Why Medicare Part D Will Drive You Nuts | Part D explained!
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- เผยแพร่เมื่อ 29 ก.ค. 2024
- Part D plans are NOT perfect, as they have formularies, pharmacy networks and a coverage gap. Along with this, you have deductibles, copays, quantity limits, and prior authorizations. Your Part D plan might be driving you NUTS, but it's all worth it! Let us simplify all of this for you in this video.
Start (0:00)
Deductibles & Donut Holes (2:07)
Tier-Specific Deductibles (3:35)
Donut Hole Depression (5:15)
Monthly Premium Pandemonium (7:00)
Utilization Management Tools (12:55)
Why to Not Skip Part D (16:36)
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I've already had to fight through understanding the " maze" for 2yrs and the rules change every year! Very depressing for aged, ill citizens. SMH
on purpose i surmize....yes try taking no drugs just OTC......imagine changing conditions willy nilly on everthing in insurance what a scam.....just like credit cards changing their interest fees whenever they want to...uneithical,confusing,greedy and confusion will keep you looking for the changes its a game of no win.
This was really helpful. I wish I’d had this information when I needed a part D plan. No one warned me I had 62 days after leaving my employer’s drug plan to get a Part D Plan. Worse, since I had deferred Part B from 65 to 70 when I retired, Social Security told me three weeks before the deadline that I needed to proof of drug coverage for the last 5 years or face lifetime Part D surcharges based on this large gap in coverage. I was able to do this with many calls, a lot of luck and the kindness of strangers. Had I kept my drug plan ID cards for the last five years, that could have been my proof of drug coverage. Working with an employer to get a verification letter in advance of retirement is optimal. If there are multiple employers and different insurers and the odd merger thrown in, obtaining proof of 5 years of coverage after the fact may not even be possible.
Very useful/helpful information. I'd only add that just because you have Part D coverage, that doesn't mean your insurance will always provide the best price on a particular medication. Any meds you run through insurance will count toward your coverage gap. If one of those meds can be gotten more cheaply OUTSIDE of insurance, like through GoodRX, you're better off bypassing insurance and buying the med out-of-pocket... it saves you money, and won't count toward the doughnut hole.
Agree. I don’t currently take any prescription drugs but I have the GoodRx app and will certainly use it if it’s the better deal for a short-term med.
There are othet plans out thete like GoodRX ...one is called SingleCare..
I am really glad I found Boomer Benefits to help me through the Medicare maze. Thank you.
I just love Danielle Kunkle-Roberts, and Boomer Benefits. Your truthful information is the best there is: clear, concise, accurate, understandable. As a Boomer Benefits client I am SO GLAD you’re in my corner. There are other (wanna-be) vids out there now, but I truly believe in Danielle and Boomer Benefits and sincerely hope my peeps, who I’ve recommended your service to, believe me. This stuff is HARD, and complicated.
Where are u located?
You do such a nice job with these videos and also managing your Facebook Group. Quality on both fronts.
Thank you, Mavis! :)
What you pay is not the amount that goes toward your donut hole. The retail price is. That's why we hit the donut hole real fast if you have expensive drugs or are on several. The donut hole needs to go away and so does the deductible. I've found that Good RX coupons help me and my husband a lot. Just don't use the drug plan.
I paid my first premium directly and got a bill for my 2nd month's premium. I paid the 2nd months premium AND Social Security deducted it also. This was in February 2021. I still haven't received my refund from the carrier despite numerous requests.
I really enjoy your videos! You are such as pleasant presenter! I have your book and have watched your videos more than once. Thank you very much 😁
Thank you for the kind words, Henry! We're always here and happy to help in any way we can. :)
Great video. I like how you made part D simple to understand:)
Glad it was helpful for you!
Just viewed your video. Great information, thanks, I'll be looking for more of them, I'm thinking about moving from my Gov't plan to Medicare.....
Isn't Medicare government? It's just a money maker for the rich. Isn't it time to take and govern the world to get people well?
If GoodRx can get drug prices for so much less, why can’t medicare do the same?
I didn't find that with Good Rx. Got the second shingles shot last week. There was only a $2.00 difference between Part D and Good Rx. The price for the shot is ridiculous. Got the first one when I had regular insurance and it was free.
@@erinpeacexo1854 I was told last week the first shingle shot I got at age 60 will last me for the rest of my life. He said I will now always have the antiboidies in my system. He said it’s a scam to make money telling seniors they need another two. So I saved a lot of money & time.
