Great video, as others have said. One question I didn't see (and I did actually read all the comments, though I may have missed the answer) is whether the "Total Drug & Premium Cost" includes the deductible.
Great video - i have looked for something like this website for a LONG time - your narrative is excellent. The Cost Before Deductible column is only presented for plans with a decutible - that threw me for a bit. Regardless, Excellent job! Maybe now I can simplify my XLS where I tried to do this manually....
There are $0 premium plans in most states. There isn't much of a catch other than the plan premiums can and will change in the future, and the company will try to sell you a Medicare Advantage plan whenever possible.
Prior to 2025, I had always heard to just choose the lowest cost Part D plan. But then I started reading reviews of some of the plans, and for one in particular, almost all the comments were negative 1-star reviews. The biggest complaint was the company throwing up road blocks, like requiring prior authorization or simply denying the drug. I would think the latter (flat out denying the drug when the Medicare analysis shows the drug as covered) would be illegal or at least "wrong." So I guess my question is, how much should i take into account the star (1 - 5 stars) rating of each plan? I'm in CA and Cigna only has 2.5 stars. Might it be wise to pay more per year and stay with the plan I already have since I know they'll cover my drugs?
Hard to say. It depends on how much "paying more" it would actually cost. Hundreds more? I would say no. Up to $100 more? It could certainly make sense. Overall, all companies have plenty of online complaints, so it still generally just makes sense to go with the plan with the lowest overall costs (or close to it).
The coverages are different and they cover some different medications (for example, the more expensive AARP plan generally has stronger coverage for more expensive medications). The plan that makes sense for you just comes down to the medications you are taking and the pharmacy you use.
I can't wait to see what mine would cost. Having tier 4-5 meds, I'll never get a plan for me. My Medicare Advantage Plan has an 800. out of pocket price for 2025. I'll stay with what I have. I'm so sick of not getting mail order, or 90 day supply. These plans are not good! I wouldn't pay that much!
I put my drugs in the pharmacy list and shows Wegovy and Rapatha as a co pay of 5k to 6k for these 2 drugs. How does the new 2k maximum out of pocket 🤷🏻♀️Thank you 🙏
@@stanley8574 I’m a medical professional and peptides occur naturally in the body. There are many pesticides known to benefit the human body, but USUALLY can’t be patented, so pharmaceutical companies aren’t interested in them, and the government makes SURE they can’t be legally sold to the public. This peptide is helpful in my CVD, so I’ve been prescribed it. I studied cell biology at Duke, and the microbiome at Harvard, they are clearing receptors that have been non-functional, it’s also rejuvenating DNA and boosting cells that have been reduced with age. It is KNOWN to rejuvenate the microbiome, and energize the midiocondria. I will stay on these peptides for the rest of my life, and I’m anti-pharmaceutical. We just got blessed a short-chain amino acid, a hormone, the building blocks of our body was ACTUALLY manipulated in a way big pharma found a way to patent it or it never would have become available.
Great video. One quick question on the $2000 cap. If I take a plan with lower premium and it estimates my total cost in the $4K range (all drugs are "covered" so no full price ones), if I take away the premium cost (let's say $300 per year) will my copays end at $2000 even if the Medicare comparison says my total cost will be $4K? In other words, am I right in assuming that the comparison engine isn't considering the $2K max? My current plan premium has gone from $20 to $100 and change.
Are your total drug costs showing more than $2,000 for the year? If so, there must be something wrong with the analysis since it should not say more than $2,000 when all meds are covered. Did you possible go over the quantity limits for a medication?
@@GiardiniMedicare Thanks for instant reply. I don't think so. The killer is an asthma inhaler. I will re-check the higher ones to make sure I am reading it correctly. The only one which came in under $2000 total had a premium of $100+ per month. None capped at $2000 out of pocket. However, it was my first shot for this year and so I will re-check. It sounds like you are saying that the Medicare engine DOES include the cap -- that alone is good information. For my drugs then, it should be premium plus $2000 (assuming all drugs are Medicare approved) as a max. Have I got that right?
@@rkvt That is correct that Medicare.gov takes the $2,000 cap into account. If all the meds are covered then the estimated prescription costs should not be over $2,000 for the year. If it helps, you can also email us a PDF of the analysis to info@gmedicareteam.com and we can take a closer look if you want!
