My present Part D company notified me that they were raising my premium 75% and my drug costs would go up dramatically. Following your easy to use instructions, switching to a lower premium along with lower drug costs was a snap! Thank you!
Even with my state retirement insurance, I am now -2025-obligated to pay a subsidy for my medicare advantage. If I don't enroll I lose the option for good and then must rely on third party options. Our healthcare costs continues to rise, and we get less and less for the care and yet obligated to abide by the USA's very complicated healthcare system. (Reading through a 400 page plan)As a senior, I will not live to see any resolution. Been going on for decades. The healthcare CEO's make 20 million dollars while citizens struggle to find life over death. Just frustrating. But did enjoy your video and helps to understand our complicated mess. Triggers my anger too! lol.
Thanks Erik. I did this for myself and my sister. We're both on low cost generic drugs so, we're both keeping the $0 premium W plan. It's odd too that one of her drugs which is Tier 2 this year has moved to Tier 1 for next year.
Thank you for this very informative and very helpful video. I was trying to check before open enrollment to see if my current plan D was still the best for me. Now that open enrollment has started I will check again with the setting you said to use.
Excellent information and presentation, as always, Erik. I am shocked at the increase of my place holder Part D (I take NO medications) from $9.90 per month in 2024 to $44.90 for 2025! If my math is correct, that is approximately a 453% increase! I will be looking at other plans. What is your interpretation of these across-the-board large increases among many plans/companies for 2025?
Thank you so much! Yes... you're not alone with those increases :( Do you have one of the $0 plans available in your area? This video sort of goes over those thoughts :) ruclips.net/video/lS1LJS9tues/видео.html
Wait until Medicare starts paying for Ozempic, the magic weight loss drug. Just turn 67 yesterday. I have kept my weight at 168lb (5'10") for the last 30 years. I have been on Intermittent Fasting for 15 years, basically no calorie intake after dinner until noon time. I put in 5 miles walking on an empty stomach at 5:30am every morning. None of my friends or neighbors willing to do that. I try not to think of the fairness issue.
@@Theretirementnerds Yes, sadly, not the "Lone Ranger" on this one. Thanks, Erik. You are appreciated by all who take advantage of your Medicare expertise! God bless!
As you said - easy peasy. I laughed a few weeks back when I got the new costs for my existing Part D for 2024 (half year) - an increase of 258%. Um nothankyouverymuch. I don't know how these zero monthly premium plans make any money, but guessing that's because of our totally effed up Big Pharma involvement (as a retired healthcare provider, don't get me started...) Thanks as always for your assistance. I was waiting for you to weigh in! And hope y'all had a fun road-tripping summer. It was fun to watch.
Yeah... you're not alone on those big increases :( Road trip was amazing! Only 1 more state Medicare video to post from that, haha! Took a long time to get through those and get them edited. Appreciate you!
Here we were offered a zero plan. It covered all of my drugs so I took it. I think just about everyone that changes (if it covers their drugs) will change to that plan. I wonder if the RX company that offered it is relying on numbers. They might make enough via large numbers of people (many with low cost drugs) signing up for their plan to break even or even make a little.
Don't forget, (CMS, the federal government, your tax dollars) pay insurance companies a monthly amount for each person on a Part D drug plan. So, Wellcare is getting quite a bit of money from tax dollars to offer the $0 plan. (I have that plan as well.)
Thank you for this information. My dad got his renewal from Aetna Silver Script, and his rate increased 660%. I think that is terrible for a person that is taking one prescription (tier 1). Using your information, I will be able to find a plan that is a much better option.
Erik - this is one of the most useful videos I’ve seen on any topic. Thank you! So very well done! Quick question: Let’s assume that someone makes the best choice for themselves based on the low cost drugs they are on. Then, mid-year their doctor prescribes higher cost drugs to handle their worsening condition. Looking at the higher cost drugs, a different plan would be better. Is that person stuck with their current plan until the next open enrollment period? Take care, my friend. Awesome job!
You are too kind Anthony. Appreciate you! Yes, that person is stuck in their current plan until the next annual enrollment period unless they have a special election period reason - like they move outside their current plan's coverage area. But, most likely stuck on that plan until the following January.
