What I find absolutely ridiculous is that you cannot use any manufacturer's coupons when on Part D. We have some of the most expensive health care and drugs in the world, and the drug companies spend billions on expensive reps to push the latest drugs and constantly ram expensive commercials for them down our throats. There ought to be a law...
Definitely a different system. The fact that manufacturers take on 70% in the Donut hole is something, but still leaves a lot of responsibility. There are some programs like copay assistance that exist out there, even for those on Medicare. Thank you for watching!
There was a law. The constitution. Most of what the government does to "help" us is unconstitutional. Once the government is free to use public money and special legislation to line the pockets of private corporations- that's fascism. That's what we have. Any charity for people who cannot pay for the fundamentals, such as food, housing and health care, should be a separate, transparent system that functions to pay otherwise private bills from a mostly private/free market system. The corrupt FDA. The corrupt, anti-competitive legislation. Without the proper free market restraints costs become exorbitant simply because they can, for the payer is "the people" as an abstraction, just like any socialist system. There's a reason an army of lobbyists sprung up just outside of Washington, DC exactly to the proportion government programs to "help" the public piled up. They are there to kiss the ring and make special arrangements, exactly what the founders called "monied interests" and made a system to prevent. But we've had generations of idiots propagandized to hate capitalism, unwittingly creating the government tyranny we see today.
I did too until I discovered those people with the least money can get just about everything free or close to it. Feel sorry for the elders who worked, saved, and planned for their retirement only to discover they get no help at all for these high cost drugs. Matter fact, we’re the group penalized the most. I need a drug that’s $14K a month; if I was broke, it would be free. Unfortunately I worked, planned, and saved for retirement so I get to pay for mine.
One thing that would be really nice is if Part D plans were required to lock their formularies for the year against tier increases or deletions. I am shocked that is not already the case. You can choose a plan thinking you're good because it covers the drugs you currently take or are contemplating adding, only for the formulary to change mid-stream. You could be switched to a higher copay/coinsurance tier or even have a drug completely removed from coverage. Unlike the insurer you are locked in until the next enrollment period, rendering you SOL in the meantime.
That would be nice. There are usually what could be considered reasonable reasons for tier changes, but yes, to lock them in for the year would make certain things easier for people, especially when the beneficiary has to wait until AEP to change.
You should always shop your PDP every year, that is the plan that changes the most. Only about 10% of all Medicare members shop their PDP each year. Premiums, co - pays, formularies can all change- you also might be on different Rx from the prior year.
Thank you so much for using clear examples and for the step-by-step format of these videos. Medicare is so complicated and opaque, and they don't teach you this stuff in school! This has helped a lot.
Thanks! Your info is always so helpful. I'm not quite ready for Medicare yet, but I'm trying to stay on top of all the changes so I don't get surprised. Thank you so much for your help.
I’m really glad I watched this because I am 67 and on high cost meds. I’ve been dreading the prospect of having to retire and being unable to afford my meds.
It sure pays off working out, miles of walking each week. No smoking, no alcohol, at the weight I was in my 20's. Not on a Single Medication for illness. I was hospitalized for 7 days. Aspiration pneumonia, it did give me AFIB, and I did suffer respiratory arrest and heart failure. BRIEFLY. why? Because I had a GREAT HEART MUSCLE to begin with. I was off medication in 6 days after discharge. The cardiologist is dumbfounded. I told them, I have been working on making a strong HEART MUSCLE for 14 years now. I am 66.
It maybe boastful, but I do get his point. Trying to stay healthy and off medication is the best alternative. Unfortunately the US medical society combats any health problem with drugs.
For those who don't have high-cost medications, yes, this could prove to raise premiums to try and offset those with high cost meds. Thank you for watching!
Great news. I am paying $42.43 for my part d premium. Fortunately, I am not on any high-cost drugs, I suspect my premium is going to be higher than it might have been if these changes didn't come. I'm not gonna complain as it helps everyone.
I take only one medication but it is branded from Japan. No generic in USA but I can get the generic in India. USA cost recently down from $550 to $385 a month. India cost $12 a month. Needless to say I go to India, have a nice vacation and still save thousands.
Thank you for explaining this so well. I always wondered how the manufacturers’ contributions and insurance plans’ contributions work. Your videos are awesome!
