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This is horrifying to think if someone ends up on ALL of these meds like my Mom is, that she would be forced to go from pharmacy to pharmacy to get the best price. This is insanity for an elderly person.
@@chris5942 it is so terrible. I did it yesterday for my husband after surgery meds. I could not control what meds his surgeon sent to pharmacy. Usually, when he went to doctor I give him a list of meds his part D plan cover. 🤦♀️🙄
Another consideration when choosing a Part D: Last year when I compared, I drilled it down to the price for each of my drugs on the different plans. One pesky drug was jacking up the price on all choices. I discovered I could get it at Costco at a great price, not running it through Plan D. Saving what I do, it's worth it to buy that one med at Costco and the others through CVS using my Part D plan. Good luck, everyone!
@@maryanne9884 Yes, and if you don’t think you will ever reach your deductible, use GoodRx or other discount cards to save money instead of Plan costs.
There are other opportunities to save. Discounts are available through free sources like GoodRX. There are also online subscription plans such as Mark Cuban's CostPlus Drugs that may be less expensive than going through a particular Part D or Advantage plan.
Its pretty sad that in the united states of America in 2024 that we have to go through this confusion to buy a pill we can afford. Absolutely ridiculous!
Why can't we get a printed formulary for all drugs from all plans without adding the medications we take? If we had the formularies we could look at drugs that might be next in line for our medical problems.
You can go to each carriers website and look at their formularies. I suggest finding a good independent pharmacy. A good one with a pharmacist that will talk to you. They are out there.
The moral of the story is that you never know what can happen but do all you can while you are younger to be as healthy as humanly possible to mitigate the high number of drugs you will use when you have to go on medicare.
Why does nobody ever inform the public that higher cost medications do not have to go through your insurance company. You can have it priced without insurance especially through walmart and get a lower price. You can also compare prices with good rx and single care and choose your cheapest option at your cheapest pharmacy. Why does nobody ever inform the public that they have this option??? The people should know.
It should be obvious to any consumer that they can shop with or without insurance. I go to Canada and pay cash for some expensive prescriptions. But like everything else having to do with Medicare, it takes a lot of work and constant attention!
But isn't it the case that if you go outside of your Part D plan to buy medications, the money you spend does not count towards the max $2,000 out of pocket? (I really don't know if this is true. I'm asking a question here, not insinuating a caveat.)
Marvin Musick is the best for giving Medicare information! Medicare School is the best way to go for anything you want and need to know regarding Medicare! ❤ Thank you, Mr Marvin Musick for Your service! Amen.🙏😊❤
This video is wonderful, and I went to the link in the description where you can request a phone consultation and I got a call at exactly the date and time that I had requested and I spoke to a wonderful gentleman who is a pleasure to deal with and I was able to change my Plan G policy to one that cost only half as much as I’ve been paying! And I changed to a much cheaper Part D policy as well! There was no charge to me for the call or the consultation. I definitely recommend doing it! ❤❤❤❤
Thank you so much for sharing your experience! We're thrilled to hear that the video was helpful and that your phone consultation went so smoothly. It's wonderful to know that our representative was a pleasure to work with and helped you find significant savings on both your Plan G and Part D policies. Your kind recommendation means the world to us, and we’re delighted that we could make a difference for you. ❤❤❤❤ If you have any further questions or need assistance in the future, feel free to reach out to us at 800-864-8890. Thank you for trusting MedicareSchool.com!
So if my husband and I can barely dish out for a supplement plan and a drug coverage plan, we have to pay approximately $400 per month (together) because we both take a drug that is Tier 5. What are fixed income people supposed to do 😞
Be grateful you even have this coverage at all. My mother was ill for years and died before they had Part D. She was on all sorts of meds and had to pay for them all out of pocket. Even though it may seem costly its still a gift.
You could see if you qualify for Medicaid to help with cost, if you find that supplement plans are being very costly you may want to review other plans options that can be beneficial. If you would like for our team to help we are more than happy to. You can call us at 1-800-864-8890.
If you live in New York and are middle class with income over $24K you cannot get any special help from gov't . How can you possibly afford the high monthly premium for Plan N or G and then a drug plan which had risen by up t0 300%. Its outrageous..
You are to rich to be poor. In other words you make to much in an expensive cost of living state to get any type of assistance. Thousands of people are in the same boat. For many elderly in this boat it is already underwater.
Thank you for doing this. It's all very confusing. I actually was dealing with an agent and he printed out stuff from the Medicare site which showed prices. When I went on the Medicare site myself, I got very different numbers. I'm not sure why, but now I'm going to do the comparison and see why the numbers didn't make sense before. Again. Thanks for your help.
I am going from $3.50/month to $38.70/month due to the increased coverage. My current plan is the cheapest 2025 plan that I can get. My drug costs are about $1.25 for a 3 month supply. I am not happy with having a 11x increase in premiums. NY, zip 14435. Funny how the politicians don't talk about how they raised drug costs for many people.
@@jhfitgetting out of of WellCare. I cannot understand the techs who are foreign and they don’t know what they are doing. So much confusion and anxiety dealing with with this
The pharmacy manufacturers are loop holing the meant for good cap of $2,000 by jacking up prices elsewhere! The Government need to put a stop to this and change the law to allow FULL DRUG PRICE NEGOTIATIONS like they do in Europe!
Can you do a video about the difference between "basic" and "enhanced" Part D plans and how it applies out of pocket expenses to $2000 cap? It is very confusing. I have seen other You Tube channels talk about the two different plans and how each plan affects what amount is actually APPLIED to the maximum out of pocket cap ($2000) whether you actually paid it or not. If you paid less than the "standard benefit cost" of the medication, the higher benefit amount applies towards the $2000 cap. I would like to see Medicare School explain this in detail so I can make an informed decision on whether to go with a "basic" or an "enhanced" drug plan in 2025.
I also would like the Medicare School to explain the "enhanced" Part D plans. I ran across the following via google: "And you might spend even less if you’re one of the roughly 75% of Part D members with an “enhanced” Part D plan, which could provide extra credit toward the out-of-pocket cap. (When enhanced plans have benefits that reduce your out-of-pocket spending, the value of those benefits can count toward the $2,000 total.) As a result, you might reach the cap before paying $2,000 in out-of-pocket costs, a CMS spokesperson confirmed in an email."
@@cseward7192 Exactly. I would like to know how to find the “enhanced” Part D plans on Medicare.gov. I don’t see this designation on any of plans listed on Medicare.gov
@@cseward7192 Exactly. I would like to know how to find the “enhanced” Part D plans on Medicare.gov. I don’t see this designation on any of plans listed on Medicare.gov
@@flolacandola9396 Yea, we pay insurance to find out later what we need is not covered. No wonder the amount of Americans crossing the border in AZ to get their meds is growing. It all caters to Americans, for Dental, Pharmacy, and more.
