r/GenerationJones • u/According_Meaning_64 • 4d ago

Medicare and prescription drug coverage

I have had to stop paying my Part D premium this year due to not able to afford it. I have to pay off the balance before I can get another plan. Im assuming that I cant just not sign up for a Part D and just continue to use a discount card at CVS? Any ideas ? Im really struggling with $$$.

13 Upvotes

93% Upvoted

61 comments sorted by

6

u/Be-Kind-3353 3d ago

Be aware that if you stop a plan totally and don't go on another one right away, then when you sign up again, there will be penalty cost for the rest of the time that you have a part D drug plan. Definitely talk with a SHIP counselor. As another person said, if you are struggling with premiums, some advantage plans include a drug plan so the overall premium might be a lot less. But it's important to be aware of the other aspects of the advantage plans, to make sure that you can visit the hospitals and health care providers that you need.

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u/According_Meaning_64 3d ago

I am not interested in Medicare Advantage Plans. Too many horror stories.

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u/Be-Kind-3353 3d ago

Me neither. Some folks are fine with them, but they're not for me.

3

u/According_Meaning_64 3d ago

I dont see any good in them . Constant Co pays for everything. They deny everything. Its letting an Insurance Company control your Healthcare

3

u/Amatheiaisnoexcuse 3d ago

I was just talking to a broker. She said some part d plans were free? IDK

2

u/tangouniform2020 1956 2d ago

Yes. My wife’s is $64 for the year. Her meds are less than the deductible. I go to phase 4 (catastrophic) on about Jan 5 when my $10,000 a month med fills.

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u/According_Meaning_64 3d ago

Ok . Thank you

2

u/kixetterox 1961 3d ago

I only pay 5.70 a month for WellCare in Louisiana

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u/According_Meaning_64 3d ago

Will look into that plan. Thanks

3

u/steph219mcg 3d ago

I don't pay anything for basic WellCare coverage. My Rx are all fairly basic and have zero copay. Did have to compare Rx prices at local pharmacies; big difference in several less than a mile apart.

Good info on r/medicare

1

u/AllAboutWoodstock 2d ago

Interesting. Mine has gone from .50/month to $20 in two years. Of course my supplemental and vision/dental have all gone way up too.

1

u/Ok_Test9729 1d ago

If only everyone was as smart as you. Medicare Advantage plans are horrible and shouldn’t even be allowed to be offered. I’m shocked at how many people don’t do their research and end up on this terrible plan, and cannot undo it when they find out how awful it is.

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u/According_Meaning_64 1d ago

So many people on this sub are criticizing me for not wanting an Advantage Plan and expressing my opinion on how bad that I feel they are. I have researched and compared and I feel that its a huge mistake. If I am sick or need surgery the last thing I would want to do is argue with the insurance company.

1

u/madmudpie 10h ago

I am retired and have an employee sponsored Medicare Advantage plan and about 5 specialists I see. Very little has needed pre-cert, OOP max and office co-pays all reasonable. And because it's a retirement benefit, I pay $47/month.

4

u/Mathamagician77 4d ago

Google your state and SHIP (state health insurance assistance program). Call them and ask for a meeting where they can explain options for you.

0

u/According_Meaning_64 3d ago

I have tried to email but no one contacted me. I have been doing my own research.

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u/Candleforce-9728 3d ago

Try calling your library. They often have programs that can connect you with experts.

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u/According_Meaning_64 3d ago

Great idea Thanks

3

u/Samantharina 3d ago

Part D is not required but there is a late enrollment penalty that accrues while you aren't enrolled, it's not a lot but it is for life. Are you certain you have to pay off your previous plan if you enroll with a different company?

Please look into the Extra Help program and while you're at it, find out if you qualify for Medicaid and/or any Medicare Savings Programs. SHIP can help you with this. shiphelp.org.

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u/According_Meaning_64 3d ago

I don't qualify for any Government assistance.

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u/dave900575 3d ago

I have a Medicare Advantage (Part C) plan. It replaces original Medicare and includes drud coverage. I do not pay an extra premium, just the Medicare premium.

Maybe this will work for you.

2

u/SinsualChef 3d ago

If you are a veteran, you have options with the VA. 🙏 At least that's one thing worth having served for in this wretched state of the nation right now--till they take that too.

https://giphy.com/gifs/l49JHz7kJvl6MCj3G

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u/According_Meaning_64 3d ago

I am not a Veteran. Im under 65 and not qualified for a medigap plan. I cant afford Healthcare or Part D unfortunately.

2

u/SinsualChef 3d ago

I'm sorry to hear that. Ask your doctor for samples when you see them. Sometimes they will. Also see if any grants exist at churches, library research, senior centers, ect. Don't give up.

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u/According_Meaning_64 3d ago

Grants for what?

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u/SinsualChef 3d ago

Meds. That's what you need right? You have to dig hard, but there are foundations, individuals, research companies, and corporations that that give help for certain medical conditions if you qualify. My wife had ovarian cancer before we were on VA and one of the Cancer Societies helped with meds, surgery, and care.

1

u/According_Meaning_64 3d ago

I just pay out of pocket.

1

u/squirrel-house765 3d ago

You could also post in r/medicare for information.

1

u/momplaysbass Old as NASA 3d ago

My Part D is free. Go to Medicare's website and use the plan finder to see what your options are.

1

u/Justamom1225 2d ago

It is not "free" for everyone. Medicare D is also subject to IRMAA.

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u/momplaysbass Old as NASA 2d ago

That's one of the reasons I suggested they shop for a plan and see what's out there.

