary care physician and that physician is financially incented to limit referrals. Note that the only way these plans can make money (and they're all profit oriented) is to ration care and pay their physicians less. So you ask, "Which physicians will work for less money?"

HMOs and Medicare Advantage plans can work well as long as you're healthy. They tend to fail when you develop an unusual, expensive condition.

You can encounter a problem with moving from a Medicare Advantage Plan back to traditional Medicare. Traditional Medicare pays 80% and most people purchase a supplemental plan to cover the other 20%. When you first sign up for Medicare, those supplemental plan companies have to take you without regard to preexisting conditions. After that initial period, for example, suppose you went with an Advantage Plan for 5 years, and then decided to go back to traditional Medicare, you may have to go through underwriting for a supplemental plan. This may make your supplemental insurance plan cost prohibitive.

The main reason people decide to go back to traditional Medicare is to gain access to physicians which are not part of the HMO or Medicare Advantage Plans. Usually they have developed some expensive condition and are not happy with the service they are receiving from the HMO or Medicare Advantage Plan, or those plans refuse to provide certain treatments which are available in traditional Medicare.

Mike

[I've seen too many horror stories with Medicare Advantage Plans. I'll give one example of Kaiser. A elderly woman had a eye issue (may have been a detached retina, don't remember). She was given a referral to an eye specialists but the specialists didn't have any openings for a month. In a month, she could have been blind in that eye. Her husband had to go nuclear with Kaiser to get her an appointment within a week. If she had traditional Medicare, she could have called any Medicare participating eye specialists until she found one that could have taken her immediately.]

I’ve been extremely pleased with Kaiser. Thankfully I haven’t needed their services very often, but when I have I was seen quickly, even during the height of the pandemic when in-person appointments were discouraged. My doctors are excellent and the coverage is all-encompassing. But I live in the SF Bay Area where there are many Kaiser facilities, so I guess other areas without that advantage may be different.

[Perry Hilbert Jr]

Fortunately, I only have part A, all other coverage is through Mrs.'s employer at a much cheaper rate than medicare.

[Jim Becker]

Fortunately, I only have part A, all other coverage is through Mrs.'s employer at a much cheaper rate than medicare.


I will be "resembling" that remark next spring when I hit 65. Professor Dr, SWMBO's insurance from the university remains primary under the rules and that insurance also continues once she retires. The only material thing that changes is that upon retirement, our younger daughter cannot have coverage like she does now while The Professor is still working full time. She would need to obtain her own insurance at that point, even if under age 26.

[Doug Colombo]

My Part D plan is about $11 a month. Medicare has a web site where you can find the cost of all plans in your area. You do need to enter the medications you're taking. I think this is the web page (https://www.medicare.gov/plan-compare/?utm_campaign=pn-cmsoe2021&utm_source=Google&utm_medium=Search&utm_content=pn-10152021_MedicareBrand_V3&gclid=Cj0KCQjww4OMBhCUARIsAILndv79ci4mkWqSGgK73cR5 7xOH55RjUQrI9JKOUlx7JZ9Oz3R-kb7USMEaAoBYEALw_wcB#/?lang=en&year=2022).

I've switched plans several times over the years.

Mike

I also use the Medicare.gov web site to review and change my part D plan - in fact I just used it today. I know someone who worked with people needing assistance with Medicare and she directed me to that site. Once you add you RX’s in the system and your pharmacy, it will bring up all the plans in your state and rank them by total annual cost to you (plan cost plus drug costs). Each year you log back into the system, adjust your RX list if needed, and you are good to go. When I reviewed our plans today, mine is going to remain the same (under $13 a month with all 3 of my RX free) but we are changing my wife’s plan driven by two RX changes. Changing plans is as easy as clicking enroll button.

[Alan Lightstone]

I won't go into tremendous detail about the disadvantages of most Medicare Advantage plans. But, whichever you choose to sign up for, your medical conditions and therefore the medications you are on matter tremendously as to your costs and choice of plan.