That's a really excellent question, though hard to answer. You might want to look at things like current medical symptoms, family history, etc to "guess" how you might get "sicker". Then, research which medications typically get prescribed for that affliction. Or maybe just get a comprehensive physical around October to get results before the deadline to pick a plan by early December each year.
This is exactly why most people buy insurance, in case of an adverse event so you have coverage. The govt estimators assume you will be on the same meds next yr but of course that is not always the case. They give you one clue but no health guarantee. So choose wisely, also based on plan reliability & reputation & service as your “mileage may vary” next year!
What happens if you use a prescription medication that is not on the Medicare Drug List? I take Armour Thyroid for 15 years and refuse to change to the synthetic version. My employer drug plan charges $13 to fill my prescription via mail order.
You would pay full price for it. You could try to get it cheaper through an outside source like Goodrx, and you can also request a formulary expectation to see if the Part D plan you enroll in will add it to your coverage.
Thanks Cameron. You always supply GREAT information. It is REALLY appreciated. Also, a little off topic question: If you need to go through underwriting for a Med Supplement plan, how far in advance do insurance companies let you apply via underwriting? 30 days, 60 days, 90 days?
I am starting Medicare December 1 my birth month turning 65. Going with a Supplement plan and part D drug plan. How do I chose a Part D plan for 2024 (December) and make sure the Part D plan is right for me in 2025. Do I have to choose two Part D plans if the plan is changing in 2025 ?
You have to put in your medications and look at both 2024 and 2025 plans once you get to the results. There should be a plan option that works well for the month of December, and then also for 2025. If that happens, you can enroll in that plan for December and then keep it for next year. You may have to apply for one plan just for December, and then before December 7th, you can apply for a different plan for 2025.
If I am on no medications which is the best Part D to buy? Seems to me with a $2000 max you should just buy the cheapest plan and use discount cards most of the time unless you are sure you will max out every year.
Hi Cameron, I have a Part D plan that costs $6 a year in premiums, and drops to $0 a yearin 2025. Why does this plan exist ? I'm wondering how it is profitable for the company. Thanks, Eric
Definitely an interesting one! A few of the reasons (in my opinion) are below, assuming you are talking about the company I am thinking of. 1. They receive subsidies from the government, as well as additional subsidies due to the new premium stabilization program 2. They are no longer paying brokers any commissions 3. It is a strategy to gain more market share so they have more Medicare Advantage clients in the future.
@@GiardiniMedicare (1): any mechanism other than a distribution of IRMAA dollars (presuming that is a thing) ? (3): I'm not following your reasoning. In what way are advantage plans and this Part D plan linked ? I've never used my Part D plan (I only signed up as something of an afterthought that it would be smart to not be exposed to the Part D penalty in the future) but I looked around the website today. If I chose a medication, I was given a list of pharmacies I could use and the medication cost. I wondered if the Plan D company kept part of the drug cost. There is also a deductible of about $500 a year that would fit that narrative. Seems like small potatoes though. The Plan D website has a link to an online company that writes Rx. It is certainly more expensive than competitors so that strikes me as a 'profit sharing arrangement.' Those were the only revenue generators I could drum up. On the flip side, each Plan D company has to pay for certain vaccinations. Curious. Thanks for your thoughts
@@GiardiniMedicare I believe I have the same plan. My premiums were $6.oo for the year and now o for premiums. I just received info in the mail today and the cost for the drugs I take for 2025 have gone up in price. Thank you for the great info.
@@GiardiniMedicareAre you talking about Well Care? My dad & I use the same broker for our Medicare needs. Last year, they recommended Well Care to us as an alternative to Silverscript. My dad changed over to Well Care and I chose to stay with Silverscript. My premium for 2025 will be going from $5.30 to $28.30 a month. I contacted the broker and they suggested a Humana plan for me. When I emailed back asking about Well Care (which is available in my zip code), they didn’t respond!! I bet they don’t sell Well Care plans anymore and you might be correct about them not paying commissions.
I will definitely be shopping this year. My monthly Part D premium for 2025 went up 700%. Thanks Biden. You are taking my money to pay for your Medicare "enhancements". Taking from Peter to pay Paul.