@@Theretirementnerds Thank you! There are all kinds of risk calculations that we all have to make. Although those choices are hard no matter what, they are made easier by having your great information. Appreciation back at you!
@anthonygardner400 yeah, so hard to try and predict the future. Would hate to get a higher cost plan, pay for it, and never need it. we don't ever make drug plan recommendations like that, but definitely happens.
I'm staying with my Wellcare Value Choice. I've already checked it out for 2025 -- my monthly premium will be $0.00 and I will only pay $5/month for one of my maintenance medications and the other three are zero copay. Thus, my total Part D cost for 2025 will be $60.00 unless I get prescribed an antibiotic or some other type of medication. My wife's Aetna Silver Script premium is going up from $9.80/month to $44.80/month and the copays will be much higher for her drugs, so she is going to switch to Wellcare Value Choice.
This video is excellent. Can this possibly be true? I'm on 3 generic tier 1 medications on the 2025 Wellcare Value Script (PDP) that are listed at $0.00 (zero) at preferred pharmacies near me. I understand that there is a $590 deductible for tiers 3-5 but I don't currently take any medications in those tiers. So, assuming my current medications remain the same, how is it that I can sign up for a plan and pay nothing all year?? Can this be true? Why would I keep my 2024 plan where total drug and premium costs for 2025 will be over $700? What is the catch?
Very helpful video for someone going thru this for the first time. You don't mention looking for the qualifiers, like pre-authorizations (PA) or Quantity Limits (QL). How different are those between plans?
Great video! Even though we are planning on staying on employer insurance for another couple of year I thought I’d check the part D plans out especially because we have family and friends already on them and the possibility we would be forced to switch if employer insurance is considered not credible due to the new out of pocket limits. I was surprised to discover how many drug aren’t on any part D formulary in our area including some generic drugs. I know these drugs were covered last year because I know people taking them and getting them through the part D plans. I’ve had to remind some family and friends to double check this year because they’re used to just letting the plans roll over. There was a lot of eye rolling but they’re doing it.😂 PS. You forgot the magic word.
Thank you for checking it out! Yes... people need to be reviewing this year. A LOT of changes out there. And left out the magic word for this one :) Have a lot of partners who want to use this video on their own communications, so kept it a bit more professional :)
@@TheretirementnerdsI also want to use this in communications with my clients. Your work is amazing, admirable, inspiring, etc. What does it take to partner with you? What would you need or want from me to get your blessing?
For most, fixed costs through premiums are going up in 2025. For some, they will stay the same or could go down :) Medications make a big difference :) Appreciate you watching!
My wife Part D plan went up by almost $30. She is not on any prescribed medications. My drug plan does not have any premium costs. Should I just change her over to my same plan because we know there are covered pharmacies in our catchment area? By the way, just love your videos.
IF she isn't taking any medications, I'd switch her to the $0/mo. Wellcare plan. My spouse starts Medicare in April 2025 and takes no medications as well. That's the plan he'll be signing up for as well -- just to have drug coverage.
I have a good Advantage plan in California. And I have never signed up for Part D as I have not required much in the way of drugs. But when my retirement income increased and the monthly Medicare premium increased, now I have an additional charge of $12 per month for Part D. Is that correct?
Yes, it is. Your advantage plan has a Part D plan included in it, so you are getting the Part D surcharge for having a higher income. If you just had 1 year with the higher than normal income, that extra amount will only last for a year.
During this open enrollment period, can you do a video regarding difference between "basic" and "enhanced" Part D plans? It is my understanding (from another Medicare You Tuber) that "enhanced" plans will have less TROOP (true out-of-pocket) costs because the TROOP is based on the "standard benefit cost calculation" and with an "enhanced" Part D plan you will have lower ACTUAL out of pocket copays/coinsurance/and 0 deductibles and reach the $2000 cap without actually having incurred the full $2000 cap since it is based on "standard benefit cost". Confusing, isn't it? Need you to explain all the differences between the two different types of Part D plans.
I agree. Many RUclips videos don’t explain this at all. One who takes high cost drugs may assume to go with cheapest plan assuming she/he has to pay $2,000 out of pocket anyway.
