I am paying a part D premium to Medicare every month. Do I understand it correctly that all this premium does is give me the right to sign up with a 3rd party insurance company that will actually cover (partially) the price of any drugs I might require? I currently have retiree health insurance through my final employer and, as part of that, Express Scripts which apparently is the part D provider I'd use when I need drugs. I don't understand what the Medicare part D premium buys for someone, except the privilege of shopping around for an additional monthly premium to cover drug expenses (which is probably a good thing). Am I right?
Hi @linybob - Part D is important to have since it does help with your cost of medications and it also prevents you from having a lifelong penalty. Having a drug plan is optional, but for each month you go without coverage, you are accruing a penalty. Additionally, you can only sign up for a drug plan during the Annual Election Period each year, so if you need a drug in the middle of the year and you don't have coverage, you will have to wait until the enrollment period to enroll into a plan.
I take two decades old generics. Companies play games and don't put them into Tier 1 or even Tier 2. I end up just using GoodRx rather than pay through the nose going through insurance. This is why I got the lowest premium plan.
Hi There - Yes you do! You will receive a Explanation of Benefits quarterly with all of your drug charges and it will also mention what stage you are in.
Part D is so confusing. I think I’m starting to get it now after watching though so thanks... One question though.. can we use a discount program with our Part D plan to help with our copays or the donut hole?
thanks for watching! You can apply for a Formulary exception on your plan - if you are a Boomer Benefits client, we can do this for you. You can also use CleverRX coupons and change your plan during the Annual Election Period in the fall each year to get a plan that does cover all of your medications!
Orgovyx (brand name = Relugolix) "retail cost = $2,950/month." My "share" = $850/month. Now, in catastrophic coverage the 5% would cost me $147/month. What a wonderful savings, eh? Nope, same med in India = $90 per month. Welcome to America and the PharmaKing empire.
My husband Medicare Part B became effective 12/2022. At this time he still had his Employer Health Insurance plan which terminated on 03/31/23. He attempted to apply for the Part D ( drug prescription plan )and was told that he had to wait until the next enrollment period. Is there not a special enrollment period? He has been offered COBRA but is unsure if we will need it or not as a secondary to Medicare . He has met his employer insurance deductible for the year and his coverage will state the same. After looking at the video I’m not sure if we should continue with the COBRA or apply for the Part D prescription plan . He also Has a medical condition that requires expensive medications and treatments.I’m open to suggestions.
HI LaTasha - Did his employer have more than 20 employees? If so, he will have 60 days to qualify for a special election period due to leaving employer coverage. I would recommend us for more information - 817-249-8600.
Substitute the word "price" for "cost". When the price of a medication varies by factors of 4 or 5, the issue isn't the COST of the drug. It's the pricing.
If I go through Cost Plus or Amazon is it possible that I will pay less? I'm not yet 65 so figuring things out but am wondering if I can use those online pharmacies and if Medicare will track those costs. In other words, if I purchase a part D plan, can I still use those online pharmacies if the cost is less?
Hi Rebecca - You can use Cost Plus, Amazon, or other discount coupons when you have a Part D plan. However, those costs will not apply to your Part D costs. So, whatever you pay using those alternatives will be completely out of pocket, and your plan won't keep track of those costs.
When I try to compare plans after entering my prescriptions and pharmacies the total est. cost is $XXX "partial year" I of course want to know what a full year would cost, how do I do that?
Hi @2wrdr - It is because we are in the middle of the year! Your Drug plan is only calendar year, so you cannot see more than August - December at the moment.
@@BoomerBenefits Is there a way I can see a full year? I'm on monthly Dupixent. If D plans have a cap Dupixent would be one to max it out so then my real cost would be much higher?
Each plan works the exact same way. You can switch your plan each year if want to find different coverage. Call us and we can help review your options! 817-249-8600
Once you have reached stage 4 - Catastrophic - will any drug be included in the 95% coverage regardless of the particular Part D plan that you are enrolled in?
