I am still working and still enjoying an insignificant amount of payment for my Besremi. I will turn 65 in January and be eligible for Medicare and 'might' retire.
The Donut hole goes like this as explained to me in a seminar, I will have a prescription drug cost deductible of $7,450; and will be paying 5% each month of the aproximately $17K cost of Besremi (which is about $850). This is a big number/dollar amount on a yearly basis.
I can continue working to avoid this cost or work for Costco, Starbucks, or places that offer insurance for employees (even at a part-time basis).
Any comments regarding how to save money when someone goes on Medicare without an employer sponsored insurance?
In the seminar, I was also told that the US Congress push for lower prescription drug bill will not happen until year 2025 and not all drugs are being targeted for eligibility to the lower pricing. Also, please do not politicize this topic as it only intended for someone who wants to save on the cost of Besremi.
Thank you.
Written by
Pat032018
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Medicare Part D covers self administered prescription costs. Go to the Medicare site where you can choose a plan and input Besremi as your only drug. The site will compute your annual cost taking into account the 4 cost sharing levels. This will tell you what you want to know. I believe the $7450 is not a deductible but rather the total cost to you and the plan which lifts you to the catastrophic level where you pay 5%. I have no idea what an employer's insurance might do with the cost of Besremi. Be aware that your drug costs will be heavy in the first few months of the calendar year and then drop down. This might be a reason to time starting Medicare for Jan 1.
There is a lot of variance in donut hole plans coverage for medicare Part D. As a retiree on an employer-sponsored retiree plan, I pay $100/month for Besremi with a $2000 annual cap. I am aware that I am fortunate as many do not have plans that would provide this level of coverage. However, there are some other issues to be aware of.
Even good retiree Medicare Part D plans do not necessarily have the same formulary for medications as employee plans. Some medications covered as an employee may not be covered as a retiree. It is important to look not just at the cost but also at the formulary and how access to the more expensive medications works. Note that I had to do extensive appeal work to get Besremi approved on my retiree-Medicare D plan.
if you you are in the upper middle class ($88,000+) when you retire, there is an income penalty you have to pay (IRMAA) to access Medicare. This ranges from about $2,200/year to as much as $5,000/year in the upper income brackets, Depending on your income bracket, this needs to be taken into account when calculating costs.
You are quite wise to have started the research into your costs for treatment before it becomes an issue. Careful planning should help you find a plan that will work for you.
All good points. I'm not retiring but I will be forced to move to a new healthcare plan next March on my 65th birthday because my husband is now a retiree and I'm on his healthcare (which we pay for out of pocket now.) Medicare and Anthem advised I review the formulary for each Medicare insurance plan CalPers offers as early as December of this year. Anthem mentioned that employee plans are better...just as you stated. Right now I don't even have a co-pay for Besremi.
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