One possibly important comment: Since in 2025 there will be a $2K max out of pocket, things get a little flakey about "cheapest plan". Like your example, for me, there were 2 very different "least expensive" plans, one with $0 premium, and one with a $92 premium. The $92 plan was cheaper overall for 2025...BUT: That cheaper plan was around $1800 total cost, while the $0 plan was $1900. The thing is, as you noted, for the max out of pocket, the premium does not apply. So while I am just about to go into the max out of pocket for the $0 plan (when all my drugs would be come free), the "cheaper" $92 plan is actually over $1000 away from the max out of pocket. That means that if I had an expensive drug added to my 'scripts, I would still be paying for it under the supposedly cheaper plan, while the slightly "more expensive" plan would max to immediately and all further costs would be covered.
I think this is what you implied but I would like to confirm: If someone is in a drug plan for 2024 and enrolls in a different plan for 2025, will they be AUTOMATICALLY un-enrolled from their current plan, or will they have to un-enroll themselves?
I've used the tool, and there's something I don't understand. I've got some high cost drugs in there, and I know I'll hit the $2,000 cap. Yet I'm presented with plans that show me hitting the cap in mid year, but the total yearly cost is less than $2,000. How is that possible? Are there some nuances to the $2,000 cap that I just don't understand?
I've since learned that the $2,000 cap isn't quite straight forward. The $2,000 Out of Pocket isn't always what the customer pays. It's based on the Medicare defined standard costs, which isn't explained anywhere in the Medicare information.
My understanding, each Part D plan falls under one of the two Drug Benefit Category, Basic or Enhanced. With Basic, $2,000 Max out of packet is applicable. With Enhanced, calculations are complicated and could very well be less than $2,000 for certain plans that have $0 deductible and fixed $ copay (vs % co-insurance, i.e. 25%) for higher cost drugs.
I was surprised that it seems like all of the available plans have changed their Tier 3 copays from a fixed price ($11 for my Wellcare Value Script plan) to a 25% copay...which for an expensive drug is a *huge* difference! Do you know what happened that this change happened?
I'm going to change this to lowest monthly premium immediately followed by "PLEASE DON'T EVER DO THIS" I understand the reasoning behind this, but still funny.
You'd need to wait until the next annual enrollment period to make a change. Or, if you have a special election period, like you move outside your existing plan's coverage area.
My wife encountered this. The insurance company went ahead and covered the initial 30 day fill, but informed her that they would not cover any refills, and provided a list of alternative drugs that they do cover. She will take the list of alternative drugs to her doctor to get a prescription for one of the alternative drugs that is covered by her prescription plan. The company said that she could apply for an exception.
If you don't have any high cost medications to add how do you assess a plan's formulary? The formulary seems to be the biggest driver of cost passed to the customer. I'm looking for the best zero/low cost plan and have no current medications, but want to choose wisely in case this changes. I tried adding in the drugs mentioned in the video, but they default to the high cost plans with the best formulary.
I assume that the "high cost" plans you refer to are the ones with higher monthly premiums. When the tool does that, it is showing you the plans that would be the lowest total cost, drugs & premiums combined. You can still show the details for the zero premium plans to see the cost for the drugs you added.
Some plans have a deductible and some don’t. Does sorting by lowest drug cost and premiums still give you the lowest overall cost or do you have to add the deductible to the cost presented to get your true cost?
Sorting with lowest drug cost and premiums will still get you the lowest overall cost. It's looking at your medications and factoring in any premiums, deductibles, and copays/coinsurance :)
Can you shop at two different in-network pharmacies for your meds? On my list of yearly cost of drugs, the two Tier 4 drugs are cheaper at the local family pharmacy by $250; however, all the Tier 1 drugs are cheaper at CVS. (Though I did hear you say costs can vary through the year.)
@@dianedimidio7353 I have never had any issue using multiple pharmacies during the year. Just be sure that both pharmacies are "in-network" and "preferred" to get the best prices.
@@dianedimidio7353YES you definitely can. It is a good way to get your overall cost lower than the Medicare calculated cost. A little less convenient but if the cost saving is worth it to you, Do It.