Yep, it's all President Biden's fault. I bet all your problems will disappear if Trump gets reelected. Don't forget about the $0 premium part D plans in many areas.
![[Sub Thai] APT. - ROSÉ & Bruno Mars](http://i.ytimg.com/vi/bYjhzP8x_uc/mqdefault.jpg)
i meant to add....this is a valuable tutorial. Bookmarked and Saved.
I'm amazed at how well the Medicare website works, and the difference between the prices.
The most clear and helpful video. Other ones are so confusing for a Medicare first-timer like me. Thank you.
You have the best Medicare vids on TH-cam! Thank you!!
Wow, thank you!
@@GiardiniMedicare My pleasure, the cream rises to the top.
Excellent instructions followed along on my laptop and your tutorial on my cell phone.
Worked like a charm. Thank you.
Great video, as others have said. One question I didn't see (and I did actually read all the comments, though I may have missed the answer) is whether the "Total Drug & Premium Cost" includes the deductible.
Yes it does
@@GiardiniMedicare Good. Thank you for the quick response!
I love your videos! They are so thorough and you explain things so well. Thank you!
Appreciate you watching!
Great video - i have looked for something like this website for a LONG time - your narrative is excellent. The Cost Before Deductible column is only presented for plans with a decutible - that threw me for a bit. Regardless, Excellent job! Maybe now I can simplify my XLS where I tried to do this manually....
It should be much easier using the website! Glad it helped
Based on your video it looks like WellCare is a good choice if you don’t take any medication. Right? Cheaper
Possibly. We can't and won't give specific plan recommendations on TH-cam
The new changes that make meds more affordable for people who take them made it a WHOLE LOT MORE expensive for those of us who don't take any meds.
There are thankfully still low cost options in most markets for those that take very few or no medications
@@GiardiniMedicare Please help us by naming some for us to look up. Thanks from SC
@@mariaw593 Premium prices available via the Medicare website. I paid $6 a year in 2024. It is going down to $0 in 2025
Why…how?
@@mariaw593 For South Carolina it would be Wellcare or Cigna
Great video!
Thanks for the video.
Are there any 0 premium for 2025 and what is the catch . This was first video that did an excellent job on explaining part d drug plan.
There are $0 premium plans in most states. There isn't much of a catch other than the plan premiums can and will change in the future, and the company will try to sell you a Medicare Advantage plan whenever possible.
Prior to 2025, I had always heard to just choose the lowest cost Part D plan. But then I started reading reviews of some of the plans, and for one in particular, almost all the comments were negative 1-star reviews. The biggest complaint was the company throwing up road blocks, like requiring prior authorization or simply denying the drug. I would think the latter (flat out denying the drug when the Medicare analysis shows the drug as covered) would be illegal or at least "wrong." So I guess my question is, how much should i take into account the star (1 - 5 stars) rating of each plan? I'm in CA and Cigna only has 2.5 stars. Might it be wise to pay more per year and stay with the plan I already have since I know they'll cover my drugs?
Hard to say. It depends on how much "paying more" it would actually cost. Hundreds more? I would say no. Up to $100 more? It could certainly make sense. Overall, all companies have plenty of online complaints, so it still generally just makes sense to go with the plan with the lowest overall costs (or close to it).
@@GiardiniMedicare Okay, thanks. It is $600 more, so, I like your advice 🙂
I am confused by the huge variance in premiums for example between Wellcare and AARP. The coverage appears to very similar. What am I missing?
The coverages are different and they cover some different medications (for example, the more expensive AARP plan generally has stronger coverage for more expensive medications). The plan that makes sense for you just comes down to the medications you are taking and the pharmacy you use.
I can't wait to see what mine would cost. Having tier 4-5 meds, I'll never get a plan for me. My Medicare Advantage Plan has an 800. out of pocket price for 2025. I'll stay with what I have. I'm so sick of not getting mail order, or 90 day supply. These plans are not good! I wouldn't pay that much!
I put my drugs in the pharmacy list and shows Wegovy and Rapatha as a co pay of 5k to 6k for these 2 drugs. How does the new 2k maximum out of pocket 🤷🏻♀️Thank you 🙏
That means they do not cover those drugs at all. You need to look for a plan that does.
