Changes are Coming to Medicare Drug Coverage. Not All Of Them Are Good.
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- เผยแพร่เมื่อ 28 พ.ค. 2024
- Landmark changes are coming to how prescription medications are covered under Medicare Part D in 2025. Many are touting how great the new coverage will be, and there are positives, but there are negatives as well that many people are glossing over. Don't make the same mistake.
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Erik@TheRetirementNerds.com
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⏰ TIME CODES ⏰
0:00 Tricky Changes
0:56 Formularies & Tiers
2:00 How Drug Coverage Worked
3:57 Misunderstanding #1
6:21 Misunderstanding #2
8:49 Misunderstanding #3
9:52 Why We Made This Video
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#medicare #theretirementnerds #socialsecurity #retirementnerds #finance
Federal Disclaimer:
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
As an insurance broker who specializes in Medicare, I appreciate your very informative video to the public. It’s accurate, presented in a way to understand manner, and very professional. Thank you.
It should have read “presented in an easy to understand manner”
Thank you so much! Genuinely hope it helps your interactions with clients come October!
I am an career insurance professional. I agree with dma. Your explanations are great. The complexity of the Medicare System is mind boogling.
Earlier this year, I was talking to a friend, about the new drug plan MOOP caps for '24 and '25, and told her that the insurance companies, will probably double (or worse) the cost of our drug plans, to recover those losses. That would be awful, for all of us. I'm not too far off, eh? I too, noticed that the average cost of a drug plan that was allegedly going to be reduced in 25 was actually doubled from '23, to make it look like it was being decreased. Thank you so much, for all the clarity you bring to these, most critical decisions!
It'll be interesting to see how this all shakes out... Thank you so much for watching!
I will never give up my original Medicare and Plan N supplement for a ( Dis) advantage plans inclusive drug coverage.
I am one of those 'fortunate" people that has a monthly medication that is Tier 5. The OTC price of that med went from 3,500.00/mo in 2023 to 5200.00/mo in 2024. Needless to say I was happy when I only paid 3300.00 for 2024 and will only pay 2000.00 in 2025. But I am concerned about changes in the formulary and other shenanigans come 2025.
Thank you for sharing! We are concerned with you!
Good video, Erik as usual. I was in Las Vegas last week and there were TV commercials for a US Senator from Nevada running for re-election. The main thing that the Senator's ads tout is that she lowered healthcare costs and specifically the ad mentions that she championed the $2,000 cap for 2025 for Part D drug plans. It's amazing how politicians will vote for changes in legislation without realizing that unseen cost for people down the line. I'm one of those $0.50 Part D plan people as is my sister and two friends of mine. I will be paying VERY close attention to my NOC letter and will immediately shop around if needed in October. Thanks again!
Thank you Tom!
You are 100% correct and yes, keep an eye out in September!
Saves me about $14k next year with that change! Thank them for me. Tagrisso is the drug.
@goodlucking244 That's AWESOME! As an agent, just make sure your carrier will have that on their formulary for 2025!
Afterall, carriers will need to offset the dollars they will be paying, from somewhere! Smart shopping to you, in October !!
@@soundlysouth2962 Exactly, great point making sure access is maintained. So far so good. Have a great rest of your weekend.
As a 60+ person who is not on Medicare yet, but starting to learn about the system, I don't know if I mind the idea of cost sharing for drugs. The idea that everyone pays more to make sure that if you become that unlucky person who needs a high priced drug you won't be in the poor house makes sense to me. But, I know I will need to learn much more about how all these programs work over the next few years.
100%. Cost sharing is what insurance is all about.
I don't want to pay more for my medication because all the fat people want ozempic
Wow! My head could explode. You are so good at unpacking such complex information. thank you
Appreciate you tuning in! It's complicated... but hopefully this helps a bit :)
Thank you for this important information on Medicare
I'm 63 & not eligible for Medicare yet. It took me 2 years to secure an insurance. Thanks to you on a previous video I learned not every insurance covers everything. Luckily I was able to secure an insurance that covers cateracts. I was finally able to go back to the opthemologist yesterday. I'm legally blind in one eye now & the other one is fading fast. I get to have cataract surgery June 2nd! I'm thrilled & grateful to you that I knew to ask for an insurance that covered what I needed. Also the opthemologist told me the most popular & most used insurances in my little rural town that most people are satisfied with. It's good to know what your local doctors & hospitals take. Which is another thing I wouldn't of thought of.
I had BCBS PPO while my husband was alive & no concerns because I could pick any doctor or hospital. I didn't realize at the time what a luxury that was.