Question - do all prescription drug plans follow the same tier level for a given prescription? I ask because if not then I don’t think the total premium and drug costs are accurate but I may be wrong in my assumption. Thanks!
If my drug is not in formulary of my Medicare advantage plan. I was told by the licensed agent to have the prescribing doctor ask the insurance company to add the particular drug to their formulary. Does that really work?
Correct! Mail order calculations work a bit differently. In the first example, you are correct. For the lowest overall cost plan, the default is to show retail pharmacy costs! Yet another thing to keep in mind through all this!
Just so I am clear, only the drugs listed in your drug list are covered? What about random "I am sick" prescriptions i.e. antibiotics, some sort of rash cream, whatever. None of those are covered because they are not on "the list"?? That seems insane. Regular employment insurance pays for whatever you come into the pharmacy for. So what price point does one have to pay if it isn't "on the list"???
The list of drugs that you enter, at the Medicare site, are used to calculate the yearly cost of each plan. During the year you are never limited to the list. The list that you should be concerned with is the insurance company formulary list, which says which drugs the company covers and which tier they are on. The tier determines your cost for the drug. The random "I am sick" drugs can still be covered by the prescription plan, and usually are covered, as long as they are commonly prescribed drugs, but each company has a different formulary list.
What happens if I signed up for a stand alone part D for the very first time to comply with the Medicare rules and the following year I cancel the plan. What will Medicare do???
@@cheezit58 To avoid any penalty in the future, just sign up for a zero premium plan. You can always switch to a different plan in future years during the AEP.
✓✓✓✓✓✓✓✓✓ If he is talking too fast for you, you can set the playback speed at a slower rate. Just click on the video to display the Settings icon (it looks like a gear wheel) in the upper right of the video, then click on playback speed, then click on .75x. It will slow down the video to 75% of the normal speed.
![ARGENTINA vs. BOLIVIA [6-0] | RESUMEN | ELIMINATORIAS SUDAMERICANAS | FECHA 10](http://i.ytimg.com/vi/C3wPtKNbAOA/mqdefault.jpg)
My present Part D company notified me that they were raising my premium 75% and my drug costs would go up dramatically.
Following your easy to use instructions, switching to a lower premium along with lower drug costs was a snap!
Thank you!
So glad it was helpful! Thank you for watching!
did this yesterday, but thanks so much. Was good to know we did it correctly.
Even with my state retirement insurance, I am now -2025-obligated to pay a subsidy for my medicare advantage. If I don't enroll I lose the option for good and then must rely on third party options. Our healthcare costs continues to rise, and we get less and less for the care and yet obligated to abide by the USA's very complicated healthcare system. (Reading through a 400 page plan)As a senior, I will not live to see any resolution. Been going on for decades. The healthcare CEO's make 20 million dollars while citizens struggle to find life over death. Just frustrating. But did enjoy your video and helps to understand our complicated mess. Triggers my anger too! lol.
yes while our Govt gives the illegal migrants everything.
Just found you today. Clear instructions. Thank you, and am subscribing.
Appreciate you so much! Thank you!
Thank you! I just ran the Medicare drug plan gaunlet for Denver. Simply changed plans with same company and switched pharmacies. Thanks!
Thank you for watching!
Your explanations were on point. 👍 Thanks
Thank you so much!
Thanks Erik. I did this for myself and my sister. We're both on low cost generic drugs so, we're both keeping the $0 premium W plan. It's odd too that one of her drugs which is Tier 2 this year has moved to Tier 1 for next year.
Super strange. A lot of things happen behind the scenes that can cause certain medications to move around in unexpected ways
Thank you for this very informative and very helpful video. I was trying to check before open enrollment to see if my current plan D was still the best for me. Now that open enrollment has started I will check again with the setting you said to use.
So glad it was helpful! Appreciate you tuning in! :)
Excellent information and presentation, as always, Erik. I am shocked at the increase of my place holder Part D (I take NO medications) from $9.90 per month in 2024 to $44.90 for 2025! If my math is correct, that is approximately a 453% increase! I will be looking at other plans. What is your interpretation of these across-the-board large increases among many plans/companies for 2025?