Hi, I downloaded your HSA flo chart and still don't understan something, however, someone as detailed about Medicare as you have shown can no doubt answer a rather difficult Question regarding HSA contributions during the year I turn 65. Specifically, I am wondering if the $1,000 catch-up amount can be contributed in full or does it need to be pro-rated by the number of months preceding my effective date? Example: 2023 HSA contribution is $3,850. My birthday is May 10 and my effective date is May 1st. So is my contribution 3,850 / 12 months = 320.83 x 4 = 1,283 plus the $1,000 for a total of $2280? OR is it 4,830 / 12 months = 402.50 x 4 = 1,610?
Hi There - as much as we wish we knew the exact answer to this question, we don't have enough insight on this. Our friend Andy Panko is a great resource and i would encourage you to join his Facebook group and ask this question -facebook.com/groups/retirementplanningeducation
Insulin should be Free to All and Obesity Treatments should be included with Pre-Diabetes and Weight Management and Dietician advice. We should not be forced to use generics, we should use most effective medicine advised by the doctor. We should not be lead by cost of medicine, as your life quality would be better if using advanced and better medicines. Compare your bloodwork and other tests before becoming a cheapskate on your required medicine. Use TH-cam videos to keep yourself healthy without medications.
Well-researched and informative. Good job!
Glad you liked it!
I am paying a part D premium to Medicare every month.
Do I understand it correctly that all this premium does is give me the right to sign up with a 3rd party insurance company that will actually cover (partially) the price of any drugs I might require? I currently have retiree health insurance through my final employer and, as part of that, Express Scripts which apparently is the part D provider I'd use when I need drugs.
I don't understand what the Medicare part D premium buys for someone, except the privilege of shopping around for an additional monthly premium to cover drug expenses (which is probably a good thing). Am I right?
Hi @linybob - Part D is important to have since it does help with your cost of medications and it also prevents you from having a lifelong penalty. Having a drug plan is optional, but for each month you go without coverage, you are accruing a penalty. Additionally, you can only sign up for a drug plan during the Annual Election Period each year, so if you need a drug in the middle of the year and you don't have coverage, you will have to wait until the enrollment period to enroll into a plan.
You did a good job in this video.
Hi Monica - thank you for watching!
I take two decades old generics. Companies play games and don't put them into Tier 1 or even Tier 2. I end up just using GoodRx rather than pay through the nose going through insurance. This is why I got the lowest premium plan.
Hi Chris - that is a great idea. That is something many of our clients do as well.
Thanks so much for explaining Part D! Do you receive any kind of statement during the year that tells you which stage you are in?
Hi There - Yes you do! You will receive a Explanation of Benefits quarterly with all of your drug charges and it will also mention what stage you are in.
If only the donut hole was as sweet as real donuts if I am on a Medicare Advantage plan, will my Part D be similar to this?
Hi Kelsey - yes! Your Medicare Advantage Drug Plan will work the exact same way.
Part D is so confusing. I think I’m starting to get it now after watching though so thanks... One question though.. can we use a discount program with our Part D plan to help with our copays or the donut hole?
that is a great question! Yes, you can use programs such as Clever Rx or SingleCare to pick up prescriptions without using your drug plan.
good rx or mark Cubin cost plus
This is so complicated, 😮 so glad I am not taking any medications right now. But, I will buy a cheap plan just in case.
That is what we recommend! We know it is confusing. Please let us know if you need anything in the future.
helpful video but what if i enroll in a part d plan and then later on in the year I start taking a new medication that my plan doesn't cover??
thanks for watching! You can apply for a Formulary exception on your plan - if you are a Boomer Benefits client, we can do this for you. You can also use CleverRX coupons and change your plan during the Annual Election Period in the fall each year to get a plan that does cover all of your medications!
Great. Thanks.
You're welcome!
Orgovyx (brand name = Relugolix) "retail cost = $2,950/month." My "share" = $850/month. Now, in catastrophic coverage the 5% would cost me $147/month. What a wonderful savings, eh? Nope, same med in India = $90 per month. Welcome to America and the PharmaKing empire.
We have many clients who choose to get medications outside of the US, we are glad you found an option that works!