Thank you for this very informative video. I will need to watch a few times to totally process. Have not had to use Part D, as of yet, so a learning curve, for sure. Grateful that I am on no prescription medication and just have a very low premium "placeholder" plan. I am well aware that this could change unexpectedly and, as such, would never advise anyone to skip Part D. Excellent content, as always.
These are great changes but as an insurance agent for ovwr 3 years, this will just result in many $0 premium MAPD plans now having a premium, higher premium costs, and lower tier drugs being shifted to higher tiers or not being on formulary. The insurers always win.
Agree with you. Have heard lots of rumors around premiums for standalone part D plans and it's not pretty. Have heard more around ancillary benefits on Advantage plans being reduced and drug tiering changes for sure. Appreciate you watching!
Outstanding explanation of the unexplainable! Best part is your example drug, Xarelto, should be going Generic in 2024. Cheering on the CMS negotiating team on Eliquis.
I'm going to be going into Part D next year. One of my medications is high cost so it looks like I will pay thousands the first few months and then nothing the rest of the year. Looking forward to 2025 when they introduce smoothing.
Ahh yes… We can thank the Inflation Reduction Act for the upcoming changes. I’ve heard the monthly premiums ARE going up a great deal…. Makes one wonder if “they” are going to try and get more and more people on the Medicare Advantage programs.
This is great! Is this CMS compliant (I can share with clients)? Also, idea for a future video: explain there is a cap to how much Medicare will pay out in a beneficiary's lifetime. A lot of people are under the impression that they are covered forever, and for every medically necessary malady.
Super weird. Thought I responded to this yesterday but the comment didn't save... We don't submit our RUclips videos through CMS. The reason being, we speak in generalities around how things work and, as I'm sure you've noticed, we don't mention any particular carrier or plan. This is on purpose. So, these videos don't have any sort of CMS sign off or thumbs up. Similar to our website. We ran our website by the compliance departments of multiple carriers and under the same guidelines of we don't give plan recommendations or details, we don't file that or other certain materials. Not sure if that helps or not. In regards to the cap Medicare will pay in a beneficiary's lifetime, can you help clarify that video topic? Are you referring to Part D specifically, or Part A Lifetime Reserve Days? Appreciate you!!
@@Theretirementnerds Thanks for the clarification! Just making sure I am staying compliant. More of an "educational" video, then, eh? As far as the second issue, I was mainly talking about Med A/B maximums. I understand the A "maximum lifetime days", but I remember there also being a cap on what Medicare will pay out for Part B charges as well, similar to the $1M cap on many
The requirement for pharmaceutical companies to negotiate drug prices on some drugs may help with 2025 funding. Of course, if they negotiate on those drugs, other drug prices will likely go up.
Well at least we had donuts while watching and even though they were not tasting so good at first by the time I finished mine it was pretty tasty. A cold glass of milk to go with it would have been awesome. Now before this video started AARP had an AD. I found that odd since I recently watched one of their videos, then went on their site where they actually let me key in my prescription drugs which are 2 cholesterol and 2 blood pressure. Looks like for now it would run me about $900 a year total. Sad part is my current BCBS plan at work they cost me nothing when I pick them up at my local pharmacy which is the same one AARP uses. But it is what it is. The next AD before your video was from another site that does medicare videos "Medicare School" It got me to wondering if they do this on purpose to take subscribers away. Just found it odd. I feel for people who have to take these expensive drugs and am glad they are working towards a better solution but I do agree with you that they will make increases else where to absorb their costs. Still highly leaning towards the "G" plan so I am looking forward to the next video with the comparison of the 2 plans. Great Job!
I'm a sucker for the maple bar, which doesn't have a donut hole :) Interesting about the ads. We have no control over those, so knowing Medicare School shows up is interesting. He does a great job on his videos. With your medications being $900 per year once you move to Medicare - definitely something to look at as we get closer. There may be other plans with other companies that are more or less. That's why we're here :) Appreciate you! Finishing up the next video soon! Hoping to post on Sunday.
Part D coverage structure with the different phases is the same for Advantage and Supplement plans, so yes. We have a video we're planning to release this week that goes over that specifically! You're thinking ahead 😊
Depends on where your drug costs fall. For some, yes, it is a good things. For others, it adds dollars. We would say that for most people, yes, it'll keep them out of the coverage gap for longer. Thank you for watching!