I always have trouble understanding all these figures when I look at the drug plans for future enrolment since I am about to turn 66 and retirement keeps getting closer and closer. Could be sometime in 2025 since I am only working because I want to. This video helped me so much in understanding it. Thank You!
@@MedicareSchool Apparently the two different plans affect the true actual out of pocket expense cap ($2000) based on the "standard benefit cost" of the medication.
@@lexseec6124 It sure is confusing. That is why I asked Mr Musak to do a video explaining it all. I’ve seen other TH-cam channels discussing the two different plans but want to hear Medicare School explain it to us in full detail. The difference in the two plans is how the $2000 out of pocket cap is applied.
@@lexseec6124 Exactly, it is very confusing. I have seen other You Tube channels talk about the two different plans and how each plan affects what amount is actually APPLIED to the maximum out of pocket cap ($2000) whether you actually paid it or not. If you paid less than the "standard benefit cost" of the medication, the higher benefit amount applies towards the $2000 cap. I would like to see Medicare School explain this in detail so I can make an informed decision on whether to go with a "basic" or an "enhanced" drug plan in 2025.
How do I know what medications I may need in the coming year? What if it is NOT on the formulary? Perhaps a deep look at formularies in each plan is necessary
One example of one they took out of the formulary. My husband uses authorization cream that has a $99 co-pay in his current MAPD. When I ran the drugs through, this particular medication is no longer covered at all and he would have to pay full price which is over $500. We have never gotten this medication at all from the pharmacy because it is too expensive with all of the other medications he takes. It would have been good if part of the example used in the video would have been diabetic medicines such as jardiance. There are other ways to get medications either through Pharmacy drug cards, charitable pharmacies, and through the manufacturers programs. We get my husband's jardiance through bi cares.
If in the event something changes and you have a new prescription. You can ask your provider to write a formulary exception to the carrier and explain why you now need that added into the plan for the year. In most cases the carrier will accept.
Just be careful if you use an agent for Part D plans. Some are not offering WellCare as an option, because there is no commissions for WellCare plans. I seen a YT video where a trainer selling Medicare/AGS agent video's, said he would not be a part of what he would offer if it did not have a commission.
Thank you for the detailed explanation how to find the plan and pharmacy. As explained, so after patient spend $2000, go to phase 3, it is better to switch from generic drug to Brand Name Drug without patient to pay any?
I’m confused! When going over the M3P plan, he shows that in April the person reached the $2000 max out of pocket, but stated they would still be paying the $181.31 in this example, each month through December. I thought once the person reached the max out of pocket(which is inclusive of the plan and manufacturer payments) they wouldn’t pay any more out of pocket. So that’s not the case?
@@VM-123 , Please tell me where I’m wrong here. Without the payment plan, one drug costs $500/mo. In January the person gets their med and pays their deductible, $500, which leaves a balance of $1500. In February they get their next dose. They still have $90 to pay of their deductible, so they pay that and then owe 25% of $410= $102.50. So now they’re oop $692.50 and the plan and manufacturer have paid $307.50. In March the next med is purchased. The person pays their 25% of $500 =$125 and the plan/manufacturer pays $$375. Repeat for April. So at this point the person has paid OOP $942.50 and the plan/manufacturer has paid $1057.50. So $942.50 + $1057.50 =$2,000.00. The person has paid OOP $942.50, but on the payment plan the person pays OOP of $2000. As I understand it from the research I’ve done, the deductible, and person 25% and the plan/manufacturer payments all count towards the $2000 moop. But in the payment plan the person appears to pay the full $2000 OOP. Can you please clarify what I’ve got wrong?
Yes, add a couple of tier 4 drugs. Especially for pain. Oh my, you will pay 10 times what you should, be discriminated against, especially by CVS. No 3 months supply, no mail order or delivery. So people with crippling pain are treated the worst, in every way. As the Lilly commercials say; we will all get better when we're not blamed for our conditions, our pain not minimized. We'll all get better when Health Care gets better! Thank You
We would advise speaking with your provider about getting the generic to get that covered by the plan. Or you can ask for a formulary exception from your provider to get to the Part D carrier about getting that adding explaining why you take that medication.
If your plan has a $47 tier 3 copay, does the 25% still count towards the $2000? What if the plan offers a $300 deductible, does the $590 still count towards $2000?
@@stanley8574 yep, weird that was left out, that's gonna be a big factor of picking which plan to go with. one plan you may only be out like $500 but you've already hit the $2000 limit
My wife has Leukemia and recently (December 2023) had a stem cell transplant. Have been on Obama care which is so expensive. She is retired disability and will turn 65 July of 2025. We are horrified trying to take all this in and dreading what it will cost us. And the double whammy is the getting taxed on her Social Security which could help pay these ridiculous Cancer med costs. Lord help us.
Tell her to try to get expensive procedures done before turning 65. Get Part A and Part B, then get a supplement plan. Her enrollment starts 3 months before her birthday. She also needs a Part D plan with a supplement plan.as well. That's got to be cheaper than Obama care.
Sending prayer to you all, we are happy to help when it comes time for her enrollment to ensure you have the best coverage for her needs. You can give us a call at 1-800-864-8890. You all have a great week and we hope that we can be of assistance down the road!
@@threeftr3349 Plus I think if you are enrolling in Medicare for first time, they cannot deny you coverage based upon pre existing conditions, but you only get one shot at doing this and I think in first 60 days or 6 months, not sure which. Do enroll in Original with Supplemental, not Advantage. Yes, your premiums will increase with age like all plans do, but unless the government changes the way things work or the health org you choose goes bankrupt and out of business, you will be fine. Good thing is with a serious medical conditions, you can go anywhere in the country and to any doctor or specialist you want as long as you are Org+Sup.
Hope your wife get better soon.😮. These Drug Plans are fine with generics, anything else they cost $$$$.😮I found that all the blood thinner drugs are $500 and up for 30 days. Big Pharma is in the pockets of Congress. I hope they will fix this , but who knows?😮
What about the special programs that were used for drugs that were not in the formularies in 2024, are those drugs going to be in the formulary in 25? I’m thinking of inhalers in particular.