My husband Medicare Part B became effective 12/2022. At this time he still had his Employer Health Insurance plan which terminated on 03/31/23. He attempted to apply for the Part D
( drug prescription plan )and was told that he had to wait until the next enrollment period. Is there not a special enrollment period? He has been offered COBRA but is unsure if we will need it or not as a secondary to Medicare . He has met his employer insurance deductible for the year and his coverage will state the same. After looking at the video I’m not sure if we should continue with the COBRA or apply for the Part D prescription plan . He also Has a medical condition that requires expensive medications and treatments.I’m open to suggestions.
HI LaTasha - Did his employer have more than 20 employees? If so, he will have 60 days to qualify for a special election period due to leaving employer coverage. I would recommend us for more information - 817-249-8600.
Substitute the word "price" for "cost". When the price of a medication varies by factors of 4 or 5, the issue isn't the COST of the drug. It's the pricing.
Yes, we agree!
If I go through Cost Plus or Amazon is it possible that I will pay less? I'm not yet 65 so figuring things out but am wondering if I can use those online pharmacies and if Medicare will track those costs. In other words, if I purchase a part D plan, can I still use those online pharmacies if the cost is less?
Hi Rebecca - You can use Cost Plus, Amazon, or other discount coupons when you have a Part D plan. However, those costs will not apply to your Part D costs. So, whatever you pay using those alternatives will be completely out of pocket, and your plan won't keep track of those costs.
When I try to compare plans after entering my prescriptions and pharmacies the total est. cost is $XXX "partial year" I of course want to know what a full year would cost, how do I do that?
Hi @2wrdr - It is because we are in the middle of the year! Your Drug plan is only calendar year, so you cannot see more than August - December at the moment.
@@BoomerBenefits Is there a way I can see a full year? I'm on monthly Dupixent. If D plans have a cap Dupixent would be one to max it out so then my real cost would be much higher?
Each plan works the exact same way. You can switch your plan each year if want to find different coverage. Call us and we can help review your options! 817-249-8600
Once you have reached stage 4 - Catastrophic - will any drug be included in the 95% coverage regardless of the particular Part D plan that you are enrolled in?
Hi There - as long as the drug is covered by your plan, yes! You can find out if it is covered in the formulary.
Hi, I downloaded your HSA flo chart and still don't understan something, however, someone as detailed about Medicare as you have shown can no doubt answer a rather difficult Question regarding HSA contributions during the year I turn 65. Specifically, I am wondering if the $1,000 catch-up amount can be contributed in full or does it need to be pro-rated by the number of months preceding my effective date? Example: 2023 HSA contribution is $3,850. My birthday is May 10 and my effective date is May 1st. So is my contribution 3,850 / 12 months = 320.83 x 4 = 1,283 plus the $1,000 for a total of $2280? OR is it 4,830 / 12 months = 402.50 x 4 = 1,610?
Hi There - as much as we wish we knew the exact answer to this question, we don't have enough insight on this. Our friend Andy Panko is a great resource and i would encourage you to join his Facebook group and ask this question -facebook.com/groups/retirementplanningeducation
@@BoomerBenefits Thank you for an honest response to a highly technical question, much appreciated.
@@mauinuts8844 You're very welcome!
Thank goodness the current administration got these changes passed. Prescription costs will continue going up but these policies protect us.
Thank you for watching!
There is no generic drug to treat chronic lymphocytic leukemia so everyone gets hammered with 10,000 dollars every January
Hi there - we hate to hear that! Hopefully these changes in 2024 & 2025 will help with that cost.
Yep. Been there and done that. Obinutuzumab and Venclexta. Paid just under $10,000 co-pays, etc.
Insulin should be Free to All and Obesity Treatments should be included with Pre-Diabetes and Weight Management and Dietician advice. We should not be forced to use generics, we should use most effective medicine advised by the doctor. We should not be lead by cost of medicine, as your life quality would be better if using advanced and better medicines. Compare your bloodwork and other tests before becoming a cheapskate on your required medicine. Use TH-cam videos to keep yourself healthy without medications.
Hi Anna - we understand the frustration with the cost of medications!