Go to Medicare.gov and type in all of your medications and dosages. Then compare plans (both Medicare Advantage (Part C) and Part D) to see your real costs. Also, type in your doctors and hospitals to see if your plan takes them. That's really important. Many unhappy surprises there. It is very unlikely that your doctor takes all of these plans, and may take none of them. And checking if the best hospital in your area is in network is also key with a Medicare Advantage plan. Many aren't, though almost every hospital will take Medicare.

Also, your costs for biologics and insulin are typically far cheaper with Part D than with an Advantage Plan (Part C). Difference can amount to tens of thousands of dollars per year.

[Dave Fritz]

Let me second Doug's post. If you go to a person that sells insurance they'll sell you what they have. Like a Ford dealer isn't going to sell you a new Chevy. Medicare.gov is a fantastic resource. I used to be on the Commission on Aging for our county and for a time volunteered to help people navigate medicate.gov. We saved folks lots of money.

[Curt Harms]

I made a relevant discovery yesterday. There is a local pharmacy a few miles away that charges less for common meds than Walmart pharmacy charges for copay. I doubt that would be true where no generic exists yet.

[Mike Henderson]

I'll add one more medical warning - about hospitals. Most people when they (or someone they are responsible for) are being admitted to a hospital will just sign all the paperwork put in front of them.

However, one piece of paperwork can cost you a lot of money if you're on Medicare. Even though the hospital may be Medicare participating, they may have doctors on staff that are not Medicare participating. The piece of paperwork you'll be asked to sign is an acknowledgement that you may receive treatment from a Medicare non-participating provider and you will be responsible, "out-of-pocket", for that provider's fees. And that provider's fees are not limited in any way, as they are with Medicare.

DO NOT SIGN THAT PAPERWORK. Instead, write on it, "I wish to only receive services from Medicare participating providers. I will not be responsible for fees from Medicare non-participating providers." If you sign that paper, you can be on the hook for thousands of dollars, out-of-pocket, even though you have Medicare.

The hospital will threaten to not admit you if you don't sign. Don't give in. They will admit you.

Hospitals depend on doctors bringing their patients to the hospital and therefore bend over backward to the doctors. Hospitals exist for the benefit of the doctors, not for the patients.

Some doctors feel that what Medicare pays for their services is too low and they opt out of Medicare. In their regular office hours, Medicare covered people are not in such a difficult circumstance as when they (or someone they love) are being admitted to a hospital so it is difficult to get them to pay "out-of-pocket" (the doctor will mostly treat younger people with commercial insurance, which pays better). But under the stress of hospital admission (perhaps in an emergency) Medicare covered people will sign.

Mike

[This warning is mainly aimed at people on traditional Medicare. I assume that if you're on an Advantage plan you will be directed to a hospital that is part of that plan.]

[Jim Becker]

However, one piece of paperwork can cost you a lot of money if you're on Medicare. Even though the hospital may be Medicare participating, they may have doctors on staff that are not Medicare participating. The piece of paperwork you'll be asked to sign is an acknowledgement that you may receive treatment from a Medicare non-participating provider and you will be responsible, "out-of-pocket", for that provider's fees. And that provider's fees are not limited in any way, as they are with Medicare.

DO NOT SIGN THAT PAPERWORK. Instead, write on it, "I wish to only receive services from Medicare participating providers. I will not be responsible for fees from Medicare non-participating providers." If you sign that paper, you can be on the hook for thousands of dollars, out-of-pocket, even though you have Medicare.


This HHS rule that goes into effect shortly will hopefully help with this kind of "surprise billing" but the text at this link indicates it's already banned for Medicare and Medicaid patients.

https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule-to-protect-consumers-from-surprise-medical-bills.html

[Mike Henderson]

You're correct. I see that non-participating providers can only charge up to 15% more than the Medicare approved amount, not any amount they want. Note that since Medicare pays 80% of the Medicare approved amount, you could be on the hook for 35% (the 20% Medicare doesn't pay, plus the 15% extra).

I encountered this situation when I went to a hospital for a test. They wanted me to sign a form that I was responsible for the fees of any non-participating provider. I refused to sign it and said I only wanted services from participating providers.