Thank you so much!
Yes... you're not alone with those increases :(
Do you have one of the $0 plans available in your area?
This video sort of goes over those thoughts :)
ruclips.net/video/lS1LJS9tues/видео.html
Wait until Medicare starts paying for Ozempic, the magic weight loss drug.
Just turn 67 yesterday. I have kept my weight at 168lb (5'10") for the last 30 years. I have been on Intermittent Fasting for 15 years, basically no calorie intake after dinner until noon time. I put in 5 miles walking on an empty stomach at 5:30am every morning.
None of my friends or neighbors willing to do that.
I try not to think of the fairness issue.
@@Theretirementnerds Yes, sadly, not the "Lone Ranger" on this one. Thanks, Erik. You are appreciated by all who take advantage of your Medicare expertise! God bless!
As you said - easy peasy. I laughed a few weeks back when I got the new costs for my existing Part D for 2024 (half year) - an increase of 258%. Um nothankyouverymuch. I don't know how these zero monthly premium plans make any money, but guessing that's because of our totally effed up Big Pharma involvement (as a retired healthcare provider, don't get me started...)
Thanks as always for your assistance. I was waiting for you to weigh in! And hope y'all had a fun road-tripping summer. It was fun to watch.
Yeah... you're not alone on those big increases :(
Road trip was amazing! Only 1 more state Medicare video to post from that, haha! Took a long time to get through those and get them edited. Appreciate you!
Here we were offered a zero plan. It covered all of my drugs so I took it. I think just about everyone that changes (if it covers their drugs) will change to that plan. I wonder if the RX company that offered it is relying on numbers. They might make enough via large numbers of people (many with low cost drugs) signing up for their plan to break even or even make a little.
Don't forget, (CMS, the federal government, your tax dollars) pay insurance companies a monthly amount for each person on a Part D drug plan. So, Wellcare is getting quite a bit of money from tax dollars to offer the $0 plan. (I have that plan as well.)
You do a top notch job. Thank you.
Thank you so much!!
Super helpful! Thanks. You helped me better understand drug plans.
Thanks, The Retirement Nerds, for your continued excellence in teaching vital need-to-know information about Medicare!
Appreciate your support David!
@@Theretirementnerds My pleasure.😎
Great job! I learned some things!
Thank you for the Medicare information Eddie
Appreciate you Eddie!
Thank you for this information. My dad got his renewal from Aetna Silver Script, and his rate increased 660%. I think that is terrible for a person that is taking one prescription (tier 1). Using your information, I will be able to find a plan that is a much better option.
Erik - this is one of the most useful videos I’ve seen on any topic. Thank you! So very well done!
Quick question: Let’s assume that someone makes the best choice for themselves based on the low cost drugs they are on. Then, mid-year their doctor prescribes higher cost drugs to handle their worsening condition. Looking at the higher cost drugs, a different plan would be better. Is that person stuck with their current plan until the next open enrollment period?
Take care, my friend. Awesome job!
You are too kind Anthony. Appreciate you!
Yes, that person is stuck in their current plan until the next annual enrollment period unless they have a special election period reason - like they move outside their current plan's coverage area. But, most likely stuck on that plan until the following January.
@@Theretirementnerds Thank you! There are all kinds of risk calculations that we all have to make. Although those choices are hard no matter what, they are made easier by having your great information. Appreciation back at you!
@anthonygardner400 yeah, so hard to try and predict the future. Would hate to get a higher cost plan, pay for it, and never need it. we don't ever make drug plan recommendations like that, but definitely happens.
Thank so much...great video!
Thank you!
Thank you.
Very helpful video…. For realzees!
Haha! You caught that... :)
I'm staying with my Wellcare Value Choice. I've already checked it out for 2025 -- my monthly premium will be $0.00 and I will only pay $5/month for one of my maintenance medications and the other three are zero copay. Thus, my total Part D cost for 2025 will be $60.00 unless I get prescribed an antibiotic or some other type of medication. My wife's Aetna Silver Script premium is going up from $9.80/month to $44.80/month and the copays will be much higher for her drugs, so she is going to switch to Wellcare Value Choice.