When Congress was debating Part D, the Rx companies were unbelievable in their lobbying, so our leaders caved and Medicare Part D was passed
saying that Medicare would not take bids for cheaper Rx prices. The Veterans Administration takes bids for medications, and therefore the drugs issued thru the VA are much cheaper.
Lobbying at its best.....
@@chrischamberlain7628 Shingles vaccine has 2 brands. One takes one shot and is about 50% effective, the other takes 2 shots and is about 90% effective. You obviously got the lessor of the 2
@@davenone7312 Why would you say I got the lesser of the two when my Dr. told me the one I got at age 60 will last me the rest of my life? He said it’s a scam & people don’t need to get two more shingles shots that cost a lot of money.
Fantastic videos. Thank you so much 💓
You are so welcome!
This is the best explanation video for Medicare thanks.
You bet!
Excellent video on a very complex topic.
Glad it was helpful!
If I'm paying $40 for a med with a $300 price, that does not make me a winner. The only winner is the pharma company with all the pricing power. The price is ultimately baked into all of our premiums.
Yep, that's why Medicare Part D is not perfect and really does drive people nuts. We hope to see this begin changing in 2026 when they begin negotiating these prices directly with the pharmacy manufacturers per the IRA legislation.
In Florida, where competition for Medicare Part C marketplace is highly competitive, the included Part D plans are generally vastly superior to the standalone plan offerings. Almost no all have initial annual deductibles, and include more coverage in the coverage caps!
Compare drug prices with Good Rx and you will be shocked by how much money can be saved by using Good Rx pricing and avoiding Part D completely.
Feel free to check out our video, GoodRX vs. Medicare Part D | Which should you get?
th-cam.com/video/uZsXzBZ0_E8/w-d-xo.html
YMMV, so far I've not found any covered drug that does better on Good RX.
Thank you”
Hello 👋 Maria.. How are you doing today?
EXCELLENT
Thank you for this video, very helpful. I was going to call you but when I selected more I noticed you are not licensed in NY which is were I live.
Glad it was helpful! We hope to be in New York by the end of the year - give us a call and we can help then :)
I know 25% and 5% sounds good but it’s still to high when your drug costs 10,000 a month especially when you need multiple drugs in this or higher price range.
Great information. Is there any plan that does not require a pre-auth for certain drugs?
Hi there, one plan might require a pre-authorization for a drug and another plan might not. It varies by each plan!
Well done and informative video
Glad you liked it
Note: This video begins with: "Did you know that prior to 2006, there was no retail drug coverage for people on Medicare?" ..."if you needed a brand new medication that cost $300, then that's what you paid for.? "
No matter how many times part d has been explained to me i dont understand.
Medicaid pays our deductible and premiums for Part D ...the LIS and extra help is great.
I just wish they would make the information about how each plan/company pays for chemo drugs….so that we would know up front (before it’s needed), which plan/company we would want to be on.
I keep hearing that getting the lowest cost premium plan (which is Aetna at $5.20 a month next year), is not the best idea. Why? Do they not cover things like chemo drugs or other expensive drugs, as good as more expensive plans?
It would be nice to have a ‘cheat sheet’ that one could give a glance at, and see what each plan covers…then we would know, based on our own concerns, which plan to be in to begin with!
Until then, I will buy the cheapest one, until I come down with something that they don’t cover well….and then I hope I can find out who will cover whatever I need when the time comes! How will I know which plan that is? Heck if I know! Seems there has to be some sort of a guide for us to utilize, to figure this out?! Ridiculous!
We hear you! They definitely don't make it easy. When it comes to most chemo drugs, they will actually be covered by Medicare Part B. But some cancer drugs can fall under Part D. Each drug plan must cover certain classes of drugs, but the biggest thing that separates one plan from another is how much you would pay for those drugs. Each plan sets its own cost-sharing. The best thing to do is to use Medicare's Plan Finder Tool to compare Part D plans. However, the great part is you can change your plan every year.
Besides great videos, I love your choice of clothing....love your blouses 👚
Glad you like them!
How do I get my plan's drug formulary? I paid $192 for the second shingrix shot which fell under tier 3. The first shot I got when I ACA insurance and was free. I wasn't expecting it to be so much, but the pharmacist said the billable amount came from my insurance company. Can you let me know how I can get a copy of the drug formulary?
Hi Erin - If you are a client of ours, you can contact us at 817-249-8600 and we can email your drug formulary over to you. If not, you will want to reach out to your plan's carrier and request this information. We also recommend for you to watch our TH-cam video, "Does Medicare Cover the Shingles Vaccine?"
I got a "place holder" part D because I get all my drugs free from the VA.