You can use out site to review for plans. Since you are not taking any prescriptions it's nothing wrong with getting the cheapest plan available. We advise watching the video that shows how to do this! medicareschool.com/rx-aep/
I just wanted to say how much I learned by watching your videos, and this one was dead on for me. My plan looked like its exploding for 2025 and I need to take a close look at all the plans again. However, you are missing another possible drug plan, besides a Part D or Medicare Advantage. The VA (for us vets.) I'll also be looking at what the VAs cost is for 2025. Not enthused about a mail order plan, but ....
If you are on a reasonable number of standard medications $10 a month for Good Rx Gold will cover your yearly medication for the price of one month of the plan D premium.
@@caspiana3623 The problem with that is some meds still cost an arm and a leg with Goodrx and because you are not on one of those drugs now does not mean you won't be on one next week. And I believe if you drop Plan D, you either may lose it for good or pay a yearly penalty if you try to get back on.
I was excited about the max out of pocket for Plan D. However, if I am prescribed a med in February 2025 that is not on my plan's covered med list, I have to pay for that med at my own expense. So the drug that would cost, let's say, $500 per month is on me until the next calendar year. Very disappointing.
If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
Please explain the higher-priced markets in the Northeast, especially the New York area. It's not as easy. Costs are prohibitive across the board. What would you do if you lived in those areas? I'd like to hear. My bet is to move.
In those areas, the cost is higher due to the higher population in the area. In these cases where premiums are higher they do offer advantage plans that work pretty well, or a lot of New Yorkers have decided to get onto Plan N which has a bit of a lower premium and more affordable for them. You can always give us a call we'd be happy to review those options along with you.
Please tell me what does a person do who picks their plan by Dec 7...plan starts Jan 1......mid Jan-Feb they get sick. Now they need to be on some tier 5 medication that is not covered by the plan they have chosen...so now what? They pay full price for it? Let's say Humira.......
If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
I always relied on my same agent every year. what a surprise with price increases. Same plan but different rx plan. Have to find out if my pharmacy will still be my provider.😢 could go to Rite Aid or Walgreens which are tanking in my area😢
The after spending $2000 on your meds being covered only applies to medications in their formulary. If a medication is not covered by a plan, it will not go toward the $2,000 total. Have to really pay attention to the small print.
We didn't know that at all that waiting for us after we get our retirement isnt shame to be confused at old age so now we have to be educated or what so corrupt system in usa😮😮😮
Exactly, and you have people that are a lot younger that get healthcare and don't cost them a dime and have to worry about what he just showed us. The system is right azz backwards.
I am sitting here thinking the same thing. I retired 5 years early to take care of my Mom. Now I am looking with horror upon what this will mean for me! I am NOT spending a day driving from pharmacy to pharmacy to get this laundry list of drugs. Just Say No To Drugs.
@@karenkoe7096 Because each drug will have a different price at different pharmacies. If you are on 5 or more meds, it may make sense to go to different pharmacies. It depends on the difference in price, especially if you taking a couple of expensive brand name drugs.
what about all the drug stores that have closed? CVS, and Walgreens closed. The pharmacy inside the grocery store closed. I have to drive 30 miles one way to find a pharmacy.
My deductible went from $0 to $590. Thank God I'm on insulin which is exempt from the deductible. I have to pay $35 for a 30-day supply. They also went from $47 copay for tier 3 medicine to 24% of total cost of that medicine. That's much much higher!!!😮
insane.. I just signed up for next year... the monthly premiums are 50 cents/mo and they send my drugs to my home via mail (90 day supply ) ..... whats wrong with that...
How can you tell if the plan you pick will cover a medication that you MIGHT need in 2025? It is disgusting that each plan can determine which drugs they will cover and won't cover. NOBODY knows what they might need in that year!!! AND why are the different pharmacies on the same plan that have preferred status charging different prices???? INSANITY!
Unfortunately there isn't a way that you can tell. However If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
@@MedicareSchool Thank you for the reply. The second part of my post is still confusing to me. If I get a prescription, how do I find out which pharmacy has the lowest price? Can I go back into Medicare.gov and put in the information since they are giving me that information in choosing a plan?
What prices do we pay before reaching the deductible? It implies that you pay full rx price until you reach the deductible. I have an Rx that would be $980 regular price so I think Ibwould have to get a $0 no deductible plan. Please clarify.
A major problem in choosing a plan is knowing what health care you will need in the future. The same holds true for Supplement or Advantage plans. An acquaintance was taking only two Tier 1 generic drugs and chose a very inexpensive plan with a high deductible for higher tier drugs. Unfortunately, he developed a rare condition that required a top tier drug to be taken for most of the year. A more expensive plan would have covered more of the cost. But even if he planned for such an event, it would still be a guess as to which plan would be a better deal over the year and whether it would make much of a difference in overall cost. Instead of this hodgepodge of health and drug plans, there should be uniform coverage for everyone when they need it. If this means raising the payroll deduction for Medicare, then do that. It is a lot easier for people to pay a bit more when working then to pay for a catastrophic unplanned expense in retirement. Another option is put a small Medicare tax on capital gains.
I’m new to Medicare and will be starting March of 25. Thank you for your very helpful and informative videos! I’m doing my homework now and do have a question regarding part D. We are Florida residents, but spend our summers in Minnesota. I’m leaning towards a G supplement and a part D RX plan. Are these D plans network based or is it more like Medi Gap without a network? Many thanks!!
Those are "networks", but not how you imagine. You can use those outside of your service area but you will likely pay a higher cost when you are picking up prescriptions since you are out of that area. That will likely be about a few dollars more when you are picking up medications.
That will likely come from their SS check or bank directly. They have to option of picking how they want that set up. But it wouldn't come out from the pharmacy!
So, you go to the doctor who prescribes a drug. It’s not like you get a piece of paper that you can take home and research prices. In NY the doctor electronically send the prescription to the pharmacy. So you need to have all this info before you go to the doctor, and you need to know in advance which med and who has the best price. It’s ridiculous.
$2k cap, but now my meds WILL NOT BE COVERED. I already need to find another primary care provider. I already cannot afford Medicare that I was forced onto and they tacked on a penalty for the rest of my life, because I was on a better and cheaper insurance until they went under.
With the new drug plan and if you are like my husband I, we both take a Tier 5 drug so we will both meet the $2,000 yearly deductible for drugs. The monthly cost of that drawn out over 12 months is $333.33 a month more. So basically paying for a supplement plan, the drug plan and adding the deductible to our monthly cost is around $815 per month for both of us and that does not include the $370 per month for both of us on part B. Basically $1,185 per month for both of us. We aren’t lucky to be able to take this costly coverage, we HAVE to because of our current health conditions. That cost will take up a huge part of our monthly living expenses. ☹️☹️☹️☹️
Wow, that's more than what most employer's contracted insurance co. would charge. This is not right to corner the elderly and force them into these options.. Insurance groups know, older people get sick. It's all greed, and CMS and the federal gov allows them to do this.