As long as her wellcare value choice covers her current drugs okay, sounds solid. Run it through medicare.gov if you haven't already ☺️
@@marct9587 I have WellCare Value Choice also!
My dad is in the same situation as your wife and is making the same change
@@marct9587 : I am going with WellCare Value monthly $0 too 👍 Thanks
This video is excellent. Can this possibly be true? I'm on 3 generic tier 1 medications on the 2025 Wellcare Value Script (PDP) that are listed at $0.00 (zero) at preferred pharmacies near me. I understand that there is a $590 deductible for tiers 3-5 but I don't currently take any medications in those tiers. So, assuming my current medications remain the same, how is it that I can sign up for a plan and pay nothing all year?? Can this be true? Why would I keep my 2024 plan where total drug and premium costs for 2025 will be over $700? What is the catch?
Very helpful video for someone going thru this for the first time. You don't mention looking for the qualifiers, like pre-authorizations (PA) or Quantity Limits (QL). How different are those between plans?
Well done
Thanks, Erik! Very helpful… but miss the secret word😊
Haha! Totally!
A lot of partners use this video, so had to keep this one a little more buttoned up 😊
Great video! Even though we are planning on staying on employer insurance for another couple of year I thought I’d check the part D plans out especially because we have family and friends already on them and the possibility we would be forced to switch if employer insurance is considered not credible due to the new out of pocket limits. I was surprised to discover how many drug aren’t on any part D formulary in our area including some generic drugs. I know these drugs were covered last year because I know people taking them and getting them through the part D plans. I’ve had to remind some family and friends to double check this year because they’re used to just letting the plans roll over. There was a lot of eye rolling but they’re doing it.😂
PS. You forgot the magic word.
Thank you for checking it out! Yes... people need to be reviewing this year. A LOT of changes out there. And left out the magic word for this one :) Have a lot of partners who want to use this video on their own communications, so kept it a bit more professional :)
@@TheretirementnerdsI also want to use this in communications with my clients. Your work is amazing, admirable, inspiring, etc. What does it take to partner with you? What would you need or want from me to get your blessing?
@@adamniederklein6965 you are too kind. My email is erik@theretirementnerds.com
Send me a message and we can chat
Wow. So helpful! Thank you.
Thank you for watching!
Thanks, Great Help .
Thank you for watching!
Great video thanks!☺
Wow. That's more expensive than I thought it would be... At least, that process was pretty simple and straightforward! LOL.
For most, fixed costs through premiums are going up in 2025.
For some, they will stay the same or could go down :)
Medications make a big difference :)
Appreciate you watching!
@@Theretirementnerds I'm just on a couple of low cost generics and intend to keep it that way 😂
@@ph5915 very wise!
My wife Part D plan went up by almost $30. She is not on any prescribed medications. My drug plan does not have any premium costs. Should I just change her over to my same plan because we know there are covered pharmacies in our catchment area? By the way, just love your videos.
IF she isn't taking any medications, I'd switch her to the $0/mo. Wellcare plan. My spouse starts Medicare in April 2025 and takes no medications as well. That's the plan he'll be signing up for as well -- just to have drug coverage.
Yes, what Tom said. If she isn't taking medications, get the lowest cost plan possible.
Thank you for watching and your kind words!
I have a good Advantage plan in California. And I have never signed up for Part D as I have not required much in the way of drugs. But when my retirement income increased and the monthly Medicare premium increased, now I have an additional charge of $12 per month for Part D. Is that correct?
Yes, it is. Your advantage plan has a Part D plan included in it, so you are getting the Part D surcharge for having a higher income. If you just had 1 year with the higher than normal income, that extra amount will only last for a year.
THANK YOU!!!😀😃😄
Of course! Thank you for watching!!
During this open enrollment period, can you do a video regarding difference between "basic" and "enhanced" Part D plans? It is my understanding (from another Medicare You Tuber) that "enhanced" plans will have less TROOP (true out-of-pocket) costs because the TROOP is based on the "standard benefit cost calculation" and with an "enhanced" Part D plan you will have lower ACTUAL out of pocket copays/coinsurance/and 0 deductibles and reach the $2000 cap without actually having incurred the full $2000 cap since it is based on "standard benefit cost". Confusing, isn't it? Need you to explain all the differences between the two different types of Part D plans.
