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Thread: Anyone not get Medicare Part D?

  1. #1
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    Anyone not get Medicare Part D?

    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?

  2. #2
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    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.

  3. #3
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    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!
    --

    The most expensive tool is the one you buy "cheaply" and often...

  4. #4
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    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.

  5. #5
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    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.
    Last edited by Bob Turkovich; 11-02-2021 at 9:12 PM. Reason: Added comment re: agent
    "Don't worry. They couldn't possibly hit us from that dist...."

  6. #6
    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.

    I've switched plans several times over the years.

    Mike
    Last edited by Mike Henderson; 11-02-2021 at 9:58 PM.
    Go into the world and do well. But more importantly, go into the world and do good.

  7. #7
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    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.

  8. #8
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    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.
    Last edited by Michael Weber; 11-03-2021 at 11:51 AM.
    My three favorite things are the Oxford comma, irony and missed opportunities

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  9. #9
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    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.

  10. #10
    Quote Originally Posted by Michael Weber View Post
    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
    Last edited by Mike Henderson; 11-03-2021 at 2:42 PM.
    Go into the world and do well. But more importantly, go into the world and do good.

  11. #11
    Quote Originally Posted by Bill Dufour View Post
    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.]
    Last edited by Mike Henderson; 11-04-2021 at 1:47 PM.
    Go into the world and do well. But more importantly, go into the world and do good.

  12. #12
    Join Date
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    Quote Originally Posted by Mike Henderson View Post
    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.

  13. #13
    Fortunately, I only have part A, all other coverage is through Mrs.'s employer at a much cheaper rate than medicare.

  14. #14
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    Quote Originally Posted by Perry Hilbert Jr View Post
    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.
    --

    The most expensive tool is the one you buy "cheaply" and often...

  15. #15
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    Quote Originally Posted by Mike Henderson View Post
    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.

    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.

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