Part D Coverage

Mophead

Mophead

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While browsing through the plans available in my area it is time to either keep what we have or change. Really can't find definitive differences between plans except cost differences. If you drill down into some of the plans there are varying different deductibles with some more front end loaded than others but basically the same coverage for the drugs listed. For instance, Cigna has three different plans available and the cost for each are all over the place.

What makes the most expensive plan better than the cheapest plan?

The old "You Get what you Pay for" comes to mind but not knowing the differences why would you buy the expensive one versus the less expensive one?

From conversations I have had with providers it appears the "Donut Hole" no longer exists so guessing we are front end loading to make up the donut hole being gone?

I just love dealing with government bs but that is the way it is.

Since we have some members here who are in the retirement/medicare ages just wanted to throw this out for some expert opinions because we have a lot of experts on this board.

Why would you ask a long discontinued motorcycle forum for medical advice? Because of the wisdom present, or not.

This should be fun.
 
I chose to go with a little more expensive plan (BlueRx) because of better customer service.
And I have not been disappointed as I always get a U.S. person who speaks English that I can understand. ;)
I just upgraded to their 'enhanced' plan which will actually save me money over the course of the year.
Medicare has a website that allows you to enter your prescriptions and compare plans (monthly cost, co-pays, and deductibles) to see what is best.
I believe this is the link -

Find a Medicare plan

www.medicare.gov www.medicare.gov
 
Uncle Phil said:
I chose to go with a little more expensive plan (BlueRx) because of better customer service.
And I have not been disappointed as I always get a U.S. person who speaks English that I can understand. ;)
I just upgraded to their 'enhanced' plan which will actually save me money over the course of the year.
Medicare has a website that allows you to enter your prescriptions and compare plans (monthly cost, co-pays, and deductibles) to see what is best.
I believe this is the link -

Find a Medicare plan

www.medicare.gov www.medicare.gov
Click to expand...
"A U.S. person who speaks English"? :banned1:
I spose ya mean your version of English? Me duck.
:well1:.
 
This is only my and my wife's second year in the marketplace and there are significant changes in Medicare Part D plans so I am at square one experience-wise. We were happy with our choices in 2024 but both our Part D plans were not offered again into 2025 so we had to choose those again. One constraint that we have is that the employer she retired from grants her an HRA Healthcare Reimbursement Account that pays about $1800 a year for each of us, $3600 total, toward healthcare plan premiums. In exchange, they require us to choose from plans that are offered by the preferred insurance brokerage of the ex-employer. We could go to any insurance brokerage we want but have to give up the HRAs. I'm sure the employer gets a slice from the included carriers that make it in the offerings but they are all name brand carriers licensed in Florida. Fortunately, this broker's customer service agents seem to able to speak to the pros and cons of all the offered plans.

The formulary (list of included drugs) is important as is knowing the tier # of the drug needed as co-pays vary widely on higher tier drugs. I'm only on two common medications but my wife has 10 and several are $$$ tier 4. Still, her plan with Aetna in 2025 is less than the '24 Aetna plan that is discontinued.
 
Uncle Phil said:
Medicare has a website that allows you to enter your prescriptions and compare plans (monthly cost, co-pays, and deductibles) to see what is best.
Click to expand...

My understanding as well. Go with the plan that is most advantageous for your current prescription cocktail.
 
I was lucky enough to join Janis’ group coverage that covered Alabama Educator’s union members. My addition to the plan was only $60/month! After she retired, her insurance was paid for life. After she passed, I was able to stay in the group plan as a “Survivor” at a higher rate. Currently paying about $100/month with the benefit of the educators union doing the negotiations every year. In 8 years, they’ve swapped providers 3 times, with each being a reduction of premiums.

When I call, I not only get English, but also Southern English. Sometimes, if I call about something medically serious, I’ll get a sincere ,”Well, Bless your heart,”.

John
 
The people who sell you the plan should be able to help you make a decision. Basically, the different plans cover a wider range of drugs. You give the person helping you a list of your meds and he/she looks them up in the various companies' formularies (list of drugs). You will then be presented with a total cost of buying those drugs plus the plan for a year. A cheaper plan might only be accepted by a drug chain far from you, requiring an inconvenient drive. The problem with the cheaper plans is they might not cover expensive drugs (e.g. something prescribed for cancer). You can change plans during the enrollment period (at the end of the year) with no penalties.

We chose the cheapest plan since both of us are relatively healthy. We figured if we had to pay for an expensive drug, the odds are we might have to only pay for 1/2 a year's worth until we could change plans. It is a crapshoot...betting on continued good health. As it is, I get my BP meds free at the pharmacy...they are completely covered by the cost of the plan's premium.
 
I am glad to see that some others are as perplexed by this as I am. This is my first year to have medicare, and choosing a plan is pretty darn confusing!
 
Mophead said:
While browsing through the plans available in my area it is time to either keep what we have or change. Really can't find definitive differences between plans except cost differences. If you drill down into some of the plans there are varying different deductibles with some more front end loaded than others but basically the same coverage for the drugs listed. For instance, Cigna has three different plans available and the cost for each are all over the place.