I agree. Many RUclips videos don’t explain this at all. One who takes high cost drugs may assume to go with cheapest plan assuming she/he has to pay $2,000 out of pocket anyway.
One possibly important comment: Since in 2025 there will be a $2K max out of pocket, things get a little flakey about "cheapest plan". Like your example, for me, there were 2 very different "least expensive" plans, one with $0 premium, and one with a $92 premium. The $92 plan was cheaper overall for 2025...BUT: That cheaper plan was around $1800 total cost, while the $0 plan was $1900. The thing is, as you noted, for the max out of pocket, the premium does not apply. So while I am just about to go into the max out of pocket for the $0 plan (when all my drugs would be come free), the "cheaper" $92 plan is actually over $1000 away from the max out of pocket. That means that if I had an expensive drug added to my 'scripts, I would still be paying for it under the supposedly cheaper plan, while the slightly "more expensive" plan would max to immediately and all further costs would be covered.
I think this is what you implied but I would like to confirm: If someone is in a drug plan for 2024 and enrolls in a different plan for 2025, will they be AUTOMATICALLY un-enrolled from their current plan, or will they have to un-enroll themselves?
Correct. By signing up for a new one, it'll cancel your previous plan at the new year.
@@Theretirementnerds Thanks.
I've used the tool, and there's something I don't understand. I've got some high cost drugs in there, and I know I'll hit the $2,000 cap. Yet I'm presented with plans that show me hitting the cap in mid year, but the total yearly cost is less than $2,000. How is that possible? Are there some nuances to the $2,000 cap that I just don't understand?
I've since learned that the $2,000 cap isn't quite straight forward. The $2,000 Out of Pocket isn't always what the customer pays. It's based on the Medicare defined standard costs, which isn't explained anywhere in the Medicare information.
My understanding, each Part D plan falls under one of the two Drug Benefit Category, Basic or Enhanced. With Basic, $2,000 Max out of packet is applicable. With Enhanced, calculations are complicated and could very well be less than $2,000 for certain plans that have $0 deductible and fixed $ copay (vs % co-insurance, i.e. 25%) for higher cost drugs.
I was surprised that it seems like all of the available plans have changed their Tier 3 copays from a fixed price ($11 for my Wellcare Value Script plan) to a 25% copay...which for an expensive drug is a *huge* difference! Do you know what happened that this change happened?
I'm going to change this to lowest monthly premium immediately followed by "PLEASE DON'T EVER DO THIS"
I understand the reasoning behind this, but still funny.
Haha... ya... now everyone is going to try it
Do you have to cancel the plan you are dropping or is that done automatically when you sign up for new plan ? - thank you
Automatically done for you when picking a new plan.
Your old plan is active through December 31st, 2024. New plan starts January 1st, 2025
Thank you - you are doing awesome work for Medicare recipients - and your vacation looked fantastic
@@michalsmith4668 appreciate you saying that! It was definitely a work trip ☺️ and it was incredible!
One of my medication is not even listed there ?
What if you start on one plan but in the middle of the year you need to start taking a med that isn't covered? Are you forced to pay out of pocket?
You'd need to wait until the next annual enrollment period to make a change. Or, if you have a special election period, like you move outside your existing plan's coverage area.
Got it. Thanks!
My wife encountered this. The insurance company went ahead and covered the initial 30 day fill, but informed her that they would not cover any refills, and provided a list of alternative drugs that they do cover. She will take the list of alternative drugs to her doctor to get a prescription for one of the alternative drugs that is covered by her prescription plan. The company said that she could apply for an exception.
If you don't have any high cost medications to add how do you assess a plan's formulary? The formulary seems to be the biggest driver of cost passed to the customer. I'm looking for the best zero/low cost plan and have no current medications, but want to choose wisely in case this changes. I tried adding in the drugs mentioned in the video, but they default to the high cost plans with the best formulary.
I assume that the "high cost" plans you refer to are the ones with higher monthly premiums. When the tool does that, it is showing you the plans that would be the lowest total cost, drugs & premiums combined. You can still show the details for the zero premium plans to see the cost for the drugs you added.