Why are you taking these useless overpriced drugs? You believe the commercials?
@@stanley8574 I’m a medical professional and peptides occur naturally in the body. There are many pesticides known to benefit the human body, but USUALLY can’t be patented, so pharmaceutical companies aren’t interested in them, and the government makes SURE they can’t be legally sold to the public. This peptide is helpful in my CVD, so I’ve been prescribed it. I studied cell biology at Duke, and the microbiome at Harvard, they are clearing receptors that have been non-functional, it’s also rejuvenating DNA and boosting cells that have been reduced with age. It is KNOWN to rejuvenate the microbiome, and energize the midiocondria. I will stay on these peptides for the rest of my life, and I’m anti-pharmaceutical. We just got blessed a short-chain amino acid, a hormone, the building blocks of our body was ACTUALLY manipulated in a way big pharma found a way to patent it or it never would have become available.
Great video. One quick question on the $2000 cap. If I take a plan with lower premium and it estimates my total cost in the $4K range (all drugs are "covered" so no full price ones), if I take away the premium cost (let's say $300 per year) will my copays end at $2000 even if the Medicare comparison says my total cost will be $4K? In other words, am I right in assuming that the comparison engine isn't considering the $2K max? My current plan premium has gone from $20 to $100 and change.
Are your total drug costs showing more than $2,000 for the year? If so, there must be something wrong with the analysis since it should not say more than $2,000 when all meds are covered. Did you possible go over the quantity limits for a medication?
@@GiardiniMedicare Thanks for instant reply. I don't think so. The killer is an asthma inhaler. I will re-check the higher ones to make sure I am reading it correctly. The only one which came in under $2000 total had a premium of $100+ per month. None capped at $2000 out of pocket. However, it was my first shot for this year and so I will re-check. It sounds like you are saying that the Medicare engine DOES include the cap -- that alone is good information. For my drugs then, it should be premium plus $2000 (assuming all drugs are Medicare approved) as a max. Have I got that right?
If it'd help, I can post my findings as some folk, like me, learn from the comments and responses. Many thanks.
@@rkvt That is correct that Medicare.gov takes the $2,000 cap into account. If all the meds are covered then the estimated prescription costs should not be over $2,000 for the year. If it helps, you can also email us a PDF of the analysis to info@gmedicareteam.com and we can take a closer look if you want!
The yearly premium is included in the total for drug costs.
What if I'm currently not taking any medications, but 6 months from now my health declines and I need meds? What would be the best plan?
Unless you know which medications you would be prescribed in 6 months, that question is impossible to answer.
That's a really excellent question, though hard to answer. You might want to look at things like current medical symptoms, family history, etc to "guess" how you might get "sicker". Then, research which medications typically get prescribed for that affliction. Or maybe just get a comprehensive physical around October to get results before the deadline to pick a plan by early December each year.
This is exactly why most people buy insurance, in case of an adverse event so you have coverage. The govt estimators assume you will be on the same meds next yr but of course that is not always the case. They give you one clue but no health guarantee. So choose wisely, also based on plan reliability & reputation & service as your “mileage may vary” next year!
What happens if you use a prescription medication that is not on the Medicare Drug List? I take Armour Thyroid for 15 years and refuse to change to the synthetic version. My employer drug plan charges $13 to fill my prescription via mail order.
You would pay full price for it. You could try to get it cheaper through an outside source like Goodrx, and you can also request a formulary expectation to see if the Part D plan you enroll in will add it to your coverage.
Thanks Cameron. You always supply GREAT information. It is REALLY appreciated. Also, a little off topic question: If you need to go through underwriting for a Med Supplement plan, how far in advance do insurance companies let you apply via underwriting? 30 days, 60 days, 90 days?
There isn't a set time period, but this time of year it is generally 90 days
I am starting Medicare December 1 my birth month turning 65. Going with a Supplement plan and part D drug plan. How do I chose a Part D plan for 2024 (December) and make sure the Part D plan is right for me in 2025. Do I have to choose two Part D plans if the plan is changing in 2025 ?