Thanks so much for the heads up😊❤️👍
Thank you so much for sharing!
Thanks, The Retirement Nerds! Knowledge empowers!!
Thank you David!
@@Theretirementnerds You are most welcome my learned friend.😸
As an agent here in Florida, I really appreciate the confirmations of even my own thoughts towards these VERY important changes!
Appreciate you tuning in!
Good info. My husband is turning 65 this year, and we’ve done a ton of research as Medicare is SO confusing. I didn’t know that about the Medicare marketing rules. Of course, hubby has been inundated with mail offers of all kinds, mainly Advantage plans which we are not doing. But, one Saturday morning a woman from an insurance agency knocked on our door. She had sent a mailing earlier in the week (I recognized her name when she said it). I wish I would have known that they are not allowed to do this (we are not clients of that agency), or I would have said something.
Great info, thanks!
We start Medicare June 1 and my wife is on generic meds and has a $0 plan with a projected $0 total OOP. I take Xarelto and I signed up on a $79/month premium plan as it was the lowest total cost plan for the remainder of 2024. Comes October we'll be exploring what to do next year. Thanks for consistently putting out great content!!!
Thank you for your support! Yes, keep an eye out come September & October 🙂
VERY clear and helpful video! Thanks I begin Medicare with Supplement Plan on July 1, 2024 with one of those $0 Part D plans. I now know what to expect and what to do, when and WHY.
So glad it was helpful!!
Wow. My head is spinning. Grateful that I take no medications at present; of course that may not always be the case. I am saving this video for further review. Excellent explanation of a very complicated subject.
Thank you so much Tina! So glad it was helpful and watch as many times as needed :)
This is great information. My dog Suki and I watched two videos today!
Thank you (both) for tuning in! 🙂
This whole Medicare, SSDI, Social Security stuff is incredibly complicated. My best prescription drug program is a few pairs of running shoes every year.
Lift weights
@@barreloffun10 I do that too. I have a weight set in the basement and go to the gym for heavier weights. I also play tennis which is why I recognized his RF97.
Great information as always. For me, the caps are well worth the premium increase. I am a healthy 65 yo on no meds. But in my work I've seen folks paying absolutely insane amounts every month for meds. I am quite happy to pay more monthly now, so that I'll be better covered if/when I need it. If I never need it, it's all to the good. Nothing is free. We pay insurance for others' bills now, and others will pay for it when we need it. That is called - insurance. Your videos are uniformly great, but try to avoid hyperbolic reactions. Stoking rage is everywhere today, and leads to nothing good. Unlike the private companies, who without government regulation would fleece is to the max, the government is at least nominally in our behalf. The only thing worse that our imperfect Medicare system would be- no Medicare at all - uncontrolled private insurance. And that is what many of the rage-stokers would like.
Thank you for the feedback and watching.
I guess my hope was to try and reduce the rage by reducing the surprise of what's coming. It's going to take a lot of people by surprise and will cause a lot of upset feelings. From our client's perspective, it's to help our relationship around October to understand what's happening and how we can work together to make it work. Thank you for sharing your thoughts and feelings!
The devil is always in the details. My friend has "free" dental coverage through medicate, but when she went to a dentist with wisdom tooth inflammation the doctor said that the required procedure is not covered. She end up paying $5000 out of pocket.
Thanks so much ❤
Thank you for watching!!
Y'all are the best - thank you.
Appreciate you!!
It'll be interesting to see if insurance companies also enforce the deductible for even the low Tiers as well.
Great point!
Thanks! I appreciate all you do!!!
Thank you so much!!
Thank you for this much needed explanation. This is similar to the HMO rollout dance of the 1980's.
Hook customers in with low costs and 'extras' then hold a year or 2 followed by withdrawing the 'extras' and increasing prices. I'm also seeing a reduction in 'extras' with my supplemental plan this past year. (Now I get it, thank you!!)
The time guidelines you've provided are also incredibly helpful.
Thank you for tuning in!
thank you for being so detailed
Thank you so much for watching!
I have one of the 50 cent part D plans, only because I really don't need it. This company also sells Advantage plans, so I'm sure they will try to push an Advantage plan in 2025 and crank up the cost for the stand alone drug plans, I don't expect to pay $0.50 next year. I knew this was going to happen. Seems the government sticks their nose in to things they know little about, and try to fix a problem, that causes several other issues. For the last 2 years my wife had a reasonable drug plan, very low deductible and insulin was zero cost, so 2024 comes around and insulin now cost us $70.00 for 2 different kinds each month and the $50.00 drug plan doubled to $100.00. So we switched plans.