Rx payment plan would preclude your using Single care or good rx discount coupons to fill your rxs that are cheaper than your part D price for a particular rx.
@@julielee2596 None of these plans should have a premium, if the gov is giving $160-to 180 a month. It should be like Part A, zero premium if you quality for Medicare.
@Medicare School ... Right now I am on nothing. But, I guess there is no way to plan for the future? Such as, if I went to the doctor in January, and was diagnosed with colon or lung cancer, whatever, something serious. I wouldn't even know what I would be prescribed, to pick a D Plan (/pharmacy). Well, there is the cap. So, even with nothing, I am going to enroll in the payment plan option. It wasn't clear to me: Is there a premium for that, or an extra premium?
No extra premium, it would be written into your formulary from your provider essentially explaining why you now need that prescription added on the formulary.
Just a warning, I was on Gabapentin for 10 years. I’ve always struggled with my weight and not one doctor told me Gabapentin causes 10-15 pounds of weight gain per year.
The insurance companies/PBMs (all owned by same 3 companies), want you to go to their owned pharmacies/mail order. Patient steering at its finest, and you dont have a choice. Your local pharmacy will cease to exist because of their rules.
I have been paying almost $50 a month for the part D penalty. How is that going to be affected? Is it going to triple? Probably will stay on the same plan and I only take diclofenac and alendronate total monthly cost is Seven dollars co-pay.
Thank you so much for all you do! My Mom is on a very expensive Rx (Pegasys) and with all drug plans, she will be at the 2k max by February . So it seems as though any of the Rx plans would work for her. Trying to figure out what the difference would be between the WellCare zero monthly payment and say a plan that cost 43.00 dollars per month? Does the more expensive plan have a larger formulary ? Zero month cost seems almost unbelievable . Thanks again .
What we would advise looking into is asking for a formulary exception written by her provider to get that included in the plan you select formulary. You will want to keep in mind that WellCare tends to take a bit longer on this exception and it's not guaranteed that they would. But it could help with the cost in the long run!
If Wegovy is included in your drug plan's formulary but you are not diabetic (therefore not covered by Medicare) and your Dr agrees to prescribe for weight loss, is the cost counted against your out of pocket maximum?
I take it you meant that it's not included in the formulary since it's for weight loss and not for diabetes. If it's not in the formulary it is not going to count towards your $2000 out of pocket.
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Where can I do a side-by-side comparison of Medi-gap plans? Do you have a link you can share?
As a pharmacist, I love to watch these videos to make sure I know what’s going on for my patients.
We're glad you find the videos helpful!
This is horrifying to think if someone ends up on ALL of these meds like my Mom is, that she would be forced to go from pharmacy to pharmacy to get the best price. This is insanity for an elderly person.
@@chris5942 it is so terrible. I did it yesterday for my husband after surgery meds. I could not control what meds his surgeon sent to pharmacy. Usually, when he went to doctor I give him a list of meds his part D plan cover. 🤦♀️🙄
That is NOT how this works.
That is why you use the comparison charts to determine which pharmacy is the best to use with the lowest costs.
They make everything harder for the elderly & the sickest. It truly makes my blood boil. 🙏 for you & Mom.
My husband was discharge from hospital with 7 new meds. It was hard to get a good prices for it.
What is even sadder is that we the people of USA tolerate insurance company control and deliberate confusion.
Law makers make the rules but with suggestions from lobbyists for the drug and insurance companies.
Another consideration when choosing a Part D: Last year when I compared, I drilled it down to the price for each of my drugs on the different plans. One pesky drug was jacking up the price on all choices. I discovered I could get it at Costco at a great price, not running it through Plan D. Saving what I do, it's worth it to buy that one med at Costco and the others through CVS using my Part D plan. Good luck, everyone!
Interesting, thanks for sharing another possible savings scenario for people.
@@maryanne9884 Yes, and if you don’t think you will ever reach your deductible, use GoodRx or other discount cards to save money instead of Plan costs.
There are other opportunities to save. Discounts are available through free sources like GoodRX. There are also online subscription plans such as Mark Cuban's CostPlus Drugs that may be less expensive than going through a particular Part D or Advantage plan.
Ft
Absolutely.
Its pretty sad that in the united states of America in 2024 that we have to go through this confusion to buy a pill we can afford. Absolutely ridiculous!
Its not that confusing. Its no different than it has been. We have been changing plans every year for years. If I can do it so can anyone else.
@karenkoe7096 still shouldn't be like a card playing game sort of speak to get medications !!! Drug plans is a mess with pharmacies and prices!!!!
Agree, now I'm 66, whose going to want to do this at 85?
@@karenkoe7096, It's a hott mess what we have to go thru to purchase medication!🙄
Why can't we get a printed formulary for all drugs from all plans without adding the medications we take? If we had the formularies we could look at drugs that might be next in line for our medical problems.
You can go to each carriers website and look at their formularies. I suggest finding a good independent pharmacy. A good one with a pharmacist that will talk to you. They are out there.
@@rebeccahiggins6341 yes yes and YES to this
The moral of the story is that you never know what can happen but do all you can while you are younger to be as healthy as humanly possible to mitigate the high number of drugs you will use when you have to go on medicare.
Why does nobody ever inform the public that higher cost medications do not have to go through your insurance company. You can have it priced without insurance especially through walmart and get a lower price. You can also compare prices with good rx and single care and choose your cheapest option at your cheapest pharmacy. Why does nobody ever inform the public that they have this option??? The people should know.
It should be obvious to any consumer that they can shop with or without insurance. I go to Canada and pay cash for some expensive prescriptions. But like everything else having to do with Medicare, it takes a lot of work and constant attention!
But isn't it the case that if you go outside of your Part D plan to buy medications, the money you spend does not count towards the max $2,000 out of pocket? (I really don't know if this is true. I'm asking a question here, not insinuating a caveat.)
Marvin Musick is the best for giving Medicare information! Medicare School is the best way to go for anything you want and need to know regarding Medicare! ❤ Thank you, Mr Marvin Musick for Your service! Amen.🙏😊❤
It is our pleasure!
You have a great staff! Very helpful, professional, and knowledgeable.