Some plans have a deductible and some don’t. Does sorting by lowest drug cost and premiums still give you the lowest overall cost or do you have to add the deductible to the cost presented to get your true cost?
Sorting with lowest drug cost and premiums will still get you the lowest overall cost. It's looking at your medications and factoring in any premiums, deductibles, and copays/coinsurance :)
Can you shop at two different in-network pharmacies for your meds? On my list of yearly cost of drugs, the two Tier 4 drugs are cheaper at the local family pharmacy by $250; however, all the Tier 1 drugs are cheaper at CVS. (Though I did hear you say costs can vary through the year.)
@@dianedimidio7353 I have never had any issue using multiple pharmacies during the year. Just be sure that both pharmacies are "in-network" and "preferred" to get the best prices.
@@dianedimidio7353YES you definitely can. It is a good way to get your overall cost lower than the Medicare calculated cost. A little less convenient but if the cost saving is worth it to you, Do It.
Question - do all prescription drug plans follow the same tier level for a given prescription? I ask because if not then I don’t think the total premium and drug costs are accurate but I may be wrong in my assumption. Thanks!
No they do not. Each company has their own formulary list and tiers, and costs for the same tier can vary between plans.
@@SpynCycle57 Thanks!
Does the $590 deductible figure in the "total drug and premium cost" or do you have to add it to get the real cost?
It factors in
If my drug is not in formulary of my Medicare advantage plan. I was told by the licensed agent to have the prescribing doctor ask the insurance company to add the particular drug to their formulary. Does that really work?
You can try. Can't promise results on that though.
I'm looking for a PDP that covers the drug CERDELGA.
The Medicare website tool should help with that. If a drug you list isn't covered, the comparison tool will show that.
Hi Eddie, forgive me but in the examples you showed it looks like the second drug plan is the better choice if you use a mail order pharmacy?
Correct! Mail order calculations work a bit differently. In the first example, you are correct.
For the lowest overall cost plan, the default is to show retail pharmacy costs! Yet another thing to keep in mind through all this!
@@Theretirementnerds Thank you for answering Eddie, this makes sense.
Best time you, Brett
If mail order is chosen, what happens if you need a different medication like an antibiotic that needs to be taken right away?
Just so I am clear, only the drugs listed in your drug list are covered? What about random "I am sick" prescriptions i.e. antibiotics, some sort of rash cream, whatever. None of those are covered because they are not on "the list"?? That seems insane. Regular employment insurance pays for whatever you come into the pharmacy for. So what price point does one have to pay if it isn't "on the list"???
The list of drugs that you enter, at the Medicare site, are used to calculate the yearly cost of each plan. During the year you are never limited to the list. The list that you should be concerned with is the insurance company formulary list, which says which drugs the company covers and which tier they are on. The tier determines your cost for the drug. The random "I am sick" drugs can still be covered by the prescription plan, and usually are covered, as long as they are commonly prescribed drugs, but each company has a different formulary list.
What happens if I signed up for a stand alone part D for the very first time to comply with the Medicare rules and the following year I cancel the plan. What will Medicare do???
Nothing. But if you try to get a Part D plan later, you'd be penalized.
My concern was answered. Thx for the reply and GREAT content👍
@@cheezit58 To avoid any penalty in the future, just sign up for a zero premium plan. You can always switch to a different plan in future years during the AEP.
✓✓✓✓✓✓✓✓✓ If he is talking too fast for you, you can set the playback speed at a slower rate. Just click on the video to display the Settings icon (it looks like a gear wheel) in the upper right of the video, then click on playback speed, then click on .75x. It will slow down the video to 75% of the normal speed.
Thank you! 🙂
@@Theretirementnerds Then you sound drunk LOL. It's true but I am just kidding. I didn't think of slowing the speed down.
@@laurie6332 😀
@laurie6332 haha! But hopefully a smart drunk 🥴
Yes way to fast!!!
Super fast, and he said he was slowed down in this video LOL. I had to watch, pause, back up, watch, pause, back up.
Thank you.
Appreciate you watching!