You have to put in your medications and look at both 2024 and 2025 plans once you get to the results. There should be a plan option that works well for the month of December, and then also for 2025. If that happens, you can enroll in that plan for December and then keep it for next year.
You may have to apply for one plan just for December, and then before December 7th, you can apply for a different plan for 2025.
@@GiardiniMedicare thanks
Why not skip your 2024 part D, unless you take very expensive meds.
@@yeahright532 it's free , Wellcare, Florida
If I am on no medications which is the best Part D to buy? Seems to me with a $2000 max you should just buy the cheapest plan and use discount cards most of the time unless you are sure you will max out every year.
That is what we usually recommend!
The American way...being forced to buy Part D but not wanting to actually use it as it is cheaper to buy meds using discount cards and cash.
Also - if a drug you take is not on your plans formulary, the cost you pay for that drug does not go towards the $2,000 cap.
Great video and informative. But how can any regular folk to navigate this. It takes a degree to learn all these😂😂
Wellcare has a $0/mo premium plan and a $21/mo plan. The higher premium plan also costs more OOP for the drugs. Why would that be? Makes no sense.
Just depends on how each plan covers the different medications. It's not uncommon for low or no premium plans to make more sense based on your meds
Hi Cameron,
I have a Part D plan that costs $6 a year in premiums, and drops to $0 a yearin 2025. Why does this plan exist ? I'm wondering how it is profitable for the company.
Thanks,
Eric
Definitely an interesting one! A few of the reasons (in my opinion) are below, assuming you are talking about the company I am thinking of.
1. They receive subsidies from the government, as well as additional subsidies due to the new premium stabilization program
2. They are no longer paying brokers any commissions
3. It is a strategy to gain more market share so they have more Medicare Advantage clients in the future.
Be careful. They will automatically switch your suplemental Plan G or Plan N to the Advantage Plan.
@@GiardiniMedicare
(1): any mechanism other than a distribution of IRMAA dollars (presuming that is a thing) ?
(3): I'm not following your reasoning. In what way are advantage plans and this Part D plan linked ?
I've never used my Part D plan (I only signed up as something of an afterthought that it would be smart to not be exposed to the Part D penalty in the future) but I looked around the website today. If I chose a medication, I was given a list of pharmacies I could use and the medication cost. I wondered if the Plan D company kept part of the drug cost. There is also a deductible of about $500 a year that would fit that narrative. Seems like small potatoes though.
The Plan D website has a link to an online company that writes Rx. It is certainly more expensive than competitors so that strikes me as a 'profit sharing arrangement.'
Those were the only revenue generators I could drum up. On the flip side, each Plan D company has to pay for certain vaccinations.
Curious. Thanks for your thoughts
@@GiardiniMedicare I believe I have the same plan. My premiums were $6.oo for the year and now o for premiums. I just received info in the mail today and the cost for the drugs I take for 2025 have gone up in price. Thank you for the great info.
@@GiardiniMedicareAre you talking about Well Care? My dad & I use the same broker for our Medicare needs. Last year, they recommended Well Care to us as an alternative to Silverscript. My dad changed over to Well Care and I chose to stay with Silverscript. My premium for 2025 will be going from $5.30 to $28.30 a month. I contacted the broker and they suggested a Humana plan for me. When I emailed back asking about Well Care (which is available in my zip code), they didn’t respond!! I bet they don’t sell Well Care plans anymore and you might be correct about them not paying commissions.
Are you able to changes plans each year going forward without underwriting?
Part D plans? Yes
I will definitely be shopping this year. My monthly Part D premium for 2025 went up 700%.
Thanks Biden. You are taking my money to pay for your Medicare "enhancements". Taking from Peter to pay Paul.
show me the numbers
Yep, it's all President Biden's fault. I bet all your problems will disappear if Trump gets reelected. Don't forget about the $0 premium part D plans in many areas.
Most of us know the president didn't have a thing to do with this
@@kellybaumann1450 Most people are easily brainwashed...your government counts on that.
Asking for my wife - How can I tell the difference between Wellcare Classic and Wellcare Value if she takes no drugs? Thanks.
What exactly do you mean to tell the difference? If you're asking which one to choose, she can go with the one with the lowest overall yearly costs.