2025 Medicare Part D

[3putt]

Hello fellow warriors. Quick question for the group. If the max out of pocket for prescriptions in 2025 is only $2000 is Part D really necessary? I’ve yet to ever use my United Healthcare Part D as my Good RX Gold is way way way cheaper. I’m sure I’m missing something but not sure what. As always, thanks in advance for your consideration of this request!

[fireandice123]

It’s my understanding that the $2000 cap is for Part D users.

[CAMPSOUPS in reply to fireandice123]

yep

[3putt in reply to fireandice123]

that makes sense

Thanks

[TeleGuy in reply to 3putt]

So when you run your prescriptions on GoodRx they don't contribute to your max out of pocket. But you need the Part D plan for the day when they prescribe you one of the expensive cancer drugs. Quite a few people here have commented on the 2024 Wellcare Part D plan that's free. I have been using it this year and have no complaints, and am on an expensive drug.

[3putt in reply to TeleGuy]

👍

[Scout4answers in reply to TeleGuy]

which drug?

[TeleGuy in reply to Scout4answers]

Me? Darolutamide.

[Scout4answers in reply to TeleGuy]

I have declined part D, now 76 so I think I must pay a premium or penalty to sign up for it. Did not know that there is a free version.

[dhccpa in reply to Scout4answers]

Sometimes the plans with no monthly premium make up for it with higher deductibles and higher out of pocket costs for the Rx drugs.

[Concerned-wife in reply to Scout4answers]

Medicare.gov has an online tool where you input your drugs and then you can compare the costs of the plans available to you. There might not be a free one in your area and yes it appears you will still pay a penalty even if there is. “The Medicare Part D late enrollment penalty is a monthly premium add-on that applies to people who don't sign up for a Medicare drug plan when they first become eligible or who go without creditable drug coverage for 63 days or more. The penalty is calculated by multiplying 1% of the national base beneficiary premium by the number of full months without coverage. In 2024, the national base beneficiary premium is $34.70, so the penalty is 1% of that amount multiplied by the number of months without coverage. The penalty is then rounded to the nearest 10 cents and added to the monthly Part D premium. “”

In addition there are add -on costs if your income is above certain amounts. We still chose to enroll.

[AinDC in reply to Concerned-wife]

Excellent response and to further clarify: Medicare beneficiaries are required to have drug coverage: either a plan that’s as good as Medicare Part D (e.g., a retirement health plan with such coverage) or Part D itself. This is the only way that health insurance can work as it would fiscally fail if people only bought it when they thought they would use it.

[maley2711 in reply to AinDC]

No, you are NOT requred to hhave Part D.....or show us your source please?

[AinDC in reply to maley2711]

That’s not what I said. I said either/or. What I failed to say is if you don’t have “creditable coverage,” you will have to pay a penalty. My source: cms.gov/medicare/enrollment...

[maley2711 in reply to AinDC]

You said " Medicare beneficiaries are required to have drug coverage: either a plan that’s as good as Medicare Part D (e.g., a retirement health plan with such coverage) or Part D itself. "

[AinDC in reply to maley2711]

Hey. I attempted to clarify and pointed out what I failed to say. I’m not sure why your responses seem so confrontational. I’m just trying to help.

[maley2711 in reply to AinDC]

i couldn't understand your clarification.

[4tunate1 in reply to Scout4answers]

I am not old enough (yet) for Medicare. But, having dealt with it for years on behalf of my aging parents I have some experience. They had options for Part D plans in SE Pennsylvania for $0 premium plans. In talking with the plans that $0 premium was due to competition in that particular market. So, I assume there may/may not be free plans in other markets.

[JustAnotherCancer in reply to Scout4answers]

Medicare Part D would be $34 plus 11% for 11 years of no part D.

[Tommyj2 in reply to Scout4answers]

No fee part D will only be found as part of an advantage plan to my knowledge. Advantage plans are generally a poor choice for those with advanced PCA.

[maley2711 in reply to Scout4answers]

The penalty is something like 1%/mo for every month that you delayed Part D signup.......it is 1% time some national "average" Part D premium. The penalty is for lifetime !!! If you received your 2024 Medicare and You pub, the details are there!! Looks like your penalty might be approx 120%??? Still, you've saved a lot on premiums!!! How have you paid for your PCa drugs? I guess Lupron injections have come under Part B. But abiraterone, prednisone?

[Professorgary in reply to Scout4answers]

Not free everywhere, I pay 50 cents a month.

[mrssnappy in reply to TeleGuy]

I was going to say the same thing. In my husband's case he is on Lynparza. Wellcare is a 0 dollar premium and it has worked well for us. We had United Health Care Part D last year but when the premium doubled and we crunched the numbers with both premiums and copays, Wellcare was a better deal for us. The Medicare online tool actually works very well and has been accurate for us.

[mrscruffy]

I have UHC part D and don't pay for most of my scrips. For me it works fine

[Explorer08]

I have UHC Medicare Part D and since I am on both Orgovyx and Xtandi I go almost immediately into the catastrophic level early in the year which eliminates copays for all prescription meds.