Can you clarify here? Carriers can't bypass the initial coverage phase. If someone is on a high enough cost of medication, they could run through the deductible phase and initial coverage phase in the first month, but we aren't aware of plans that are eliminating initial coverage. Maybe you have more insight?
@@Theretirementnerds Sorry for the confusion. Some plans and carriers in 2024 with have a 25% coinsurance on certain medication in the coverage phase, rather than a flat copay. This effectively is jumping people into the donut hole right away.
Before I turn 65 I had no idea that this plan was in place, for nobody talks about it in my circles ~unfortunately I’m in a place where people are dying and they’re not much older than me, I don’t plan on succumbing to the same things because of the corrupt medical and pharmaceutical industries . If the United States of America is a country founded BY the people FOR the people~~~ why are the people all letting this ugliness go on? The very young and the very old need protection, not exploitation. If the people knew what they could do to restore a good government to serve them, not rule over them with subtle evil and lies….this stuff doesn’t have to go on. Who helped write the Constitution of the United States? It was Almighty God; remember that we have an inalienable rights!!! If you’re not accessing God in your heart for that you’re subject to whatever will come destroy you. In the history of the world~ corruption breeds destruction. Who can change hearts and turn the heads of the leaders of the nations? It’s an internal thing inside people that makes them do good or evil. it’s time to get to the source of goodness, love, and peace…. where does it all come from? Let’s all get back to the source of that. Solution: All of the people repent of your sins and cut the crud in your hearts, souls, minds and lives~ turn to God so you can actually access some goodness ~~~~because things won’t change as long as you can’t overcome your own demons ~~~you can’t overcome the evil demons in the government. Jesus knows how to get rid of demons. Ask your Mighty Deliverer Jesus Christ today, what’s best for you.🕊✨
Hi. Great content. Could you please clarify something? The Kaiser Family Foundation's report on these changes says that in 2024, the Coverage Gap threshold is $8000, and that amount includes what Part D enrollees spend out of pocket PLUS "the value of the manufacturer price discount on brands." And says the Inflation Reduction Act caps out-of-pocket spending for patients at $3250 per year. So is the max out-of-pocket for Part D enrollees $3250 in 2024, or is it $8000? Is "the value of the manufacturer price discount on brands" paid by the manufacturer or the Part D enrollee?
Of course! You typed it right. $8,000 includes the manufacturer portion. The beneficiary is looking at right around $3,300 out of pocket, assuming all brand drugs. www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit/#:~:text=Out%2Dof%2Dpocket%20drug%20spending%20will%20be%20capped%20at%20%242%2C000&text=For%20Part%20D%20enrollees%20who,in%202025%20(Figure%203).
For 2024, isn't it actually a good thing for consumers that the Initial Coverage Phase is going up to $5,030 because it lets the customer stay in that phase longer before moving into the Coverage Gap?
Potentially, yes, you could look at it that way. Ultimately, the out of pocket responsibility for the consumer is going up in 2024 up until catastrophic coverage. So, the good news is there's a cap in 2024. The maybe neutral to slightly negative is that those who would normally go almost to the limit of the coverage gap and not quite to catastrophic coverage will have around $200 more out of pocket.
Curious about info for dual eligible Medicare Medicaid Special needs plans. Are they really helpful, are they advantage plans? Or should folks stay on original Medicare and Medicaid ?
They are Advantage plans and whether someone should consider them is a highly personal decision based on several variables. If you're looking into one of those, take the time to go over pros and cons with your agent.
Erik - thank you. Fellow broker here. Question: can it be said that a rough annual max out of pocket for Rx in 2024 is $3300? Or could it be higher? I ran some meds for a client for 2024 and it's showing annual Rx cost of $4500+. How is KFF calculating $3300? Is that for one med versus all meds combined?
Yes, it's a rough MOOP. KFF's assumption was that they were ALL brand medications. The cost sharing percentages and dollar amounts to the individual could potentially change when it comes to generic/specialty mixes and alter that number a bit. It's not until 2025 where they are saying, definitively, it's $2,000. Period. 2024 has some variability still in it, unfortunately.
we’re new in medicare this year. Unfortunately, we’re already using some high cost medicines. The calculation of the cost is beyond our understanding. We have medicare supplement plan N and Medicare Plan D and AARP walgreens drug plan. Is it right? Got so confused with those plans and feels it doesn’t help much when it deals with specialty drugs. Don’t know where to seek help.