Thank you for sharing!
What I know, is that we have a $0 Part D drug plan for this year. We are smart enough to figure out what to do next year, once we see the offers. We will continue with a Supplemental Part B plan, probably HDG
We were in healthcare, generics work fine for 90% of chronic illness. The eventual $2000 cap is likely much better for most people, compared to the past potential huge costs without a cap. Expensive meds are rarely better.
Thank you for sharing!
Excellent video! Great explanation of a complex subject
Thank you!
I am a few years out from Medicare eligibility and it seems the closer I get the less enthusiastic I become. More and more it looks like a mirror of the private insurance sector with all the “wonderful” copays, exclusions and denials.
Excellent information. Thank you for sharing your knowledge on this subject.
Thank you for watching! So glad it is helpful!
I am about to begin the daunting tasks involved with choosing My Medicare Part B, C, D, etc.for the first time. 2025 will impact me. I'm going to use Medicare specialist insurance broker. It is good to be as informed as possible before I take the plunge. Thank you.
Excellent plan! A broker will help a lot!
Great channel, thank you for posting this.
Thank you so much!!!
Thanks for the information. 👍
Thank you so much for watching!
My United plan was jumping from 58 a month to 118. We tried a 0 dollar Welcare plan. We are getting drugs cheaper than United gave us. But we expected them to try very hard to get us on a advantage plan
Thank you for sharing this.
Yes... keep an eye out for your Annual Notice of Change in September
I wonder what changes if both Medicare And Medicaid and Have a MA plan in NY thanks in advance
Excellent video!
It is very helpful that you show a balanced view of the changes and the reality that nothing is free. We need to be informed and realistic that the insurance companies are in business to make money, not to be our friends and that an agent should be our friend that understands everything and can help us navigate the changing world. It's not fair, it's not always (if ever) reasonable, it is what it is. Thanks for making these informative videos.
Thank you so much! Hopefully it helps us all get in front of what's coming rather than being surprised later on! Appreciate your support!
Excellent Video!! What about the rule for 2025 that says a Part D plan sponsor cannot raise their premium more than 6%? We feel like that means those $0 premium and $5 premium Part D plans will go away for 2025 which will play into the Part D plan sponsors hand to move those people to their Medicare Advantage plan.
Hi Steven, important clarification here and important definitions.
The Inflation Reduction Act prevents “Medicare Part D *base beneficiary premiums*” from increasing more than 6% each year.
The base beneficiary premiums are not the same as the amount that the Part D enrollees pay for coverage, and the law did not cap the growth in individual plan premiums to 6%. Insurance companies offering the drug plans use the base beneficiary premium to calculate their plan’s basic premiums, but they also use other factors.
The base beneficiary premium is what is used to calculate the Part D penalties for those who experience that penalty, but it is not what insurance companies charge or have to charge.
Look for much higher than 6% increases for the plans themselves, but not in the base beneficiary premium.
Please do not tell clients they won't see anything greater than 6% because that is a different number than their premium amounts. I hope that helps!
@@Theretirementnerds Wow...Helps a lot...thank you!!
I'm still on my Medicare Advantage Plan (7.5 years now) and am still not on any prescriptions. So except for maybe filling one or two Rx for a usually generic drug per year, I don't need a drug plan at all, though the price is right for mine. ($0 per year.) My premiums for Med. Advantage go DOWN each year, while the freebie debit cards the Plan gives us now go UP in value every year. $400 in '23 to $600 in '24. Honestly, how much longer can this go on?!
2025 may bring some changes...
America is a nightmare.
You are doing god's work finding these discrepancies. the US is in a state of regulatory capture and the same people working to regulate insurance companies go on to work for them or vice versa.
Thank you so much for tuning in! A lot of moving parts...
What about the 6% limit on Part D premium increases for 2025? Seems like that means many Part D plans will be discontinued for 2025.
I assume that paying the deductible in 2025 will be applied to the $2,000 OOP maximum?
Yes, you are correct :)
Thanks for disseminating this info. I’ve been telling everyone about the fact that Part D premiums will be going up up up due to the coming cap on out of pocket drug costs.
Great, helpful video as always!
Thank you!
Erik,
Thanks for continuing to provide your unbiased and passionate insight into the confusing world of Medicare, Part D plans, etc! The "misunderstandings" you highlighted in this video are just the tip of the iceberg, as you know! Thanks for having the courage to publicly share your insider perspective, despite the potential for "poking the bear" that is Big Pharma, Big Insurance and the bumbling (if not intentionally malicious) Medicare System!