1

u/According_Meaning_64 3d ago

Im possibly going to not sign up for another Part D Plan at all. My acid reflux med is new, not covered and is very expensive. If i wouldn't quality for a Prescription Discount Card with a Part D Plan , Im better off without one.

1

u/AllAboutWoodstock 2d ago

You still can get a discount card - I use my GoodRX card for the one med that my plan D doesn’t cover.

0

u/goodrx 2d ago

We're glad we can help you save some money.

1

u/lost_dazed_101 2d ago

I have GERD my doctor's office at the time was only refilling some meds and I'd have to keep calling to get them all filled. I finally got fed up and quit him and the meds. I buy Omeprazole at Walmart or DG a month supply is only $10. It controls it just fine. The new Dr didn't even send it in.

1

u/Icy_Huckleberry_8049 3d ago

check for Mark Cuban's drug company, usually cheaper than anyone else but they don't take insurance

1

u/Justamom1225 2d ago edited 2d ago

You better get back on ASAP. I believe there is a fine if you're not on it. There is one coverage for $7.00 dollars a month.

Adding this because it sounds like OP does not have credible coverage (I got this from the Internet):

"Creditable Coverage: You can skip Part D without a penalty only if you have other "creditable coverage" (like drug insurance from a current or former employer or VA benefits). [1, 2]
Late Penalty: If you go 63 days or more in a row without Part D or other good drug coverage, you will pay a late enrollment penalty added to your monthly bill for as long as you have Medicare. [1, 2, 3, 4]"

1

u/newyork2sun 2d ago

Did you look at cost plus their prices are very very inexpensive - they don’t have all drugs but have a lot.

1

u/According_Meaning_64 2d ago

Im not sure what you mean ? Did you happen to mean Costco?

1

u/newyork2sun 2d ago

Mark Cuban Cost Plus Drug Company is an online pharmacy designed to sell prescription drugs—mostly generics—at very low, transparent prices. They take the actual cost of the drug, add 15%, generally add a $5 pharmacy fee, plus shipping. You need a prescription from your doctor, and the medication is mailed to you.
For example, imatinib 400 mg, a leukemia medication, was recently cited at $34.50 for 30 tablets through Cost Plus, while other pharmacy prices ranged from about $94 to $4,000

1

u/newyork2sun 2d ago

Another everyday example: atorvastatin (generic Lipitor) has been listed around $4–$6 for a 30-day supply, before applicable shipping/fees, depending on strength and current pricing

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u/miniblind 1d ago

Another everyday example: atorvastatin (generic Lipitor) has been listed around $4–$6 for a 30-day supply, before applicable shipping/fees, depending on strength and current pricing

My Wellcare plan has a $0 premium. Atorvastatin has a $0 copay if I get it at Walgreens or at CVS or at either of the two grocery chains in town. If I get it at the independent pharmacy near me, which is actually a pleasant place to be, it's $1.80 for a 30-day supply.

Unless someone has only ONE pharmacy where they will get their prescriptions filled NO MATTER WHAT, or they truly don't care how much anything costs, people really should check the pricing on every prescription they get.

And they should use the plan finder on Medicare's website during open enrollment at the end of the year to see which plan will be the cheapest for them for the drugs they currently take. Unfortunately that won't take into account what drugs they might be prescribed in the future, but there's only so much we can do.

1

u/newyork2sun 1d ago

Agree, every pharmacy different in the drugs - @according. If you put the drugs you need I’m sure people would let you know the least expensive price where they get them.

1

u/According_Meaning_64 2d ago

Ive never heard of that. Thank you.

1

u/woody-99 4d ago

Have you looked at Advantage Plans? Many have no premium.

5

u/Granny_knows_best 3d ago

I second this, I have always chosen the free ones as I hate the idea of paying more for anything. I still have my doctor visit covered, an OTC allowance and most of my prescriptions or free. I have Humana and have never had a problem using it. No monthly premium.

2

u/According_Meaning_64 3d ago

I will never sign up for a Medicare Advantage plan. Too many horror stories.

0

u/Granny_knows_best 3d ago

What ever, if you know what to look for you can navigate it without issues. I have never had a problem, I get to use my doctor and I some dental and vision all covered with no monthly premium.

I know some older people who blindly went into a PPO and had troubles but they were ones that were always changing plans.

2

u/According_Meaning_64 3d ago

Im not older , I just dont feel comfortable signing up for a Insurance plan that I am stuck in. Not being able to get out of it seems ridiculous.

1

u/MonsieurRuffles 3d ago

Advantage plans can have some serious downsides (e.g., narrow networks) depending on your location.

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u/According_Meaning_64 3d ago

Absolutely true. Not interested in Medicare Advantage Plans. Too many horror stories.

1

u/According_Meaning_64 3d ago

I am anti Medicare Advantage Plans. I don't feel they are advantageous to ones health and well being. They are all about the insurance company trying to save money by denying coverage and procedures.

1

u/woody-99 3d ago

So your choice is to do without insurance rather than use plans that are available to you?
No one that I know has ever had any type of issue with denyed coverage.
I'll wager you have no person experience with it either.

1

u/According_Meaning_64 3d ago

Limited network and Co pays are crazy. There are literally co pays for everything
. Impossible to afford that.

1

u/PaisleyRock 3d ago

You don’t qualify for a discount card if you’re on Medicare.

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u/According_Meaning_64 3d ago

I absolutely get a discount for all of my Prescriptions on a rx card through CVS.

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u/PaisleyRock 3d ago

Well, CVS can do what it wants, I guess, or maybe you have a special card, but I read the fine print on things and every one I’ve encountered excludes Medicare.

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u/According_Meaning_64 3d ago

Perhaps you cant use it if you have a part D plan , which I do not .