So, I'm going on Medicare in April. I've enrolled in the Blue Cross Plan G Supplement plan and am now trying to decide which Part D plan to get for meds. At the moment my main concern is what it's going to cost for my new Abiraterone prescription. It looks like BCBS is going to be too expensive. Their cost estimator is saying it will be $1300/month until I reach the $8k catastrophic level. The AARP/United Health Care plan is saying it would be $58/month after I pay the $545 deductible, assuming I go for the basic plan and not the no deductible premium plan.
Does anybody have an opinion concerning the AARP/UHC plan? I'm partial to BCBS and am a bit nervous about going a different direction.
Is there an advantage of going with the premium plan as opposed the basic plan? The premium plan is $101/month with no deductible and lower co-pays and the basic plan is $34/month with a $545 deductible and higher co-pays, though the difference in the co-pays looks pretty minor. There are some what looks like minor differences in the formularies for each plan but the second tier ADT drugs, Abi, Xtandt, Erleada, etc are on both plan's formularies. The primary difference between the 2 plans is the deductible and the co-pays.
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fireandice123
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So assuming 10 months left in the year, on the AARP/UHC plan you'd pay $545 deductible plus $58 per month ($580 for 10 months) or $1095 total. With BCBS you'll still have the deductible for your other drugs, right? Plus the $124-$129/mo at costplus/costco.
So I'd go with AARP/UHC. I know some people on it that say it's fine. You can't really get attached to a Part D insurer anyway, you have to reassess every year to find the best deal with the one that has a half decent star rating.
Also try to look at the specialty pharmacies that are in network. You won't need one for Abiraterone but if you are prescribed any of the others that are specialty pharmaceuticals before the end of the year it will matter.
Yes, very important to look at possible drugs that may be needed down the road. We are navigating the process with Lynparza, which is an expensive specialty drug. Thought we would be OK with the local in network pharmacy, but their specialty pharmacy would not/could not get it. I made sure this was in the formulary when we were shopping for new Part D plan and it is so it's not an insurance issue, but a pharmacy issue. We just had to get it from the hospital pharmacy, but it is covered.
I have AARP/UHC, and I buy mt abiraterone through Mark Cuban Cost Plus Drugs. I pay about $115 per month for 1000 mg abi from Cost Plus. This saved me a lot of money in 2023. When I tried to check the AARP/UHC 2024 cost for abiraterone, I got a lot of time-wasting inconsistent answers from their web site and multiple telephone agents. So I decided not to have my Dr. switch my prescription back to AARP/UHC, and I continue to buy abi separately through Cost Plus.
It seems the max out-of-pocket for 2024 will be $3300, even for those who face insane drug costs while burdened by cancer concerns!! So, you will not face an $8000 out-ofpocket hit, even with that $1300/mo option!!!!
Next year I think will be $2000 or so max...thanks to Biden legislation!!!!!!!!!!
you can change drug plans yearly during open enrollment so we always go with an inexpensive one. We did the Abi GoodRx but then its cost in our Part D became reasonable. Medicare.gov has a tool where you input prescriptions in and it shows you the best cost plans in your area considering premium and drugs.
I started Medicare in February, went with AARP/UHC for supplement and part D. Got my abiraterone from optym specialty which has a connection to UHC. The first month was $131. Just got my second bottle, they qualified me for a copay assistance and are giving me free abiraterone for one year.
Are you sure that you want to go with an Advantage plan? These plans have tremendous leeway to deny coverage as they see fit, it may be a bad idea for someone with advanced disease.
I’ve been really pleased with Basic Medicare, a supplemental and a drug plan, no issues with coverage. I’ve had it for the past 8 years.
We have AARP UHC Medicare Advantage plan. It is saving us thousands. No monthly premium, no deductible, most of our meds are free. We each have a $2000 annual dental benefit. Any dentist, no network.
No co-pay for PCP and $25 co-pay for specialist appointments.
In the last six months we both had serious abdominal surgeries with hospital stays. Our total out of pocket cost was $590 each. I've seen people bad mouth the Advantage plan, but I don't understand why.
I am on the AARP UHC Supplement plan G. I will discuss the drug thing in a second.
Sticking with the medical side of things, I commend you for going with a supplement plan G. I really think there is not a lot of difference in BCBS, or AARP UHC. Advantage plans have somewhat lower up front costs but also may have some co pays or such. The Plan G supplements, just cover everything except a small $240 annual copay. They do however do not have a drug plan baked in as some Advantage plans do. I will however offer as evidence that even with a biopsy, MRIs, PET Scan, 31 rounds of radiation and all of the Dr visits involved with all of that I have yet to receive a bill. I look on the Medicare website and see things are getting paid and receive a monthly statement from AARP UNC, showing what they have paid. Between Medicare and the supplement plan G, about $180K paid in 2023.
Now lets talk about drugs. I am on the Well Care Value Script plan. It does a great job on BP meds, Arthritis meds, and the other things that at our age we need. They wanted about $2800 a month for the Xytiga/Abiterone. After getting over that shock, I quickly started research into Good RX and others to help. Quickly got it down under $150.
