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The Kitchen Table

Forgive My Asking Again About Medicare's Part D

8 years ago

I know I knew this, but now am not certain.

When I run the numbers on various Part D plans available to me on the Medicare.gov site, the results include monthly premium cost and estimated annual out of pocket cost of drugs. If the plan has an upfront deductible (up to $415 for 2019), is that number INCLUDED the out of pocket cost they figure, or do I have to add it to the overall?

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Comments (8)

sushipup1
8 years ago
It should be included. And it should state that somewhere, too.
chisue
Original Author
8 years ago
Thanks, sushipup1. One more query? Can I assume that if a plan has a deductible, you're not paying it unless your costs go OVER it? Amazingly, DH's plan for 2018 has not met the deductible! I never give it any thought because my Advair alone eats any deductible my plan may have.
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Gosh, I hate this whole procedure. I'm also seeing that medicare supplements are hugely more expensive for 2016. We've had Plan F high deductible in 2014 and 2015, paying under $100/month. Looks like more than DOUBLE for the same coverage next year -- and very little difference in premiums between high deductible and the comprehensive straight Plan F. I'm wondering if we will even GET a supplemental plan next year. I have yet to meet the deductible ($2800) after my hospital stay for pneumonia. (Medicare paid almost everything.) I'd have been better off not paying premiums! We have to do Part D (drug plan). Fun and games running the numbers of who will charge you less for any maintenance meds -- two for DH and one for me (Adviar, at $300/mo. retail). This is a cockamamie system we have in the US.
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This is why I am so appreciative of my Medigap policy. It pays any and all deductibles. Medicare Advantage plans are the ones that include medical (so you don't have Original Medicare) and prescription drugs. My Medigap policy is through the California Public Employee Retirement System (CalPERS) for State Retirees, so I have Original Medicare for hospitalization and medical, and the Medigap policy picks up the deductibles and is a second, supplemental, insurance for both. With this coverage I pay zero (the State even reimburses me for the monthly Medicare premium and also pays the monthly Medigap policy premium). The Medigap policy also includes prescription drug coverage (PSP). The PSP has no deductible, just co-pays (e.g., no more than $5 for a 34-day supply for a generic; no more than $10 for a 90-day supply of a generic). The great thing is that the PSP still pays for medications through what would otherwise be the Coverage Gap Stage (a/k/a the "donut hole"). All I would have to pay is the same co-pay as during the Initial Coverage Stage. When I last filled my high blood pressure medications, my co-pay on one of them was LOWER through my Part D coverage (it was $8) than it was when I was on the "basic" insurance as an active state employee (when I paid $10). ChiSue, didn't you say before that you have a Medicare Advantage Plan? Are you thinking of changing to Original Medicare with a separate Plan D?
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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.
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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.
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sushipup1
8 years ago
Your deductible comes first. You pay that until it's met, then your insurance pays.
chisue
Original Author
7 years ago
But if your costs are LESS than the deductible, you don't pay the entire deductible, right? DH's deductible is around $400. His out of pocket against that has only been $90 so far this year, and his total retail is also under $400. I can't believe it, but his three major meds are now all generic and he requires low dosages. (*I* am another story.)
sushipup1
7 years ago
The deductible is only for money actually spent. If your deductible is $100 and your meds cost $90 for the year, then your insurance does not kick in. I don't understand your question.
chisue
Original Author
7 years ago
Does the insured pay only the plan premiums and his out of pocket costs?

How does it benefit the insurer to have a deductible?
Elmer J Fudd
7 years ago
Maybe you should call a couple of the insurance companies directly. Give them your specific info and let them explain how their particular policies work. That way, you can be sure to understand what to expect. Good luck.
User
7 years ago
It will depend on the policy where the deductible is paid. Rather than worrying about that I would check each companies formulary to see what they cover for each of your medicines along with any co-pays for that medicine.

Reason why I posted the "where" is some consider the co-pay as going to the deductible others want the deductible paid before the co-pay starts. Knowing how much your regular medicines will cost is a good starting point then follow Elmer's suggestion on the ones that you think you may want.

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