I get all my drugs free from the Indian Health Service. I was told that if at some point I need an expensive drug that they don’t have, I can get a letter of creditable coverage from the IHS and sign up for a part D plan with no penalty even if it’s 20 years from now.
I was considering switching fromAdvantage to medigap and Part D but I do not react well to highly complicated plans. Advantage is $0 for my limited drug. Part D wants at least $200 annually (I think I see that correctly.).assuming I don’t screw up.
Yeah, don't screw up and get too sick.
Boomer thanks for the update question when you are receiving SS benefits are you required to get part D.
Hi Charles - Part D is not required, but if you do not have creditable coverage through a large employer, you will receive a life long penalty once you do enroll. You can learn more here - boomerbenefits.com/penalties-for-not-signing-up-for-medicare/
IRMAA QUESTION? If I apply for Part D and Part G in November 2121 with coverage beginning on Jan 1 2022, what tax year do they use? 2019 or 2020??
Hi there - The Social Security office will look at your tax returns from two years prior when determining your Part B and Part D premiums. So, if you enroll in Medicare in 2021, they will look at your 2019 returns. If you apply for Medicare in 2022, they will look at your tax returns from 2020.
Learn more here: boomerbenefits.com/new-to-medicare/medicare-cost/
@@BoomerBenefits Thanks for the info. So, it is based on the enrollment date instead of the effective date. Or stated differently. If I enroll anytime in 2021, then 2019 taxes will be used? Enroll Jan 1 2022, then 2020 will the the basis?
I am a Type 2 Diabetic and I have to take an expensive insulin which would put me in the gap by mid-year. Currently I am on my wife's insurance and will be switching to Medicare in September. Is there something to help when you are on this type of medication to help reaching the gap so fast?
Unfortunately expensive medications make hitting the coverage gap inevitable during the year. You could check out discount programs, such as CleverRX, to help you avoid the donut hole for as long as possible IF that is cost-effective for you.
Stop eating meat and Dairy. If it doesn't come out of the garden of your own it's no good.
Does my supplemental insurance cover my Part B deductible
Hi there - if you have Plan F, yes it will cover your deductible!
I pay 5.99 for good rx gold which most of the time beats med part d. And then buy the cheapest plan avail just I case I get put on a med that as astronomical
Hi Danielle I'm planning to move from California to Nevada or Arizona will my Plan D change?
Hi David - Yes, if you are moving to a new state you will need to enroll in a new Part D plan in your new state! Check out our video, Can I Move with My Medicare Plan? | Moving with Medicare
@@BoomerBenefits Thank you. I will
is Part D same as PDP drug plan?
Yes! PDP = Prescription Drug Plan
The general population should have the same Gold Lined coverage that the Politicians have. Increases should never be more than our so called raises.
We understand that!
Rather have the premium deducted from SS check to lower AGI on tax form
You still have to use your entire Social Security amount to determine how much is taxable.
I officially have a headache. Just so I'm clear, if I only deal with generic drugs, I won't have to pay any deductible?
Hi Roxanne - It will all come down to the Part D plan you are enrolled in and what tier your drugs fall into. If you are a Boomer Benefits client, please feel free giving us a call at 817-249-8600 and we can take a look at your plan's benefits.
@@BoomerBenefits Not yet but soon. :)
You are beautiful. thanks for helping us.
My pleasure!
It is real simple, You pay the first $500.00 then Medicare will pay part about 80% the balance of the year, till you go over $4000. then you pay 100%
25% of the retail drug price may be good but when you’re disabled at that is 1360$ it’s a lot.
We agree - the $2,000 cap next year should help!
Planning to die before 80 (I am 64). With all the confusion over what I won't receive despite thinking I paid for it.. ("But wait...!"), Cannot go without insurance. Why not medicare give a burial plan to avoid undesirable cremation.? Or do they?
You have a video about breast reduction? Medicare covers it but I want to know more
Hi Naila - We do not have a video that discusses breast reduction. Medicare typically does not cover cosmetic surgery unless you need it because of accidental injury or to improve the function of a malformed body part. If your doctor deems breast reduction medically necessary, then Medicare may cover it.
www.medicare.gov/coverage/cosmetic-surgery
I need & want a breast reduction. I read that Medicare won't pay for a cosmetic breast reduction. However, if there is a history of a patient complaining about the breasts such as backaches, constant rashes under the breasts due to skin on skin, etc. then it could be covered because there is a medical need but there must be a history of complaints with your md. So next time you see your md, start complaining & ask the md to make a note in your chart. And complain each time you see your md. It must be considered "medically necessary by Medicare.....