Tough to know if it's right for you or not without knowing where you live and meds. Don't put that out on RUclips, but if you'd like us to take a look, you can send us an email to Erik@90daysfromretirement.com Did you use an agent to sign up?
I am watching this belatedly, 4 months late. I am years from medicare age and I am studying up in preparation nonetheless. I am curious about drugs that are absent from the arbitrary formulary list, drugs that are delivered intravenously or subcutaneous ly at a doctor's clinic. If such drugs such as cancer, or other immunotherapy drugs are not covered under Part D, i am surmising patients and doctors can possibly claim these under Part B.
I'm so sick and tired of having to do all this calculating to retire! It shouldn't be this hard! I'm thinking of going down south and coming across the border "illegally"! FREE STUFF! Yay!
Good video. But what some of this info tells me is that all of us on Part D drug plans are continued victims of the free market system of greedy drug companies. Is there any escape from the fleecing of us folks that are on a regular drug regimen?
My amount is $ 8000. . Donut hole stinks. I heard in 2025 there will be no higher than $ 2,000 my premiums have risen x2 in one year. Aetna's customer service is "HORRIBLE ". Do people know that that premiums , meds are tax deductible.!
For 2025, once clients hit initial coverage phase is that max of 2k calculated as a sum of what client pays ( % or copay) + what carrier pays on back end + Medicare allowance contributions towards each drug =2000? I am trying to understand how the formula works exactly more in reference to an advantage plan. So for example in 2025 Let’s say hypothetically we have a mapd with a $0 deductible T1 $0 T2 $5 T3 $45 T4 $99 T5 33% Client has 1 covered drug let’s say it’s ozempic 2mg flex pen ( 1 box a month ) and it’s a T3 Under our hypothetical plan. So the Client pays $45 a month until Both plan payout on the back end and clients copays at the pharmacy total = $2,000? If that’s the case… that means they could hit the 2k in like feb/ march… and let’s say they didn’t get prescribed any new meds the rest of the year. Does that mean the rest of the year in my hypothetical situation it could potentially cost a clienf $0 a month the remainder of the year when they get their refills? Lol
It is an out of pocket max, meaning the client will pay a max of $2,000 out of their own pocket through the deductible, copays, and coinsurance. It is not a combined amount with the insurance company/manufacturers. Great question!
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What I find absolutely ridiculous is that you cannot use any manufacturer's coupons when on Part D. We have some of the most expensive health care and drugs in the world, and the drug companies spend billions on expensive reps to push the latest drugs and constantly ram expensive commercials for them down our throats. There ought to be a law...
Definitely a different system. The fact that manufacturers take on 70% in the Donut hole is something, but still leaves a lot of responsibility. There are some programs like copay assistance that exist out there, even for those on Medicare.
Thank you for watching!
There was a law. The constitution. Most of what the government does to "help" us is unconstitutional. Once the government is free to use public money and special legislation to line the pockets of private corporations- that's fascism. That's what we have. Any charity for people who cannot pay for the fundamentals, such as food, housing and health care, should be a separate, transparent system that functions to pay otherwise private bills from a mostly private/free market system.
The corrupt FDA. The corrupt, anti-competitive legislation. Without the proper free market restraints costs become exorbitant simply because they can, for the payer is "the people" as an abstraction, just like any socialist system. There's a reason an army of lobbyists sprung up just outside of Washington, DC exactly to the proportion government programs to "help" the public piled up. They are there to kiss the ring and make special arrangements, exactly what the founders called "monied interests" and made a system to prevent. But we've had generations of idiots propagandized to hate capitalism, unwittingly creating the government tyranny we see today.
I feel so sorry for the elderly who are trying to survive on social security. I doubt many of them earn enough to cover their prescription costs.
I did too until I discovered those people with the least money can get just about everything free or close to it. Feel sorry for the elders who worked, saved, and planned for their retirement only to discover they get no help at all for these high cost drugs. Matter fact, we’re the group penalized the most. I need a drug that’s $14K a month; if I was broke, it would be free. Unfortunately I worked, planned, and saved for retirement so I get to pay for mine.
One thing that would be really nice is if Part D plans were required to lock their formularies for the year against tier increases or deletions. I am shocked that is not already the case. You can choose a plan thinking you're good because it covers the drugs you currently take or are contemplating adding, only for the formulary to change mid-stream. You could be switched to a higher copay/coinsurance tier or even have a drug completely removed from coverage. Unlike the insurer you are locked in until the next enrollment period, rendering you SOL in the meantime.