[kainasar in reply to Explorer08]

Yes, thats how it works.Once over the out of pocket limit for Part D, then the meds are free until the end of the year. However, medicare advantage plans do have a choice over which Specialty drugs they cover. Maybe the arrangements differ by state, but as far as I know, one has Medicare A&B and has to sign onto a Part D plan, or one must choose a Medicare Advantage Plan which covers everything inc Part D. The Part D Supplement, and Med Advantage

still have the an out of pocket limit you have to pay before go into whats called coverage gap, where the copay is lower, or catastrophic, where its free until end if year.

[Explorer08 in reply to kainasar]

Good summary. I have UHC Medicare Advantage. Only copays are for in-patient and ER visits. It’s a negotiated deal between my state and UHC, to your point about differences.

[j-o-h-n]

Clear as mud..........

Good Luck, Good Health and Good Humor.

j-o-h-n

[RMontana]

Wow, this threw me for a loop; FREE meds! I read thru the entire pamphlet sent by MEDICARE and did not catch this...did a quick search. Dont pop the champagne yet; its a low income program. Is this correct; Google search;

"Yes, Medicare Part D offers a program called Extra Help, which can help people with limited income and resources pay for prescription drugs. Extra Help, also known as the Part D Low-Income Subsidy (LIS) program, can help with the cost of deductibles and copays. In 2024, Extra Help will expand to cover more drug costs for people who earn less than 150% of the federal poverty level. Those who qualify for Extra Help typically pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs."

I did see the Extra Help section in the medicare pamphlet but did not read it as I dont think I qualify. If you do then go for it...but its not 'free' meds...its extra help for those who qualify. Unless I am missing something...Rick

[85236442968]

3putt

I have been on Well Care value script for about 3 years now. No premium, but have not heard about next year yet. Well Care does a great job of taking care of the standard drugs the over 65 crowd uses such as cholesterol meds, most BP meds, arthritis meds, etc.

When the more expensive are needed , such as Abiraterone or such, Good RX, SingleCare, and Mfg reps do a better job. They do not go against the Out of Pocket roll up, but they are a lot less expensive.

I have not tried the Mark Cuban Cost Plus yet, but have read in this site they are even better than Good RX cost wise.

Lastly the best bet is to get one of the Non-Profits such as The Assistance Fund to take care of your expensive drug co-pays. This requires help from your Pharmacy and an application. I get a pretty good sense that the only Pharmacies that help with this is those attached to a Cancer center.

[maley2711 in reply to 85236442968]

Do you have a $$$ amount for abiraterone with one of those sources?

The most expensive cancer drugs usually have a 30% copay with D plans...until max OOP reached. How are thsose sources able to offer better than a 70% discount to retail, which is the effective discount thru a D plan????

[Professorgary in reply to maley2711]

I just paid $98 delivered from mark cuban cost plus drugs which is down from $124 a year ago. That was 120 x250mg.

[85236442968]

Maley2711

OK so lets teach you how to fish.

Bring up Good RX on your browser. GoodRX.com

There is a search box right in front of you. Enter Abiraterone then hit the blue box to initiate your search. You will get a number of prices. Walmart and Marcs will be the lowest.

I suggest you call whoever you chose from that list to check on the prices.

Then tell where you are currently getting your Abiraterone from that you can get it for this price at this place. If they do not meet it or get close (they should be able to get close) you will then have to have your MO send a prescription to the new place.

Now lets look at Cost Plus (mail order) costplusdrugs.com/ I have never used them but there are others on the site that have and speak highly about them.

When you get to the site, click on the box "See all medications". A search box will come up. type in Abiraterone. They will show you a price for 30 tablets. Usually less than $30. You most likely need 120 so it will be in the $120 range. I have never went further than this on their site.

SingleCare.com is another to research, they are a bit higher on most drugs.

Now let's talk about something completely different. I will take a guess you are getting your meds from a pharmacy attached to your Oncology Center. Ask them if they have any relationships with Non Profits or Foundations that help with co-pays. Most likely they do and should be able to help you get an application for one. My Abiraterone Copays are handled by one of these. I go to the Timken Cancer Center and their in house Pharmacy helped me with the process.

Good luck and good fishing. Let me know where you end up.

[maley2711 in reply to 85236442968]

Thank you very much. I apparently incorrectly assumed that abiraterone, Zytiga, Xtandi,etc are VERY expensive cancer drugs. I not sure what standard dosage is for something like abiraterone, but I'll try to d etermine and then compare pricing at places you've provided to what shows up for the price with a Part D plan. Also the Part D plan included with my wife's Kaiser Advantage plan....so far she has ZERO cost for 6 meds she takes....pleasantly surprised!!!

I might end up back with Kaiser too......for the 1st time in 27 years, I'm going to try the "traditional" independent clinics route, witha supplement.

I know there are lots of features of the Kaiser system that I am probably going to miss.....are there "better" Docs outside, and how will I know???

[85236442968]

Maley2711

Abiraterone, Xtandi, etc can be very expensive drugs, especially if you get them and accept the co-pay from your Part D. Abiraterone will be in Excess of $2000 a month if you do not challenge it. The right way to challenge is with facts.

BTW the std dosage of Abiraterone is 1000 mg, (4 tablets) per day.