That is wonderful to hear, thank you for sharing! :)
This video is wonderful, and I went to the link in the description where you can request a phone consultation and I got a call at exactly the date and time that I had requested and I spoke to a wonderful gentleman who is a pleasure to deal with and I was able to change my Plan G policy to one that cost only half as much as I’ve been paying! And I changed to a much cheaper Part D policy as well! There was no charge to me for the call or the consultation. I definitely recommend doing it! ❤❤❤❤
Thank you so much for sharing your experience! We're thrilled to hear that the video was helpful and that your phone consultation went so smoothly. It's wonderful to know that our representative was a pleasure to work with and helped you find significant savings on both your Plan G and Part D policies. Your kind recommendation means the world to us, and we’re delighted that we could make a difference for you. ❤❤❤❤
If you have any further questions or need assistance in the future, feel free to reach out to us at 800-864-8890. Thank you for trusting MedicareSchool.com!
So if my husband and I can barely dish out for a supplement plan and a drug coverage plan, we have to pay approximately $400 per month (together) because we both take a drug that is Tier 5. What are fixed income people supposed to do 😞
Be grateful you even have this coverage at all. My mother was ill for years and died before they had Part D. She was on all sorts of meds and had to pay for them all out of pocket. Even though it may seem costly its still a gift.
Remember there is a $2, 000 Cap on your medicine cost
donut hole gone I heard
Does Medicaid help with that
You could see if you qualify for Medicaid to help with cost, if you find that supplement plans are being very costly you may want to review other plans options that can be beneficial. If you would like for our team to help we are more than happy to. You can call us at 1-800-864-8890.
If you live in New York and are middle class with income over $24K you cannot get any special help from gov't . How can you possibly afford the high monthly premium for Plan N or G and then a drug plan which had risen by up t0 300%. Its outrageous..
You are to rich to be poor.
In other words you make to much in an expensive cost of living state to get any type of assistance. Thousands of people are in the same boat. For many elderly in this boat it is already underwater.
Thanks for a really good video. It would be helpful if you included some of the brand name medications for those who aren't able to take generics.
Thank you Uncle Sam for trying to keep my old brain functioning and keeping dementia at bay by trying to deal with the IRS and health plans.
Very well explained, thank you.
Melvin is the best teacher.
@@UncleDavesKitchen he really is..
You're very welcome, we're happy to help :)
Thank you for doing this. It's all very confusing. I actually was dealing with an agent and he printed out stuff from the Medicare site which showed prices. When I went on the Medicare site myself, I got very different numbers. I'm not sure why, but now I'm going to do the comparison and see why the numbers didn't make sense before. Again. Thanks for your help.
If they get rid of the middleman in drugs the cost of tier 3 and higher drugs would be greatly reduced!
I am going from $3.50/month to $38.70/month due to the increased coverage. My current plan is the cheapest 2025 plan that I can get. My drug costs are about $1.25 for a 3 month supply. I am not happy with having a 11x increase in premiums. NY, zip 14435. Funny how the politicians don't talk about how they raised drug costs for many people.
Same with me . Wellcare
Same here from $5.30 to $40.30 SMH😯
@@jhfitgetting out of of WellCare. I cannot understand the techs who are foreign and they don’t know what they are doing. So much confusion and anxiety dealing with with this
Thanks Marvin 😊
Our pleasure!
Hi Marvin, this was so well explained, Thank you for this information.
Glad it was helpful!
My part d monthly fee went from 74.00 to 102.00 next year. WellCare.
Don't some stand alone D Plans like Wellcare have have coinsurance rather than copays for brand-name drugs? Please explain this.
The pharmacy manufacturers are loop holing the meant for good cap of $2,000 by jacking up prices elsewhere! The Government need to put a stop to this and change the law to allow FULL DRUG PRICE NEGOTIATIONS like they do in Europe!
Can you do a video about the difference between "basic" and "enhanced" Part D plans and how it applies out of pocket expenses to $2000 cap? It is very confusing. I have seen other You Tube channels talk about the two different plans and how each plan affects what amount is actually APPLIED to the maximum out of pocket cap ($2000) whether you actually paid it or not. If you paid less than the "standard benefit cost" of the medication, the higher benefit amount applies towards the $2000 cap. I would like to see Medicare School explain this in detail so I can make an informed decision on whether to go with a "basic" or an "enhanced" drug plan in 2025.
Thank you for the recommendation!
I also would like the Medicare School to explain the "enhanced" Part D plans. I ran across the following via google: "And you might spend even less if you’re one of the roughly 75% of Part D members with an “enhanced” Part D plan, which could provide extra credit toward the out-of-pocket cap. (When enhanced plans have benefits that reduce your out-of-pocket spending, the value of those benefits can count toward the $2,000 total.) As a result, you might reach the cap before paying $2,000 in out-of-pocket costs, a CMS spokesperson confirmed in an email."
@@cseward7192 Exactly. I would like to know how to find the “enhanced” Part D plans on Medicare.gov. I don’t see this designation on any of plans listed on Medicare.gov
@@cseward7192 Exactly. I would like to know how to find the “enhanced” Part D plans on Medicare.gov. I don’t see this designation on any of plans listed on Medicare.gov
But how we could predicted our future. How I know do I’ll need any meds besides I used today?
you can’t
Now if only all of us had a crystal ball…
We can’t that’s why we pay insurance.
@@flolacandola9396 Yea, we pay insurance to find out later what we need is not covered. No wonder the amount of Americans crossing the border in AZ to get their meds is growing. It all caters to Americans, for Dental, Pharmacy, and more.
I’m thoroughly confused! Gee whiz! There goes my monthly budget! Great. Just great! Can’t afford it!
@marksmith4582 Call them, and they will find an affordable plan with you.
Why don't' you call an insurance broker to help you. They don't charge. The company doing these videos can probably help out.
ZERO RX drugs... it's frustrating to have to have a plan or be penalized for not signing up at 65 regardless of need... stupid
I totally agree!
Thank you for your knowledge and experience!
You're very welcome!
I always have trouble understanding all these figures when I look at the drug plans for future enrolment since I am about to turn 66 and retirement keeps getting closer and closer. Could be sometime in 2025 since I am only working because I want to. This video helped me so much in understanding it. Thank You!
Glad that is was so helpful!
You are a godsend. Thank you for your videos.
It is our pleasure, thank you!
I just paid 94.95 for 1. ( one pill ). Insane
That's insane!!!
What was the pill? That is really expensive. Can't imagine paying for that daily, weekly?
What on earth is it????
It was most likely $3.25 in India
You can thank your for profit insurance company and their owned PBMs. They are scumbags and are eating away at our healthcare system.
Sad that we can't afford some of our meds and tests but the ceo's of advantage plans get a yearly million dollar bonus
Thank you so much. Great information.
Glad it was helpful!
Can you do a video explaining the difference between “basic” and “enhanced” Part D drug plans?