Appreciate your support, Mike! Means a lot! Always love seeing your thoughtful comments :)
@@Theretirementnerds Just signed up for the monthly newsletter...I really like the well-rounded format and helpful offerings! Looking forward to future issues!
@@mikehenderson2039 thank you! You just missed the May release!
Here it is if you missed it:
theretirementnerds.com/newsletters/
Welcome to the world of insurance. Everyone chips in a little to keep a few from getting destroyed. The only thing that changes is the size of population groups that cover the average. If floods hit an area everyone gets an increase even if they did not flood. The old way is to let the insurance company's pick only the low cost customers and kick the expensive ones to the government to cover, which spreads the expensive costs over everyone with taxes.
Nice summary, thanks.
Thank you!!
They are only supposed to be able to raise Medicare Part D premiums a maximum of 6% in 2025. (41 year Medicare agent.)
Important clarification here and important definitions.
The Inflation Reduction Act prevents “Medicare Part D base beneficiary premiums” from increasing more than 6% each year.
The base beneficiary premiums are not the same as the amount that the Part D enrollees pay for coverage, and the law did not cap the growth in individual plan premiums to 6%. Insurance companies offering the drug plans use the base beneficiary premium to calculate their plan’s basic premiums, but they also use other factors.
The base beneficiary premium is what is used to calculate the Part D penalties for those who experience that penalty, but it is not what insurance companies charge or have to charge.
Look for much higher that 6% increases for the plans themselves, but not in the base beneficiary premium.
Please do not tell clients they won't see anything greater than 6% because that is a different number than their premium amounts. I hope that helps!
Where do I look up,the formularies and tiers for drugs?
If you are using an agent, they will have materials for the drug plans they represent. Actual booklets that list out the formulary and tiers for the plans.
The insurance companies themselves will have them as well (they provide the books to the agents).
Thanks for the heads-up. I saw big increases in premium from "reputable" providers from 2023 to 24, and I expect more from 24 to 25.
Do Advantage plans with drugs included have a formulary and tiers just like D plans, and if so, do companies use the same formulary and tiers for Advantage and Supplement? For example, does Blue Cross have the same formulary and tiers used for all Blue Cross plans?
This video goes over how the plans work differently:
th-cam.com/video/RoGM1iF82_s/w-d-xo.html
Formularies and tiers are not the same, even within the same company.
One company may offer a few different Advantage plans and each advantage plan could have a different formulary and tier structure.
Same with standalone Part D plans. Same company may offer several Part D plans, but each has a different formulary/tier structure. Great question!
@@Theretirementnerds Thanks. Those formularies are difficult to find. If we are interested in specific drugs, we can determine what tiers they are in, but it was not easy for me to find a complete formulary of a plan before enrollment.
I listened to this and it is very good, but I am not understanding what you say about the Catastrophic coverage phase being discontinued, and the OOP amounts that you reference are ones that I have not experienced meaning mine do not match what you are suggesting. I still have a catastrophic phase this year (2024) and my OOP is about $8k this year, much more than you state. So what am I missing ?
It would be interesting to take a look at your drug out of pocket payments.
The coverage gap (donut hole) threshold is $8,000, but that includes discounts from drug manufacturers. www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap#:~:text=Once%20you%20and%20your%20plan,t%20enter%20the%20coverage%20gap.
This video goes through this in more detail:
th-cam.com/video/KLUZJMY5QYw/w-d-xo.html
Happy to take a look if you have an itemized bill of your medications year to date or another great way to look at costs is through the Medicare.gov drug plan tool. We have a tutorial here:
th-cam.com/video/fWfgScM2HQ4/w-d-xo.html
Erik@theretirementnerds.com
The private insurance companies administer the Part D and Medicare Advantage plans. The government administers Parts A&B and the supplement plans. Before you choose a plan, do your research!!
Correct. Federal government regulates Part D and Advantage plans as well. They don't administer the plans, but they regulate the private insurance offering the plans.
During the Annual Enrollment Period, if someone has a Part D plan and wants to switch carriers, is s/he subject to medical underwriting?
Free, unrestricted changes are allowed for Part D plans between October 15 and December 7
No underwriting during the Annual Enrollment Period.
@brentgindelberger8851 said it perfectly.
I just need someone to recommend a good drug plan. I will be signing up with Medicare soon and have A,B & medigap N.
Whats the best drug plan for me if I dont currently take any drugs?
This video will help:
th-cam.com/video/fWfgScM2HQ4/w-d-xo.html
Medicare.gov has the ability to find what you're looking for.