Our prescription drugs here in the U.S. cost more than anywhere else in the world. Seems we all need to protest and get the costs down to what the rest of the world pays!
In the meantime, using my SingleCare card has been better than when I had insurance through an employers insurance plan! Through an employer insurance, my copay for prescriptions was usually $15. But with the SingleCare card, I have paid as low as $1! Last prescription I just got was $5 and change!
I have my Part D drug plan, but it usually costs outrageous when the prescription is billed through it! So I tell the pharmacist to screw that and use my SingleCare card! I’m not playing this asinine game of paying a $500 deductible and a stupid price for each prescription thereafter! It feels like extortion that I’m forced to pay for a Part D plan premium, or else be penalized for not having it! It’s the ‘mob’ running all of this anymore anyway, so naturally they would use extortion tactics.
Yes, unfortunately, when it comes to generic medications, coupon programs such as SingleCare can be more cost-effective. However, when it comes to more expensive brand names, there can be a savings with Medicare Part D. It truly depends on the situation, but we totally know what you are saying!
You need to explain to people that without knowing exactly what drugs they will need in the upcoming year there is no way to ensure you will be selling them the best plan. Also can you explain to people what happens when they Must have a drug that is not covered by the plan you sold them?
Why would they need to explain something that is obvious???
If a drug is too expensive to pay, just refuse to take it. Most are not absolute life saving drugs. There are alternatives. Doctors get a profit from prescribing a lot of these drugs, so throw many out there at you.
I have a plan with and get my drugs through Kroger cost $84 a year.
My medication costs $300 annually. How Part d works for me
How do I reach you?
Hi there, you can reach us at 817-249-8600! Our business hours are Monday-Thursday 8:45AM-5:30PM and Friday 8:45AM-4:30PM CT.
You are better off being informed about the meds you take. You will be better off skipping part D. I had to help my Mom and Dad wade thru Medicare part D. It is extremely confusing and it was designed to be that way for a reason. ( keep reading)
If you take matters into your own hands and spend some time researching drug prices you will save hundreds and even thousands of dollars a year by skipping part D and paying cash over the counter for your meds.
Most pharmacies have low cost generics in every category of drugs. (ie Walmart list of $4.00 meds.) Ask your doctor to prescribe from those lists from the pharmacy you use.. Doctors can and will prescribe from what you ask. Doctors will always prescibe the high dollar name brand drugs for a reason. Realize that pharmaceutical reps call on doctors each week and bring sample drugs to stock their shelves. Sorry they don't provide low cost generics, only the astronomically priced name brands. Do not hesitate to ask for samples particularly on a new med. Also realize that these pharmaceutical reps wine and dine the doctors at the local country clubs on the weekends, provide them with tickets to major college or pro sports games, NASCAR races, etc. Oh and don't forget the new name brand drug launch that is being held at a meeting center on a Bahamas island, with all expenses paid for the doctor to be there of course. Also don't forget that the pharma rep provides a catered lunch to the doctor and his entire staff every week. They only get to do that one day per week because the other high dollar name brand drug reps also get a day to bribe, I meant provide, a catered meal also one day a week. Generics are your friend.
Part D has been a scam from the beginning. Just look at the politicians who came up with the idea and promoted it and you will understand why it was designed to enrich the pharma industry rather than to save senior citizens money. It will also explain why part d is so difficult to figure out. They want it that way to confuse you. Watch the news and you will see there is one political party trying to lower RX meds and the other party opposes it every step of the way. They are bought and owned by big pharma.
If you have to have a name brand drug that has no generic, simply buy it from Canada. Canada will have a generic that costs 10X less. No that is not an exaggeration. Also use Good RX app to save bunches at your local pharmacy. Many times a generic drug under your Part D plan has a $10.00 copay when all you have to do is tell the pharmacy you want to pay cash and NOT use your Part D insurance and whip out the GoodRX app on your phone and that $10.00 generic now costs $4.00.
Yes Medicare Part D has always been a scam and will always be a scam.
The problem with that is that is some people need oral chemotherapy drugs that have no generic equivalent, and these drugs can be thousands of dollars per month. All Part D drug plans must offer anticancer drugs, so it's a good idea to pick up an inexpensive Part D drug plan as your back up, just in case.
Not a good idea. Your plan may work fine with cheap generics, but as soon as you need a tier 3 drug, like say, Farxiga or Trelegy, the cost will be $600 or more per MONTH(!). You need some protection against that.
Sorry we are not Lucky to have part D. Every civilized and other country in the world had universal single payor healthcare that includes drugs. We in the US value allowing wealth concentration to a tiny sliver of our citizenry over taking care of the overall citizenry.