That would be nice. There are usually what could be considered reasonable reasons for tier changes, but yes, to lock them in for the year would make certain things easier for people, especially when the beneficiary has to wait until AEP to change.
You should always shop your PDP every year, that is the plan that changes the most. Only about 10% of all Medicare members shop their PDP each year. Premiums, co - pays, formularies can all change- you also might be on different Rx from the prior year.
Using Cigna and Express scripts try start off in Jan as stated and go up on almost ever refill.
Some people had to work a lot of overtime to come up with such a convoluted drug cost plan. This seems more complex that the federal income tax rules.
It's quite the complicated thing, isn't it? Thank you for watching!
Thank you so much for using clear examples and for the step-by-step format of these videos. Medicare is so complicated and opaque, and they don't teach you this stuff in school! This has helped a lot.
So glad it is helpful! Thank you for watching!
Me too.
Thanks! Your info is always so helpful. I'm not quite ready for Medicare yet, but I'm trying to stay on top of all the changes so I don't get surprised. Thank you so much for your help.
Thank you so much for watching!
Thanks, Erik. Your content is just amazing. I hope you appreciate the value you are bringing to many people.
I’m really glad I watched this because I am 67 and on high cost meds. I’ve been dreading the prospect of having to retire and being unable to afford my meds.
These changes should help with that for sure :) Thank you for watching!
I feel the same
It sure pays off working out, miles of walking each week. No smoking, no alcohol, at the weight I was in my 20's. Not on a Single Medication for illness. I was hospitalized for 7 days. Aspiration pneumonia, it did give me AFIB, and I did suffer respiratory arrest and heart failure. BRIEFLY. why? Because I had a GREAT HEART MUSCLE to begin with. I was off medication in 6 days after discharge. The cardiologist is dumbfounded. I told them, I have been working on making a strong HEART MUSCLE for 14 years now. I am 66.
I assume your parents didn't teach you that no one likes a braggart?
It maybe boastful, but I do get his point. Trying to stay healthy and off medication is the best alternative. Unfortunately the US medical society combats any health problem with drugs.
I just shared with friends. 2025 I will have Medicare..so looks like perfect timing for me 👍👍
Thank you for sharing!
If you have high cost medications, it is a great thing! If you don’t... the premium costs will be interesting to monitor.
Same here, turning 65 in 2025.
Wow, I had no idea that Part D had been so bad. I'm glad that it is changing, although I'm sure premiums are going to go through the roof.
2025 will be interesting to see
Thanks for the info, to me it is not good news if it causes the premiums to go up,
For those who don't have high-cost medications, yes, this could prove to raise premiums to try and offset those with high cost meds.
Thank you for watching!
Great news. I am paying $42.43 for my part d premium. Fortunately, I am not on any high-cost drugs, I suspect my premium is going to be higher than it might have been if these changes didn't come. I'm not gonna complain as it helps everyone.
Glad to hear you're not on high cost medications! Thank you for watching!
I take only one medication but it is branded from Japan. No generic in USA but I can get the generic in India. USA cost recently down from $550 to $385 a month. India cost $12 a month. Needless to say I go to India, have a nice vacation and still save thousands.
Thank you for explaining this so well. I always wondered how the manufacturers’ contributions and insurance plans’ contributions work. Your videos are awesome!
Thank you Sherry!
Thank you for this very informative video. I will need to watch a few times to totally process. Have not had to use Part D, as of yet, so a learning curve, for sure. Grateful that I am on no prescription medication and just have a very low premium "placeholder" plan. I am well aware that this could change unexpectedly and, as such, would never advise anyone to skip Part D. Excellent content, as always.
Thank you for watching Tina! We are working on a more condensed version that goes over just 2024 that should be easier since it's not so long.
Excellent.
Thank you!
The 2025 changes are good news for me since I will only have to deal with the 4 phases for 9 months! Yay!!
Thank you for the information, great job 👏🏽
Thank you so much Eddie!
Thank you for taking the time to explain this!
Thank you so much for watching!
These are great changes but as an insurance agent for ovwr 3 years, this will just result in many $0 premium MAPD plans now having a premium, higher premium costs, and lower tier drugs being shifted to higher tiers or not being on formulary. The insurers always win.