What makes the most expensive plan better than the cheapest plan?

The old "You Get what you Pay for" comes to mind but not knowing the differences why would you buy the expensive one versus the less expensive one?

From conversations I have had with providers it appears the "Donut Hole" no longer exists so guessing we are front end loading to make up the donut hole being gone?

I just love dealing with government bs but that is the way it is.

Since we have some members here who are in the retirement/medicare ages just wanted to throw this out for some expert opinions because we have a lot of experts on this board.

Why would you ask a long discontinued motorcycle forum for medical advice? Because of the wisdom present, or not.

This should be fun.
Click to expand...
Sometimes it's difficult to determine. 'Coverage' includes both what the plan will pay for and the services/specialists available locally. Add to that you don't know what your medical future will bring.....that's usually a surprise. We have Part D (Advantage) coverage. Just continued with the company I had at work. I tried to prepare for the likely medical 'experiences' we could encounter based on our families' medical history. Hopefully, you will find you have paid too much for the service you actually needed; the reverse can be a financial disaster. Prepare for the worse, hope for the best. I wish us all good fortune there, may our laps be forever full of cats, puppies and grandchildren.
 
Uncle Phil said:
The .GOV site works really well for that because it is 'vendor neutral'.
Once you enter all your prescriptions and some other info, it lists the available plans in your area and what the premiums and costs are.
Click to expand...

Insurance brokers can do it for you. But then you still have to evaluate the quality and convenience of the services provided by the insurance. Some brokers can help with that as well.

Another headache is the Medigap plans options. Have no idea how people can figure that maze out. And once you think you are there, get ready for the benefits to be revised.

I see some people dealing with that while caring for elderly parents, handling Medicaid on top of it, and juggling plans to best match evolving conditions. Incredible skills for me.
 
We lucked out when we were shopping. Per my usual methods, I talked to as many of the providers as we could - most of them were selling Advantage plans. These replace medicare and the med payments go to the insurance company. The more of these presentations you hear, the more you learn, and the more sinks in through that thick outer covering of your brain ( :rofl1: ). We finally picked a Supplemental plan - it supplements Medicare. We paid for the best plan (most expensive) and for us, that has paid off. On the other hand, my long time friend chose a less expensive Advantage plan, and after well over 100,000 in medical bills this year, he paid only $5000. According to him, you are choosing to either pay in advance or pay as you go.

We lucked out because we ended up with a wonderful woman who is extremely helpful - fabulous customer service. She works for a company that sells supplemental plans.
 
In Tennessee (it could vary in other states), you have two 'gap' choices - an Advantage plan or a Supplemental plan.

Advantage plans are generally cheaper with little or no premiums and often include dental, vision, etc.
But they operate like a PPO - they decide who you can/cannot see on their plan, pre-certs, etc.

Supplemental plans (mine has no deductible) has no pre-certs, I see whatever specialist/doctor I want (so I can keep all my doctors I had before).
As long as Medicare covers it, my supplemental will pay the part that Medicare does not pay.
For example, my out-of-pocket cost for two complete shoulder replacements was zero (other than the premiums I pay monthly.)
I got my supplemental through Farm Bureau because they give great service and reasonable prices.

Again in Tennessee, what I learned (I assume it is still true), once you decide whether Advantage or Supplemental you can change in the 'reenrollment' period.
However, if you change, the insurers that offer plans do not have to insure you - so you could be stuck with 20% of all of your medical costs.
That really becomes an issue if you have medical problems that prove to be 'expensive' for them.
This happened to my chiropractor's brother - his Advantage plan would not pay for him to see the specialists that he needed.
His health is very bad, so when he dropped his Advantage and went looking for a Supplemental they would not touch him.
And then his Advantage plan would not touch him either - so I would be sure I had 'guaranteed' coverage before I switched.
My take is if you are in very good health and have a family history of good health, Advantage plans are okay.
Because of my wife's and my health stuff, we went Supplemental.
I have not been disappointed at all in my choices.

Drug plans are whole 'nother kettle of fish for sure!
 
Last year when we first got into this mess we were trying to decide on supplemental or advantage plans. I went to three local hospitals and go straight to the pay up window. Asked the ladies which plan is better. Three out of three said do not do the advantage plans. We have more trouble with those than anything else. We went with supplemental and thank goodness have not had to find out since we have had no medical issues pop up that wasn't completely covered.
Mutual of Omaha seems to be the way to go at least in our area. Have other friends on the same supplemental plan and they have had no problems.
 
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I must be the odd man out here as I have only original medicare and a drug plan. I love my original medicare as I go to whoever I want to with no checking with an insurance company for approval. Just called my doctor for a referal to get my colonospy and bam it was done and I payed 0.00. I pay 16 dollars a month for my drugs. It probably doesn't work for everybody but for me original Medicare is the ticket.
 
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