TRUTH
Hard to believe no mention of GoodRx.
Hi James, you can review our video here on Good Rx & Medicare Part D - th-cam.com/video/uZsXzBZ0_E8/w-d-xo.html
@Boomer Benefits - Medicare Expert Not surprised you had a separate video addressing GoodRx. Incredibly well done and comprehensive. I'm just surprised you didn't mention it in this video. Hopefully people will see this link and review...thanks!
Part D still is awful. with premiums and drug costs I still pay well over $3,000 annually, plus what my wife pays from her premiums and drugs.
Part D, at its inception, was deeply flawed. Look at 2006 and see who was in control of the government. Just saying. Part D provided great benefits for Big Pharma. Sadly, we here in the US don’t have the normal benefits for healthcare citizens in Canada and France have. Isn’t it a pity?
I completely agree. I have been treated for constant migraines and prescriptions for 2 of the medications were 1000.00 and 500.00 each under my part D plan. One med is not available under GoodRx (1000.00/month). The other is 26.47 per month with GoodRx. So I pay $80/month for plan D with virtually no benefit. Can't change or drop plan until October. Your government at work, what a great benefit!!!!
@@MikeJohnson-sy3vx You might want to go to a neurologist for Botox injections every 3 months for your migraines. My neurologist had me try 3 meds b4 trying Botox. One drug made me hyper. One made me drowsy bc my blood pressure got too low. The Botox works great. No side effects. No pill to remember to take. I have Plan G and the Botox for migraines is covered under Medicare B & supplemental G. I don't know what the protocol is but my guess is that genetic drugs might have to be tried first then Botox as a last resort.
This is where Medicare really screws over enrollees. Part D is so complicated that most seniors like my 90 year old dad just pay and doesn't ask questions. They may not know how to reasearch or may be ill and can't compare prices on Part D with GoodRX.
We hear you! We try to simplify this program the best we can so beneficiaries can understand how their coverage works. We offer a free Part D webinar, if interested. Here is the link: boomerbenefits.com/medicare-part-d-webinar-on-demand/
Your whole life you pay SSA & Medicare taxes. Whatever you were going to get for SSA is actually 10% less, because you are going to pay that in Federal tax withholding. So it sounds like they take the rest of your SSA back paying for Medicare plans, that you already paid for your whole life. SSA pays for your Medicare, and you STILL have a co-pay!
Hi Jim - We completely understand what you're saying! Unfortunately, when you pay into Medicare during your working years, you are only covering your Part A premium which is why it is $0/month for most people once they enroll. With that said, you do still need to pay the Part B premium as well as out of pocket costs. The taxes you paid while you worked covered the cost of those who actively were taking SS benefits and Medicare at that time
Yay!! I live in London England and all my medications are free now that I turned 60. My Enstilar psoriasis foam ointment which costs $2500 a month in the US cost me zilch. No copay no deductible no nothing. Pharmacy sent me a text that my prescription was ready, I walked in picked it up and walked out. In fact they had given me 2 months supply....so that's $5000 I didn't have to pay. First class trip to the Bahamas for two weeks! Woohoo!
@@steve57912 um yes it is! This is the typical cone back I get from every American. I went to college in the US plus MBA afterwards and worked at top tier financial firms in the States for over 13 years. I know the system there and here in the UK inside out and I've done the numbers. Up to 50,000 dollars annual salary in the US and the UK the tax rate is the same, even though the US has more tax bands but in the UK the first 15,000 dollars income is not taxed. Only above a salary of 100,000 does a UK person pay more in taxes than an American, but the mean salary for both countries is about the same....35,000 bucks and as I said above, at that rate of income the tax rates are the same EXCEPT here we get totally free healthcare and even a top university such as Oxford costs 15,000 bucks a year versus a comparable Harvard at 65,000 a year!!!!!!!!! I was stricken with Miller Fisher syndrome 3 years ago and was in ICU for a month and I calculated all the costs it would have cost me had I been in the US and it would have come to 450,000 bucks whereas here it was totally free. And even if I had that happen in the US and I had the best private insurance costing me 800 bucks a month because I know that's what it costs to get what we get free here, you still have co pay of 20% plus upfront deductibles of anywhere from 2000 to 5000 bucks.....which we don't have to pay here in Europe.
@@keylimepie210 Glad you are getting the care you need over there, not everyone does without long wait times.
Nightmare
All you have to do is come across the border illegally, you will get it all for free, along with free housing!
It's a damn disgrace. And they are even allowed to sue the US Government. SMH
That's horrible!
We have a few videos coming out that will explain Part D in 2024 soon!