Part D Medicare

[wat380bjw]

I am working on my Part D Medicare for 2025. I have always used AARP Walgreens preferred but did some checking and found this plan is not the most cost efficient. If I understand correctly we have a maximum out of pocket for 2025 of 2000 dollars, high premium policies are not included in the maximum out of pocket. If I need to go on one of the more expensive Meds like Erleada or Zytiga next year if will cost me 2000.00 for the year, am I missing something? All help is appreciated. Thank you all!!!

[Tall_Allen]

The drug must be covered by your Part D plan to qualify for the $2,000 cap.

[mrscruffy]

I am on Lynparza. My co-pay for single month is $2000+. I will meet the cap first month. I was prepared for the initial $2000 payment but was told by Medicare that they will bill me $166 monthly which is OK

[cigafred]

That is what I have been thinking (I have the same plan as you for 2024). Why pay a high monthly premium if one expects drug costs to top $2K regardless?

[6357axbz in reply to cigafred]

Per Tall Allen’s comment above. Make sure the Part D Medicare Supplement plan you choose includes coverage for the drugs you need

[wat380bjw in reply to 6357axbz]

Yes I did check and they are. But also found out as per gov rules there must be at least two choices in each category?

[6357axbz in reply to wat380bjw]

Please explain

[wat380bjw in reply to 6357axbz]

The drugs I am concerned about for next year are covered, if I need them and will go towards the 2000 dollar maximum out of pocket for 2025

[6357axbz in reply to wat380bjw]

What do you mean by “there must be at least two choices in each category”?

[wat380bjw in reply to 6357axbz]

I think you may want to google that. I read it somewhere when I was checking into all this.

[wat380bjw]

If you are on any drugs now you will see that Walgreens and CVS are the most expensive...I was very surprised!!

[mababa]

Wat380, you can plug your drugs in your Medicare account and look for new plans and then compare. It will show you maximum out of pocket costs based on the pharmacies you want to use. I’ve found you need to make sure your specialty pharmacy (or “mail order”) source is in network. There are some anomalies as to what is considered in network, but you can always call the pharmacy to confirm. I’m using an Aetna part D plan but have been looking hard at Wellcare. Good luck in running the maze. 😉

[wat380bjw in reply to mababa]

Thank you.....In Fl. Wellcare the premium is zero....hard to believe

[mababa in reply to wat380bjw]

Yep. They’re out of Tampa and offer that same zero premium plan where I am. They indicate that their own mail order specialty pharmacy must be used—also in Tampa. Because I’m in western Washington, I’m concerned delivery times could be compromised during inclement weather. Aetna raised their premium to $32/mo. While I could save money, the easy thing is to stay put. My meds come from Onco360 and they’ve been very proactive. Good luck!

[InqPers]

Yes, as TA notes, the most important thing is that the drug(s) is/are on formulary (i.e. on the covered list). Otherwise they will not count toward the $2000 annual out of pocket max. Beyond that, I would look for the Part D plan with the lowest premium.

[wat380bjw]

Yes I agree as long as the formulary is to your liking

[Professorgary]

I have WellCare script that costs me 50 cents a month. I used to pay 70 dollars a month and when I went on abiraterone the cost was 6600 a month and my cost was 2200 a month. I now get it at Mark Cuban Cost plus Drugs for $91 a month plus $5 shipping with no insurance involved.

[Professorgary]

one note here about the $2000 cap in that was part of Biden’s inflation reduction act so that could be eliminated be the new administration. I pray not but history shows that it is very possible.

[6357axbz]

I don’t think it can be removed in the first year