Medicare Plan D for prescriptions question

[Luke Warm]

Looking at Medicare Plan D options for my mom's prescriptions. There are several plans available varying from no deductible and mild monthly premium to a $545 deductible and $0 monthly premium. My mom's pills won't reach her yearly deductible.The three plans show a yearly total varying from $184 to $1235 (premium + drug cost). It seems like a no brainer to go with the cheapest but am I missing something? Is the more costly plan for people who spend a lot more on their prescriptions? 

The funny thing is, my sister was getting my mom's prescriptions filled in NC and the pharmacy was only charging $75 with no prescription plan and when I went to the pharmacy here it was going to be $500. The insurance guy that provides her supplemental insurance says it's some sort of discount like you get from GoodRx. Not sure why that doesn't work here. Confusing.

Anyway, thanks for the help.

[rosarugosa]

I recently became eligible for Medicare, and the prescription plans all seem to suck.  Last year, I went with a mid-level plan (Aetna Silver Scripts) that would presumably be the cheapest for me.  Once I was actually in the plan, it turned out that the one med I was taking regularly was going to cost WAY more than indicated on the Medicare website or Aetna website back when I was comparing plans and making decisions.  It rather felt like bait and switch to me.  I have ended up getting the med for a small fraction of the price through Mark Cuban's Cost Plus Pharmacy.

This year I went with the Wellcare plan that only costs $6.00 in premiums for the year.  I've recently been prescribed a generic med which looks like it will be free under this plan, and I'll continue to get my other med from Cost Plus, but at least I won't be giving Aetna $36/month for nothing.  I know that $36/month isn't much, but it frosted me to pay them a premium and then have to get my meds from another source.  I guess they at least covered me for several vaccinations. At one point I was prescribed a generic that cost me $12.99 out of pocket with my Aetna plan, and the full cost without insurance would have been - drumroll - $12.99!

Bottom line is that it depends on the meds an individual needs, and it is always worthwhile to be aware of options like Cost Plus, Good RX, and Buzz RX (which is apparently a lot like Good RX).  Good luck!

[LaineyAZ]

My understanding is that the Plan D drug plan also covers chemo drugs.  I know no one anticipates getting cancer, but if you do and chemotherapy is needed, it's wise to review that coverage now also.

[rosarugosa]

Lainey: That is a good point, but how does one assess how good the coverage would be for an unknown drug if one gets an unknown type of cancer for an unknown body part?

[LaineyAZ]

Lainey: That is a good point, but how does one assess how good the coverage would be for an unknown drug if one gets an unknown type of cancer for an unknown body part?

Agree.  None of us are psychic, and everything with health insurance coverage in the U.S. is a guessing game. 

I was thinking more about those people who are healthy enough to not need prescription drugs now, and so are willing to roll the dice and forego Plan D coverage.  That would be more of a risk than most people realize.

[Cranky]

And I suspect that a catastrophic illness is when your coverage most matters and I don’t see how you judge that in advance.

My dh has traditional Medicare and a drug plan that is partially subsidized through his retirement system. I have an Advantage plan. We each take a couple of generics and so far his plan hasn’t covered anything because he has a deductible and mine has covered everything because I don’t…

[rosarugosa]

Lainey: That is a good point, but how does one assess how good the coverage would be for an unknown drug if one gets an unknown type of cancer for an unknown body part?

Agree.  None of us are psychic, and everything with health insurance coverage in the U.S. is a guessing game. 

I was thinking more about those people who are healthy enough to not need prescription drugs now, and so are willing to roll the dice and forego Plan D coverage.  That would be more of a risk than most people realize.

I agree that would be crazy, especially since there are plans that cost as little as my $6.00 per year plan.