Agree with you. Have heard lots of rumors around premiums for standalone part D plans and it's not pretty. Have heard more around ancillary benefits on Advantage plans being reduced and drug tiering changes for sure. Appreciate you watching!
Looking forward to the next video. That's exactly what I need help on!
We'll be releasing that this week! Almost done ✔️
Best explanation I found, thank you so much !
So glad it is helpful!
Thank you for watching!
Outstanding explanation of the unexplainable!
Best part is your example drug, Xarelto, should be going Generic in 2024.
Cheering on the CMS negotiating team on Eliquis.
Terrible system. What a shame!
Thank you, Erik!! Very informative and in 2025, a saving grace. Appreciate you also!
Appreciate you Jeff! Thank you so much!
Very good stuff to know.
I'm going to be going into Part D next year. One of my medications is high cost so it looks like I will pay thousands the first few months and then nothing the rest of the year. Looking forward to 2025 when they introduce smoothing.
Yes, budget around $3,300 out of pocket (not including premiums) in 2024.
Thank you for watching!
Out of the three previous videos I have watched about this topic----this is the MOST COMPREHENSIVE AND EASY TO FOLLOW---I suggest you watch
Thank you so much for watching! So glad it was helpful :)
Appreciate you Janice!
Ahh yes… We can thank the Inflation Reduction Act for the upcoming changes. I’ve heard the monthly premiums ARE going up a great deal….
Makes one wonder if “they” are going to try and get more and more people on the Medicare Advantage programs.
For a MA part D plan in catastrophic coverage, is Medicare contributing to costs or is the payor contributing on behalf of Medicare?
This is great! Is this CMS compliant (I can share with clients)?
Also, idea for a future video: explain there is a cap to how much Medicare will pay out in a beneficiary's lifetime. A lot of people are under the impression that they are covered forever, and for every medically necessary malady.
Super weird. Thought I responded to this yesterday but the comment didn't save...
We don't submit our RUclips videos through CMS. The reason being, we speak in generalities around how things work and, as I'm sure you've noticed, we don't mention any particular carrier or plan. This is on purpose.
So, these videos don't have any sort of CMS sign off or thumbs up. Similar to our website. We ran our website by the compliance departments of multiple carriers and under the same guidelines of we don't give plan recommendations or details, we don't file that or other certain materials.
Not sure if that helps or not.
In regards to the cap Medicare will pay in a beneficiary's lifetime, can you help clarify that video topic?
Are you referring to Part D specifically, or Part A Lifetime Reserve Days?
Appreciate you!!
@@Theretirementnerds Thanks for the clarification! Just making sure I am staying compliant. More of an "educational" video, then, eh?
As far as the second issue, I was mainly talking about Med A/B maximums. I understand the A "maximum lifetime days", but I remember there also being a cap on what Medicare will pay out for Part B charges as well, similar to the $1M cap on many
The requirement for pharmaceutical companies to negotiate drug prices on some drugs may help with 2025 funding. Of course, if they negotiate on those drugs, other drug prices will likely go up.
Agreed. It'll be interesting to see it all play out. Hopefully Medicare beneficiaries aren't hurt in the process. Costs will be made up somewhere.
How many companies are dropping high cost drugs
Not all of us are on medications!! I needed info on which Medicare I need....
Then you need to talk to an agent like this gentleman. This video is specifically about medications.
Well at least we had donuts while watching and even though they were not tasting so good at first by the time I finished mine it was pretty tasty. A cold glass of milk to go with it would have been awesome. Now before this video started AARP had an AD. I found that odd since I recently watched one of their videos, then went on their site where they actually let me key in my prescription drugs which are 2 cholesterol and 2 blood pressure. Looks like for now it would run me about $900 a year total. Sad part is my current BCBS plan at work they cost me nothing when I pick them up at my local pharmacy which is the same one AARP uses. But it is what it is. The next AD before your video was from another site that does medicare videos "Medicare School" It got me to wondering if they do this on purpose to take subscribers away. Just found it odd. I feel for people who have to take these expensive drugs and am glad they are working towards a better solution but I do agree with you that they will make increases else where to absorb their costs. Still highly leaning towards the "G" plan so I am looking forward to the next video with the comparison of the 2 plans. Great Job!
I'm a sucker for the maple bar, which doesn't have a donut hole :)
Interesting about the ads. We have no control over those, so knowing Medicare School shows up is interesting. He does a great job on his videos.