Thank you for that recommendation!
@@MedicareSchool Apparently the two different plans affect the true actual out of pocket expense cap ($2000) based on the "standard benefit cost" of the medication.
What does that even mean??
@@lexseec6124 It sure is confusing. That is why I asked Mr Musak to do a video explaining it all. I’ve seen other TH-cam channels discussing the two different plans but want to hear Medicare School explain it to us in full detail. The difference in the two plans is how the $2000 out of pocket cap is applied.
@@lexseec6124 Exactly, it is very confusing. I have seen other You Tube channels talk about the two different plans and how each plan affects what amount is actually APPLIED to the maximum out of pocket cap ($2000) whether you actually paid it or not. If you paid less than the "standard benefit cost" of the medication, the higher benefit amount applies towards the $2000 cap. I would like to see Medicare School explain this in detail so I can make an informed decision on whether to go with a "basic" or an "enhanced" drug plan in 2025.
Thanks. This was a very informative video. ❤
I did Well Care $0 premium and very happy with the costs. Gabapentin is an expensive one on the plan.
But don't a lot of the drugs covered don't take effect until January 2026? Like Eliquis?
Why don’t you ad an expensive drug commonly pushed like eliquis?
Does the $590 deductible count towards meeting the $2,000 per year spending cap?
Yes it does!
How do I know what medications I may need in the coming year? What if it is NOT on the formulary? Perhaps a deep look at formularies in each plan is necessary
No one can predict that. All you can do is chose what is best for you currently.
One example of one they took out of the formulary. My husband uses authorization cream that has a $99 co-pay in his current MAPD. When I ran the drugs through, this particular medication is no longer covered at all and he would have to pay full price which is over $500. We have never gotten this medication at all from the pharmacy because it is too expensive with all of the other medications he takes. It would have been good if part of the example used in the video would have been diabetic medicines such as jardiance. There are other ways to get medications either through Pharmacy drug cards, charitable pharmacies, and through the manufacturers programs. We get my husband's jardiance through bi cares.
If in the event something changes and you have a new prescription. You can ask your provider to write a formulary exception to the carrier and explain why you now need that added into the plan for the year. In most cases the carrier will accept.
In your example with the added drugs, I would stay with WellCare and buy the expensive drugs through Gold RX. It would be way, way cheaper that way.
Just be careful if you use an agent for Part D plans. Some are not offering WellCare as an option, because there is no commissions for WellCare plans. I seen a YT video where a trainer selling Medicare/AGS agent video's, said he would not be a part of what he would offer if it did not have a commission.
@@threeftr3349 You can contact them directly. Great company for Tier 1 drugs.
Thank you for the detailed explanation how to find the plan and pharmacy. As explained, so after patient spend $2000, go to phase 3, it is better to switch from generic drug to Brand Name Drug without patient to pay any?
Always helpful and easy to understand information (or as easy as Medicare information can be)!
Glad that we can help!
I’m confused! When going over the M3P plan, he shows that in April the person reached the $2000 max out of pocket, but stated they would still be paying the $181.31 in this example, each month through December. I thought once the person reached the max out of pocket(which is inclusive of the plan and manufacturer payments) they wouldn’t pay any more out of pocket. So that’s not the case?
It was basically spread out over the year. In the example, the person did not pay the $2,000 up front.
@@VM-123 , Please tell me where I’m wrong here. Without the payment plan, one drug costs $500/mo. In January the person gets their med and pays their deductible, $500, which leaves a balance of $1500. In February they get their next dose. They still have $90 to pay of their deductible, so they pay that and then owe 25% of $410= $102.50. So now they’re oop $692.50 and the plan and manufacturer have paid $307.50. In March the next med is purchased. The person pays their 25% of $500 =$125 and the plan/manufacturer pays $$375. Repeat for April. So at this point the person has paid OOP $942.50 and the plan/manufacturer has paid $1057.50. So $942.50 + $1057.50 =$2,000.00. The person has paid OOP $942.50, but on the payment plan the person pays OOP of $2000.
As I understand it from the research I’ve done, the deductible, and person 25% and the plan/manufacturer payments all count towards the $2000 moop. But in the payment plan the person appears to pay the full $2000 OOP.
Can you please clarify what I’ve got wrong?
Excellent video,thanks!
Glad you liked it! If you have any questions please give us a call at 800-864-8890.
Yes, add a couple of tier 4 drugs. Especially for pain. Oh my, you will pay 10 times what you should, be discriminated against, especially by CVS. No 3 months supply, no mail order or delivery. So people with crippling pain are treated the worst, in every way. As the Lilly commercials say; we will all get better when we're not blamed for our conditions, our pain not minimized. We'll all get better when Health Care gets better! Thank You
What if you take a brand drug that is not in your formulary that costs 600 a month. Is it covered?
If its not in the formulary its not covered.
We would advise speaking with your provider about getting the generic to get that covered by the plan. Or you can ask for a formulary exception from your provider to get to the Part D carrier about getting that adding explaining why you take that medication.
@MedicareSchool Thank You, love your videos !
If your plan has a $47 tier 3 copay, does the 25% still count towards the $2000? What if the plan offers a $300 deductible, does the $590 still count towards $2000?
Yes it does
@@stanley8574 yep, weird that was left out, that's gonna be a big factor of picking which plan to go with. one plan you may only be out like $500 but you've already hit the $2000 limit
This is criminal! Seems like 52 card Monte😡
My wife has Leukemia and recently (December 2023) had a stem cell transplant. Have been on Obama care which is so expensive. She is retired disability and will turn 65 July of 2025. We are horrified trying to take all this in and dreading what it will cost us. And the double whammy is the getting taxed on her Social Security which could help pay these ridiculous Cancer med costs. Lord help us.
praying with you🙏
Tell her to try to get expensive procedures done before turning 65. Get Part A and Part B, then get a supplement plan. Her enrollment starts 3 months before her birthday. She also needs a Part D plan with a supplement plan.as well. That's got to be cheaper than Obama care.
Sending prayer to you all, we are happy to help when it comes time for her enrollment to ensure you have the best coverage for her needs. You can give us a call at 1-800-864-8890. You all have a great week and we hope that we can be of assistance down the road!
@@threeftr3349 Plus I think if you are enrolling in Medicare for first time, they cannot deny you coverage based upon pre existing conditions, but you only get one shot at doing this and I think in first 60 days or 6 months, not sure which. Do enroll in Original with Supplemental, not Advantage. Yes, your premiums will increase with age like all plans do, but unless the government changes the way things work or the health org you choose goes bankrupt and out of business, you will be fine. Good thing is with a serious medical conditions, you can go anywhere in the country and to any doctor or specialist you want as long as you are Org+Sup.