Overall, I think a hospital that is Medicare participating should only have Medicare participating providers. The patient should not have to ask every provider that enters his/her hospital room whether they are a Medicare participating provider.

Mike

[Jim Becker]

Mike, while not a Medicare situation, I had the "surprise" $800 billing problem when I had my eye surgery last year. The anesthesiologist was apparently part of an independent group owned as an investment by some entity and not a participant in our insurance plan. (from a BCBS insurer) I was never notified of that even though the young lady appeared to be part of the hospital team. I appealed it to BCBS and fortunately got them to pay up to the equivalent of an in-network provider. And that surprise bill was actually 9 months after the completion of the surgery.

I wholeheartedly agree that the patient shouldn't be on the hook to deal with all this stuff when getting something attended to in an "in network" facility, private insurance or Medicare/Medicaid. There should be no surprises. But then again, I'm not a fan of the whole system overall, but we'll not go there. ;)

[Mike Henderson]

There are providers who are not limited by the 15% over rule - they are called "Opt-Out Providers". Here's some information from the Medicare web site (https://www.medicareinteractive.org/get-answers/medicare-covered-services/outpatient-provider-services/participating-non-participating-and-opt-out-providers?gclid=CjwKCAjwz5iMBhAEEiwAMEAwGD-QASXWC4F0fcLaADb9jXI7PYLJmh5fZh-H-6aA_4VPtgoyO8npIhoCFPIQAvD_BwE):



Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. This means they can charge whatever they want for services but must follow certain rules to do so.

Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
Opt-out providers do not bill Medicare for services you receive.
Many psychiatrists opt out of Medicare.


The situation I encountered may have involved Opt-out providers.

Mike

[Alan Lightstone]

Hospitals depend on doctors bringing their patients to the hospital and therefore bend over backward to the doctors. Hospitals exist for the benefit of the doctors, not for the patients.

Mike

Mike, with all due respect, that comment is outdated by about 15-20 years, or more. And this is coming from a hospital-based physician who worked his entire career in hospitals. Usually Level-1 trauma centers where a huge percentage of my patients never paid for their care. And we took care of them just like any other patient who came to our doorstep. In reality, I never knew if my patients would pay their bills. I just took care of them to the best of my abilities.

Hospitals exist for the benefit of themselves, their administrators, and their shareholders. The doctors are a captive audience, except for the few that bring in massive numbers of patients (think large orthopedic surgery practices, specialized surgeons like thyroid surgeons who get huge numbers of patients, etc...) All the other physicians are typically treated like serfs. The daily beatings from the mid-level nursing staff are so much fun.:eek:

[Mike Henderson]

Mike, with all due respect, that comment is outdated by about 15-20 years, or more. And this is coming from a hospital-based physician who worked his entire career in hospitals. Usually Level-1 trauma centers where a huge percentage of my patients never paid for their care. And we took care of them just like any other patient who came to our doorstep. In reality, I never knew if my patients would pay their bills. I just took care of them to the best of my abilities.

Hospitals exist for the benefit of themselves, their administrators, and their shareholders. The doctors are a captive audience, except for the few that bring in massive numbers of patients (think large orthopedic surgery practices, specialized surgeons like thyroid surgeons who get huge numbers of patients, etc...) All the other physicians are typically treated like serfs. The daily beatings from the mid-level nursing staff are so much fun.:eek:

Yes, you're probably correct. I see it from the outside but, like all corporations, I'm sure that profit for their shareholders are very important.

Mike

[Larry Frank]

This thread went way off the rails !
On the Medicare website, you can enter your medications and get a good estimate of the costs from various plans. If you know your RX costs without Part D, you can make a financial decision on what to do.

This forum is not the best place to find information or misinformation on Medicare.

[Wade Lippman]

I wasn't looking for information; I was asking if other's had gone without part D and had problems.

My Part D is now $16, but the part D IRMAA is $71. That goes away if I drop part D.

[Dave Fritz]

Wade, I had a neighbor that bragged about not needing insurance that he could get his prescriptions at Walmart for $2. That was the case then, but not now. Insurance isn't for the present but rather protection for what's in the future. You pay your money, and take your choice.