Will plan D drug changes - formularies, tiers - also be available in October?
Yes. If you are on a plan, you'll get a letter in September. Once October rolls around your agent/Broker can run your drug list across a bunch of different plans and compare costs. You can also do this on Medicare.gov.
@@Theretirementnerds thank you
I’m super confused. I’m just getting on Medicare. After listening, I don’t know what if anything I can do.
In other words - Is it all inevitable and we have no positive choices, or is there a way or plans that mitigate this?
Work with an agent/broker to take the medications you are on and they can compare against the plans available in your area to find the lowest cost plan. Or, you can do something similar through Medicare.gov.
If you're just coming into Medicare, it'll sort of be the normal for you, coming into plans with certain premium levels. For those on Medicare already, they will likely experience higher premiums than what they're used to but the out of pocket max which is a good thing.
wife's script is $24,000 per MONTH
So expensive! That $2,000 cap will be great!
Sleight of hand folks…mine was $40 in 2023 now it’s $80 a month. I worked in a clinic for 12 years and we did not take most Advantage plans.
But old Joe Biden said he was going to make the pharmaceutical companies lower the costs of drugs.
Oh and Trump said he was going to fix it, yet did nothing in 4 years on his watch...well except play more golf than Obama did.
Spreading the risk among all people on a insurance plan is how all insurance plans work. I dont see anything bad here. I am on a medicine that costs about $27,000.00 per dose. If i was on Medicare i eould be responsible to pay a $7,000.00 copay every 8 weeks. Under the Inflation Reduction Act medicare out of pocket max will be $2,000.00. my wife is on medicare and out of pocket costs are killing us financially.The changes coming are going to make our lives easier.
Yes, insurance spreading risk is how it works, and the cap is a great thing, especially for those with high cost medications.
The announcements of how 2025 will be sunshine and rainbows for everyone is what we're trying to bring to light. That is not the case. Those who do not have prescriptions and are on the no-cost or less-than-a-dollar plans, from all indications, will see major cost increases. Those on Advantage plans will likely see other benefits reduced to compensate for the drug changes.
If people only hear their costs will go down, and then they increase by 100%, 200%, 300%... it causes problems. If we can inform people of the realities of what's coming and explain why, some will still be upset, but hopefully less upset because they know the why behind the changes.
Cancer is the second leading cause of death in this country only behind heart disease. Chemotherapy drugs can be anywhere from 10 to $15,000 a month. I'm thinking that a person probably better served paying a premium maybe $100 a month with a $2,000 limit is better than not being able to afford this medication if needed. The best thing is to prevent cancer, of course. 90% of all cancers are preventable by lifestyle choices. It's a tough situation with the average person needing $315,000 in retirement just for medical care.
Thank you for watching.
Most chemotherapy is actually covered under Part B, not Part D, so these changes wouldn't necessarily impact most on Chemo. There are exceptions of course.
There are other medications that run just as high though and will be a great benefit for those who face this issue.
@@Theretirementnerds thanks for the info!
Ugh, and we still don't have enough emphasis on becoming healthy at the same time. I believe that those with unhealthy habits should pay higher costs, although I don't know how we'd verify that...especially since doctors themselves are woefully ignorant on true nutrition! Going low carb healthy fat allowed my 93-year-old mother to stop 8-9 Rx medications in late 2019. She faced the pandemic with NO comorbidities!
Thank goodness we have fabulous MA plans in my area SO FAR...great large medical groups with additional free benefits, low MOOP, ($699-$800 for us in 2024), low to no copays at all, rich free supplemental benefits, etc. And, best of all, love, love, love our medical group sponsoring free MA overview seminars each Oct-Dec.7 to discuss the top 5-6 MA plans for our area! We've changed plans nearly every year to choose for THAT year the best one per our health conditions and needs. Has been great over 15+ years for my retired physician father and RN mother.
This is all the more reason the US needs a national health care system.
Us poor people thanks the rich people by paying our expenses.
At the end of the day, three quotes come to mind: my father- "there is no free lunch," Pres. Ronald Reagan- “The nine most terrifying words in the English language are ‘I’m from the government and I’m here to help.’” and Prime Minister Margaret Thatcher, "The problem with socialism is you run out of other people's money." Follow the money.... We have a 30+ trillion dollar deficit, long term Medicare insolvency, and huge backdoor subsidies to the drug companies who will drastically raise rates and donate to the politicians who vote for that system. While we are told this all makes prescription drugs "affordable," and some naively believe it. Wage and price controls never work, because they go against basic economic law. The only solution is competition and customers who have incentive to save by controlling their own costs.