Hope your wife get better soon.😮. These Drug Plans are fine with generics, anything else they cost $$$$.😮I found that all the blood thinner drugs are $500 and up for 30 days. Big Pharma is in the pockets of Congress. I hope they will fix this , but who knows?😮
Excellent as always
We're here to help keep you updated!
!!!!!!!!!!!!!!!!!!!!!!! Insane in the membrane. Feel like I'm on a Roller Coaster Ride!!! LoL
This is such a confusing mess my head is spinning
And it's done this way purposely to confuse us..lovely😢
My mind is spinning too
What about the special programs that were used for drugs that were not in the formularies in 2024, are those drugs going to be in the formulary in 25? I’m thinking of inhalers in particular.
I am 69 and don't take any prescription drugs. How would I decide on a plan.
You can use out site to review for plans. Since you are not taking any prescriptions it's nothing wrong with getting the cheapest plan available. We advise watching the video that shows how to do this! medicareschool.com/rx-aep/
I just wanted to say how much I learned by watching your videos, and this one was dead on for me. My plan looked like its exploding for 2025 and I need to take a close look at all the plans again.
However, you are missing another possible drug plan, besides a Part D or Medicare Advantage. The VA (for us vets.) I'll also be looking at what the VAs cost is for 2025. Not enthused about a mail order plan, but ....
Did you compare to GoodRx?
If you are on a reasonable number of standard medications $10 a month for Good Rx Gold will cover your yearly medication for the price of one month of the plan D premium.
Good RX is BEST
Ridiculous
@@caspiana3623 The problem with that is some meds still cost an arm and a leg with Goodrx and because you are not on one of those drugs now does not mean you won't be on one next week. And I believe if you drop Plan D, you either may lose it for good or pay a yearly penalty if you try to get back on.
I was excited about the max out of pocket for Plan D. However, if I am prescribed a med in February 2025 that is not on my plan's covered med list, I have to pay for that med at my own expense. So the drug that would cost, let's say, $500 per month is on me until the next calendar year. Very disappointing.
@@Rustic307 I wonder the same. No one knows what drug they may be on down the road
If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
@@MedicareSchool Thank you!
Please explain the higher-priced markets in the Northeast, especially the New York area. It's not as easy. Costs are prohibitive across the board. What would you do if you lived in those areas? I'd like to hear. My bet is to move.
In those areas, the cost is higher due to the higher population in the area. In these cases where premiums are higher they do offer advantage plans that work pretty well, or a lot of New Yorkers have decided to get onto Plan N which has a bit of a lower premium and more affordable for them. You can always give us a call we'd be happy to review those options along with you.
It’s what happens when you live in a Socialist Utopia, just like my state California.
Please tell me what does a person do who picks their plan by Dec 7...plan starts Jan 1......mid Jan-Feb they get sick. Now they need to be on some tier 5 medication that is not covered by the plan they have chosen...so now what? They pay full price for it? Let's say Humira.......
If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
Thank you, Marvin, you are a great teacher
Glad you found the video helpful!
I always relied on my same agent every year. what a surprise with price increases. Same plan but different rx plan. Have to find out if my pharmacy will still be my provider.😢 could go to Rite Aid or Walgreens which are tanking in my area😢
The after spending $2000 on your meds being covered only applies to medications in their formulary. If a medication is not covered by a plan, it will not go toward the $2,000 total. Have to really pay attention to the small print.
We didn't know that at all that waiting for us after we get our retirement isnt shame to be confused at old age so now we have to be educated or what so corrupt system in usa😮😮😮
Exactly, and you have people that are a lot younger that get healthcare and don't cost them a dime and have to worry about what he just showed us. The system is right azz backwards.
I am sitting here thinking the same thing. I retired 5 years early to take care of my Mom. Now I am looking with horror upon what this will mean for me! I am NOT spending a day driving from pharmacy to pharmacy to get this laundry list of drugs. Just Say No To Drugs.
@@chris5942 Why would think that you have to drive from pharmacy to pharmacy?
@@karenkoe7096 Because each drug will have a different price at different pharmacies. If you are on 5 or more meds, it may make sense to go to different pharmacies. It depends on the difference in price, especially if you taking a couple of expensive brand name drugs.
what about all the drug stores that have closed?
CVS, and Walgreens closed. The pharmacy inside the grocery store closed.
I have to drive 30 miles one way to find a pharmacy.
My deductible went from $0 to $590. Thank God I'm on insulin which is exempt from the deductible. I have to pay $35 for a 30-day supply. They also went from $47 copay for tier 3 medicine to 24% of total cost of that medicine. That's much much higher!!!😮
I think there is a ceiling for total costs. Most of us have a deductible for some time.
I love Origal Medicare A and B plus stand alone pard D
insane.. I just signed up for next year... the monthly premiums are 50 cents/mo and they send my drugs to my home via mail (90 day supply ) ..... whats wrong with that...
How can you tell if the plan you pick will cover a medication that you MIGHT need in 2025? It is disgusting that each plan can determine which drugs they will cover and won't cover. NOBODY knows what they might need in that year!!! AND why are the different pharmacies on the same plan that have preferred status charging different prices???? INSANITY!
Unfortunately there isn't a way that you can tell. However If the medication isn't covered by your insurance plan's formulary, it won't count towards your $2,000 out-of-pocket maximum. You can ask your doctor to request a formulary exception from your insurance company. They can explain your new diagnosis and the need for this medication. In many cases, with a detailed explanation, your insurance company will approve the exception.
@@MedicareSchool Thank you for the reply. The second part of my post is still confusing to me. If I get a prescription, how do I find out which pharmacy has the lowest price? Can I go back into Medicare.gov and put in the information since they are giving me that information in choosing a plan?
i guess i'm an idiot. where do i go to get this info? what web site?
Medicare
He’s creating these scenarios straight from medicare.gov
I am not understood how I could enrolled to payment plan? Do I need to call to my part D plan or it is something else?
When you get your enrollment packet from the carrier that will be listed in the paperwork how to go about getting set up on payment plans!
@@MedicareSchool thank you 🙏🏻
What prices do we pay before reaching the deductible? It implies that you pay full rx price until you reach the deductible.
I have an Rx that would be $980 regular price so I think Ibwould have to get a $0 no deductible plan. Please clarify.