With your medications being $900 per year once you move to Medicare - definitely something to look at as we get closer. There may be other plans with other companies that are more or less. That's why we're here :)
Appreciate you! Finishing up the next video soon! Hoping to post on Sunday.
In 2025 are the new maximum out of pictures cost of $2000 apply for all medication INCLUDING specialty medication?
Yes, as long as the medication is covered by the plan you pick. Not all plans cover all medications.
so will there be similar changes for advantage plans?
Part D coverage structure with the different phases is the same for Advantage and Supplement plans, so yes. We have a video we're planning to release this week that goes over that specifically! You're thinking ahead 😊
Isn’t initial coverage stage going up a good thing?
Depends on where your drug costs fall. For some, yes, it is a good things. For others, it adds dollars. We would say that for most people, yes, it'll keep them out of the coverage gap for longer.
Thank you for watching!
thats some confusing stuff
They don't make it easy
A lot of carriers are jumping people directly into the donut hole after the deductible. It’s a rare scenario but some people could get hit hard
Can you clarify here?
Carriers can't bypass the initial coverage phase.
If someone is on a high enough cost of medication, they could run through the deductible phase and initial coverage phase in the first month, but we aren't aware of plans that are eliminating initial coverage.
Maybe you have more insight?
@@Theretirementnerds Sorry for the confusion. Some plans and carriers in 2024 with have a 25% coinsurance on certain medication in the coverage phase, rather than a flat copay. This effectively is jumping people into the donut hole right away.
Ohhhh... okay. Yes, that makes more sense. Sorry for our confusion!
Before I turn 65 I had no idea that this plan was in place, for nobody talks about it in my circles ~unfortunately I’m in a place where people are dying and they’re not much older than me, I don’t plan on succumbing to the same things because of the corrupt medical and pharmaceutical industries .
If the United States of America is a country founded BY the people FOR the people~~~ why are the people all letting this ugliness go on? The very young and the very old need protection, not exploitation.
If the people knew what they could do to restore a good government to serve them, not rule over them with subtle evil and lies….this stuff doesn’t have to go on. Who helped write the Constitution of the United States? It was Almighty God; remember that we have an inalienable rights!!! If you’re not accessing God in your heart for that you’re subject to whatever will come destroy you.
In the history of the world~ corruption breeds destruction. Who can change hearts and turn the heads of the leaders of the nations? It’s an internal thing inside people that makes them do good or evil. it’s time to get to the source of goodness, love, and peace…. where does it all come from? Let’s all get back to the source of that.
Solution: All of the people repent of your sins and cut the crud in your hearts, souls, minds and lives~ turn to God so you can actually access some goodness ~~~~because things won’t change as long as you can’t overcome your own demons ~~~you can’t overcome the evil demons in the government. Jesus knows how to get rid of demons. Ask your Mighty Deliverer Jesus Christ today, what’s best for you.🕊✨
Hi. Great content. Could you please clarify something? The Kaiser Family Foundation's report on these changes says that in 2024, the Coverage Gap threshold is $8000, and that amount includes what Part D enrollees spend out of pocket PLUS "the value of the manufacturer price discount on brands." And says the Inflation Reduction Act caps out-of-pocket spending for patients at $3250 per year. So is the max out-of-pocket for Part D enrollees $3250 in 2024, or is it $8000? Is "the value of the manufacturer price discount on brands" paid by the manufacturer or the Part D enrollee?
Of course!
You typed it right. $8,000 includes the manufacturer portion. The beneficiary is looking at right around $3,300 out of pocket, assuming all brand drugs.
www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit/#:~:text=Out%2Dof%2Dpocket%20drug%20spending%20will%20be%20capped%20at%20%242%2C000&text=For%20Part%20D%20enrollees%20who,in%202025%20(Figure%203).
For 2024, isn't it actually a good thing for consumers that the Initial Coverage Phase is going up to $5,030 because it lets the customer stay in that phase longer before moving into the Coverage Gap?
Potentially, yes, you could look at it that way. Ultimately, the out of pocket responsibility for the consumer is going up in 2024 up until catastrophic coverage. So, the good news is there's a cap in 2024. The maybe neutral to slightly negative is that those who would normally go almost to the limit of the coverage gap and not quite to catastrophic coverage will have around $200 more out of pocket.