There is also value in not using your Plan D for your Abiterone. The Oncology center I go to has a Specialty Pharmacy. When not using the Plan D, they offered a cash price of $180 per month. In the end I just use Good RX at Discount Drug Mart, for $143 a month.
I was on AARP Plan D for two years (FL). Not the most costly, the one that is now $58. This year, though, I switched Wellcare Classic as it fit my current AND possible future drugs (AA is one of this) very well. Even Daro and Enza are about $2800 on it, probably less next year. It is $37/month with $545 deductible.
Are you using Medicare's drug plan search tool? Really great resource, and Medicare's Web site makes you realize how bad most insurance carrier websites are.
Someone else mentioned the Medicare tool as well and I tried it. It was very good. I put in my prescriptions. I take 2 inexpensive drugs, besides the Abi. It listed ok the plans available to me and the annual price I would pay. The basic AARP/UHC plan was the cheapest. I’m going with that plan. If the estimate they give for the Abi turns out to be inaccurate, it’s only an estimate after all, I’ll fall back to GoodRx, Costco, etc and pay $120-something/month. I can deal with that. The lowest I’ve seen in my area is using SingleCare at Walgreens for $122.
Always interesting when it comes to this discussion. There are differences from state to state on some things with Medicare Advantage plans and such. I just started on Medicare in February and since I had been on BC/BS insurance chose a BC/BS Advantage plan. I elected for one with a payment and since they rolled my information forward Abiraterone was concern. I deal with Onco360 and they had put me in a program where I pay $0. That got pulled forward with my change. I was concerned and my doctor was ready to change to CostPlus but it wasn't necessary. I've been on Abi for not quite 2 years and will stop taking it in May (date of my choosing) - all tests have been great. Even with that, if needed they have guaranteed if restarted that it is approved and free for 1 year from February. Take time to discuss the cost and your concern with the insurer and pharmacy, there are alternatives out there.
I'm hanging out with the nasties who raid Drugstore/pharmacies....huge bottles but no warning labels........(next invasion, to include kidnapping a pharmacists).....
I'll just make a suggestion - GOODRX.COM - put it on your phone, put it on your computer.
My old Part-D plan was doubling it's deductables, and moving many of the drugs I take to higher tiers, so I used medicare.gov to try to pick out a better plan. The old plan was around $218/month, the new one I selected is $13/month. It has a co-pay at the beginning, I think around $200 (from rather bad memory..)
It's an interesting plan - typically on Plan-D plans, the in-house mail order pharmacy is the best price you can get. With this plan - they're the worst, typically 20-30% higher for any drug that there is a copay for (anything tier-2 and up) than a local pharmacy.
SO - my meds are all being filled, including the $0 co-pay by an Acme Pharmacy (consistantly the best prices..)
BUT what I found was - as good as the Acme copay prices are - I could usually beat them using "coupons" from GoodRX. Example - one co-pay was $18/month - with GoodRX it was $0.28. Same pharmacy, same drug - a tiny fraction of the cost.
My MD told me HE uses it for his prescriptions, and he's puzzled how they do it.. I have to admit - it puzzles me too. He mentioned there is another one (I've gotta search it out) that sometimes beats GoodRX, and the two in tandem cover almost everything that might be considered a common drug.
What none of them cover is repatha - self injection for high cholesterol LDL. I did get "prior approval" for it from the drug plan - at around $1800/year. Strangely - the Medicare website, using their drug cost calculator has the plan providing it at $1200/year. I now have filed an appeal against the drug plan price with Medicare (which is done through the drug plan - go figure)..
Anyway - GoodRX - remember it. It will save you money.
Replying to myself - I found a website that has it cheaper than GoodRX - "wellrx.com"
Try testing it with "fenofibrate" for an example. In my area - the "regular" price of it is around $242 for 90 day supply. GoodRX has an Acme coupon for it - $34.42, WellRX - $20.25 - ALL from the same pharmacy. Same generic drug, three dramatically different prices.
Already have GoodRx. I used it for my sildenafil prescription. The problem I had was that the pharmacy I was using for that, a relatively small regional chain, suddenly stopped accepting GoodRx. I then found SingleCare, which they still accept. It seems similar to GoodRx. It’s good to have as many alternatives as possible. SingleCare.com
SingleCare does fenofibrate for $18.91 at the Acme
So we have
o - GoodRX - $34.42 at the Acme
o - WellRX - 20.25 at the Acme
o - SingleCare - $18.91 at the Acme
Just checked the drug plan - mail order from them - $28.64, copay for Acme - $9.54
o - Drug plan copay - $9.54 at the Acme- the winner!
And under the price for the drug plan is:
You pay 100% of the cost.
Your plan pays $0.00 per 90 days.
SO - the drug plan copay at a local pharmacy is the cheapest in this case even though they claim to be paying NOTHING at all toward it.. And I have to do this with every drug I take.
So far I haven't found a single one that was cheaper using mail-order from the drug plan, which seems particularly stupid.
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