>>Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? >> I've read several articles (must have been either AARP, NYTimes or WSJournal) that say that 80% of Medicare's budget is spent on 20% of insureds - the very frail and dying. But we should remember, this is true the world over. It's merely a question of who pays for it and for how long. Nobody anywhere wants to be the one who says to the family, "the plug has to be pulled because we're not going to pay for it any longer." Now, the ridiculous claim of "Medicare Death Panels" has been thoroughly debunked already, so no need to go over that ground again. Factually, ALL insurance companies globally have a Chief Medical Examiner whose job it is to approve or disallow payment for expensive treatments. That's what they do - balancing medical guidelines, doctor preferences, patient coverage, and company profit (no, company profit is not always paramount; but is an important factor in overall portfolio risk management). In the absence of clear, specific legal forms by the patient as to how end-of-life treatment is handled, the medical profession by its nature will do everything to save you from dying. Palliative care and pain management is only beginning to make an impact on their thinking, but again - without clear legal guidelines as to what the patient wants, ESPECIALLY if those instructions are contrary to what the family expresses - the doctors will do everything possible. And these days, "everything possible" is usually expensive with little regards to the quality of life. That's why it's absolutely critical to talk about what you want with not only your spouse, but your doctor and your family. Then put it in writing! BTW, I should amend my posting about the 'wellness' exam of the Healthcare Reform Bill. The NYTimes did an absolutely wonderful, comprehensive piece on this subject - what is covered, what is not, and why some consumers are surprised when they receive a bill they didn't expect. We have to remember, a physical exam for a 16-yr-old is going to be different than that of a 50-yr-old, which is again different than the exam for a 70-yr-old with severe medical issues. As it stands now, with the government gradually clarifying what is paid for and what is not, the two key things to note are: most of these don't begin until next year, and in areas where it's still 'gray' without legal definition, the insurers are allowed to make their own decisions about what is covered and what is not. (Access to the NYTimes is limited to 20 free articles/mo.) Preventing Sickness, With Plenty of Red Tape NY TImes September 19, 2011 (Excerpt) "Prevention has never been the cornerstone of American medicine. In this country, we tend to go to the doctor only when something is wrong, a habit long bemoaned by researchers and medical groups. The federal government aims to change that, and soon. Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms. Just last month, the Department of Health and Human Services released additional guidelines specifying fully covered preventive services for women. Mammograms, cervical cancer screening and other services already had been mandated; the new recommendations expand that list to include screenings for human papillomavirus (which causes cervical cancer) and domestic abuse, and reimbursement and counseling for contraceptives. These services are to be fully covered by most insurance plans beginning in August 2012. Despite these new regulations, there's still a lot of ambiguity - and not just among consumers - about what qualifies as preventive care and what insurers are obligated to pay for. "I've seen so much confusion among patients and doctors alike trying to figure out what's paid for and what isn't," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and a primary care doctor. " Here is a link that might be useful: Full Article: Preventing Sickness

I figured it out. The answer may help someone else. The annual cost is less than the premium plus the deductible because DH won't use up the whole $400 deductible paying for his two daily meds under this plan. (Of course he will have some additional prescriptions, but it's not possible to know what those meds will be.) With this plan his meds total $316/year. Meds @ $316 + Premiums @ $270 = $586/year. It still seems 'too good to be true' because other plans figure his meds costing much more than this plan, even using those plans' preferred pharmacies. (This plan uses Walgreens.) *I* am still stuck with the Never-To-Be-Generic Advair. I will pay an insurance company $350/year for the privilege of paying $850/year for the Advair. (Retail $4000/year.) Minimum medication costs for us will total $1786. We have another $2500 for Medicare Part B. Then there are our ($2100 deductible) Medicare supplement policies...another $2000. We're over $6000 before other Out Of Pocket medical and medication expenses. The total will be more than I budget for food.

We have access to licensed health insurance advisers (brokers) through my DH's former employer. After I ran the numbers on the Medicare Part D site, I called these people to verify my understanding of the two different plans I had selected for us. They could tell me nothing about the one I selected for myself because...it's not one that they 'broker'. So -- I wouldn't rely on just what one broker offers. Mutual of Omaha is new in our area in 2020. I enrolled in their Value Part D plan because it was among the cheapest when combining the cost of the premium and the cost of my meds. (Advair is my big expense at $450 retail per month.) I'm OK with their preferred pharmacy being CVS. I'll pay $22.80/month premium, and a total of $1232/month average out of pocket including known meds. (My 2019 Part D plan with United was completely overpriced for 2020 when I ran the numbers on the Medicare guide.) My 2020 Part D card arrived in the mail within two weeks of our October enrollment sign-ups; impressive. DH has so few meds that he rarely exceeds the deductible, so a low premium is a goal for him. (Nearly all Part D plans in our area have a $435 deductible in 2020.) He'll have WellCare Select Part D for 2020. Premium is $15.50/month; total with meds averages $249/month. (He also has to pay an $8 penalty in addition to this, dating from when he did not take a Part D plan the first year it was required.) We're OK with this CVS plan. His Part D card has yet to arrive -- despite two letters confirming enrollment; not impressive. We choose to have premiums paid by deduction from our Soc. Sec. benefits. No coupons. No direct withdrawal from bank account.

You are required to have a Part D plan if you have Medicare. You will be penalized later if you haven't signed up for Part D coverage when you are eligible for it. If you have few meds or very inexpensive ones, take the plan with the cheapest premium. DH often goes a whole year without using half of a plan's scary-big 'deductible' (over $400 in recent years, and most plans have them). ALWAYS search the Part D plan offerings for the coming year, and check with the insurer to be certain the information on the Medicare.gov site is correct -- regarding the premium and the cost of each drug. "Mistakes are made," early on as the companies are submitting their information to Medicare. Other nations control the price of prescription medications without this nonsense of Part D insurance. They only people who benefit from the US system are the insurers and the pharmaceutical companies. Ours is also the only nation to permit advertising of prescription drugs. (Not certain if New Zealand still does this, but they were the only other one.) I have yet to find mail order to be less expensive than a local pharmacy by more than a few dollars.