You are amazing. Hope the comment helps to push your videos out
Thank you so much!
Curious about info for dual eligible Medicare Medicaid Special needs plans. Are they really helpful, are they advantage plans? Or should folks stay on original Medicare and Medicaid ?
They are Advantage plans and whether someone should consider them is a highly personal decision based on several variables. If you're looking into one of those, take the time to go over pros and cons with your agent.
Are drugs issued while inpatient covered under A?
Usually, yes. There are some exceptions, but usually, yes.
Question...
Can anyone on Medicare apply for the card that will help me with my groceries , OTC needs etc.?
Thank you.
That is a Medicare Advantage plan that offers those. Anyone on Medicare can get an Advantage plan. Not everyone should.
Erik - thank you. Fellow broker here. Question: can it be said that a rough annual max out of pocket for Rx in 2024 is $3300? Or could it be higher? I ran some meds for a client for 2024 and it's showing annual Rx cost of $4500+. How is KFF calculating $3300? Is that for one med versus all meds combined?
Yes, it's a rough MOOP. KFF's assumption was that they were ALL brand medications.
The cost sharing percentages and dollar amounts to the individual could potentially change when it comes to generic/specialty mixes and alter that number a bit. It's not until 2025 where they are saying, definitively, it's $2,000. Period. 2024 has some variability still in it, unfortunately.
we’re new in medicare this year. Unfortunately, we’re already using some high cost medicines. The calculation of the cost is beyond our understanding. We have medicare supplement plan N and Medicare Plan D and AARP walgreens drug plan. Is it right? Got so confused with those plans and feels it doesn’t help much when it deals with specialty drugs. Don’t know where to seek help.
Tough to know if it's right for you or not without knowing where you live and meds.
Don't put that out on RUclips, but if you'd like us to take a look, you can send us an email to Erik@90daysfromretirement.com
Did you use an agent to sign up?
okay. I will email you our situation. Thanks
I am watching this belatedly, 4 months late. I am years from medicare age and I am studying up in preparation nonetheless. I am curious about drugs that are absent from the arbitrary formulary list, drugs that are delivered intravenously or subcutaneous ly at a doctor's clinic. If such drugs such as cancer, or other immunotherapy drugs are not covered under Part D, i am surmising patients and doctors can possibly claim these under Part B.
Those are covered under Part B 🙂
Great observation.
That’s not so bad.
Better than it was, for sure!
I'm so sick and tired of having to do all this calculating to retire! It shouldn't be this hard! I'm thinking of going down south and coming across the border "illegally"! FREE STUFF! Yay!
Good video. But what some of this info tells me is that all of us on Part D drug plans are continued victims of the free market system of greedy drug companies. Is there any escape from the fleecing of us folks that are on a regular drug regimen?
My amount is $ 8000. .
Donut hole stinks.
I heard in 2025 there will be no higher than $ 2,000 my premiums have risen x2 in one year. Aetna's customer service is "HORRIBLE ".
Do people know that that premiums , meds are tax deductible.!
Here is a video on some 2025 changes to be aware of: ruclips.net/video/vRoK3Cr0IPM/видео.html
For 2025, once clients hit initial coverage phase is that max of 2k calculated as a sum of what
client pays ( % or copay) + what carrier pays on back end + Medicare allowance contributions towards each drug =2000?
I am trying to understand how the formula works exactly more in reference to an advantage plan.
So for example in 2025
Let’s say hypothetically we have a mapd with a $0 deductible
T1 $0
T2 $5
T3 $45
T4 $99
T5 33%
Client has 1 covered drug let’s say it’s ozempic 2mg flex pen ( 1 box a month ) and it’s a T3
Under our hypothetical plan.
So the
Client pays $45 a month until Both plan payout on the back end and clients copays at the pharmacy total = $2,000?
If that’s the case… that means they could hit the 2k in like feb/ march… and let’s say they didn’t get prescribed any new meds the rest of the year. Does that mean the rest of the year in my hypothetical situation it could potentially cost a clienf $0 a month the remainder of the year when they get their refills? Lol
It is an out of pocket max, meaning the client will pay a max of $2,000 out of their own pocket through the deductible, copays, and coinsurance. It is not a combined amount with the insurance company/manufacturers. Great question!
If you choose not to have any Part D coverage would your limit still be $2,000 in 2025?
No. You would not have a limit.