A major problem in choosing a plan is knowing what health care you will need in the future. The same holds true for Supplement or Advantage plans. An acquaintance was taking only two Tier 1 generic drugs and chose a very inexpensive plan with a high deductible for higher tier drugs. Unfortunately, he developed a rare condition that required a top tier drug to be taken for most of the year. A more expensive plan would have covered more of the cost. But even if he planned for such an event, it would still be a guess as to which plan would be a better deal over the year and whether it would make much of a difference in overall cost. Instead of this hodgepodge of health and drug plans, there should be uniform coverage for everyone when they need it. If this means raising the payroll deduction for Medicare, then do that. It is a lot easier for people to pay a bit more when working then to pay for a catastrophic unplanned expense in retirement. Another option is put a small Medicare tax on capital gains.
My drug plan went up 1000. %
I’m new to Medicare and will be starting March of 25. Thank you for your very helpful and informative videos! I’m doing my homework now and do have a question regarding part D. We are Florida residents, but spend our summers in Minnesota. I’m leaning towards a G supplement and a part D RX plan. Are these D plans network based or is it more like Medi Gap without a network?
Many thanks!!
Those are "networks", but not how you imagine. You can use those outside of your service area but you will likely pay a higher cost when you are picking up prescriptions since you are out of that area. That will likely be about a few dollars more when you are picking up medications.
Many thanks!
Where is that payment each month taken out of…social security check or payment at the pharmacy?
That will likely come from their SS check or bank directly. They have to option of picking how they want that set up. But it wouldn't come out from the pharmacy!
is the $2000 cap on OOP apply to all tier costs?
Anything spent on prescriptions go toward to max out of pocket, including the deductible as well.
thx for this update
Of course!
I am on UHC special needs plan . Can I get on Medicare g plan and what would be a good prescription plan
You can call our office our team would be happy to help with a review, you can call our office at 1-800-864-8890!
So, you go to the doctor who prescribes a drug. It’s not like you get a piece of paper that you can take home and research prices. In NY the doctor electronically send the prescription to the pharmacy. So you need to have all this info before you go to the doctor, and you need to know in advance which med and who has the best price.
It’s ridiculous.
Does the 2,000 deductible include medications that are NOT covered by your part D plan
No, they must be included in the formulary for it to apply towards the $2,000 cap!
$2k cap, but now my meds WILL NOT BE COVERED. I already need to find another primary care provider. I already cannot afford Medicare that I was forced onto and they tacked on a penalty for the rest of my life, because I was on a better and cheaper insurance until they went under.
Something doesn't sound right about that. You must have delayed signing up for Medicare.
@@karenkoe7096 Why are we penalized for not wanting to pay for something we don't need.
What website url is being k g used in the video to compare side by side the plan companies and with our meds?
With the new drug plan and if you are like my husband I, we both take a Tier 5 drug so we will both meet the $2,000 yearly deductible for drugs. The monthly cost of that drawn out over 12 months is $333.33 a month more. So basically paying for a supplement plan, the drug plan and adding the deductible to our monthly cost is around $815 per month for both of us and that does not include the $370 per month for both of us on part B. Basically $1,185 per month for both of us.
We aren’t lucky to be able to take this costly coverage, we HAVE to because of our current health conditions. That cost will take up a huge part of our monthly living expenses. ☹️☹️☹️☹️
Wow, that's more than what most employer's contracted insurance co. would charge. This is not right to corner the elderly and force them into these options.. Insurance groups know, older people get sick. It's all greed, and CMS and the federal gov allows them to do this.
Rx payment plan would preclude your using Single care or good rx discount coupons to fill your rxs that are cheaper than your part D price for a particular rx.
are the premiums included in the 2,000 out of pocket for the year?
No. Consumer pays the policy premiums, plus first $2k of expenses.
@@julielee2596 None of these plans should have a premium, if the gov is giving $160-to 180 a month. It should be like Part A, zero premium if you quality for Medicare.
No premiums are not included in the our of pocket amount. If you have a deductible that however is included!
@Medicare School ... Right now I am on nothing. But, I guess there is no way to plan for the future? Such as, if I went to the doctor in January, and was diagnosed with colon or lung cancer, whatever, something serious. I wouldn't even know what I would be prescribed, to pick a D Plan (/pharmacy). Well, there is the cap. So, even with nothing, I am going to enroll in the payment plan option. It wasn't clear to me: Is there a premium for that, or an extra premium?
No extra premium, it would be written into your formulary from your provider essentially explaining why you now need that prescription added on the formulary.
Anyone have the Medicare part D website link for those prescription coverage comparisons? Thank you
Here is a link for Part D comparison! medicareschool.com/rx-aep/
Thank you
Our pleasure!
Im soo freaking confused
Just a warning, I was on Gabapentin for 10 years. I’ve always struggled with my weight and not one doctor told me Gabapentin causes 10-15 pounds of weight gain per year.
What about Retired Postal Employees that are staying with our PSHB Plan ? Will our Meds still be Covered by our PSHB Plan ?
Meds can be covered by that plan.
Things are getting worst
What about local pharmacy
The insurance companies/PBMs (all owned by same 3 companies), want you to go to their owned pharmacies/mail order. Patient steering at its finest, and you dont have a choice. Your local pharmacy will cease to exist because of their rules.
People on diabetes meds such as Ozempic victoza or jardiance are really hurting they are so high
I have been paying almost $50 a month for the part D penalty. How is that going to be affected? Is it going to triple? Probably will stay on the same plan and I only take diclofenac and alendronate total monthly cost is Seven dollars co-pay.
The penalty will be the same
I’m retiring!!!! I shouldn’t have to look at what’s available every time we have to take a new medicine. It is easier when I’m working.
My part D went up $9.80 to $40.00.
Thank you so much for all you do!
My Mom is on a very expensive Rx (Pegasys) and with all drug plans, she will be at the 2k max by February . So it seems as though any of the Rx plans would work for her. Trying to figure out what the difference would be between the WellCare zero monthly payment and say a plan that cost 43.00 dollars per month? Does the more expensive plan have a larger formulary ? Zero month cost seems almost unbelievable .
Thanks again .
What we would advise looking into is asking for a formulary exception written by her provider to get that included in the plan you select formulary. You will want to keep in mind that WellCare tends to take a bit longer on this exception and it's not guaranteed that they would. But it could help with the cost in the long run!
Good thing my Medicare Advantage plan has no changes in costs or coverages for 2025, including drug costs.
If Wegovy is included in your drug plan's formulary but you are not diabetic (therefore not covered by Medicare) and your Dr agrees to prescribe for weight loss, is the cost counted against your out of pocket maximum?
I take it you meant that it's not included in the formulary since it's for weight loss and not for diabetes. If it's not in the formulary it is not going to count towards your $2000 out of pocket.