Medicare prescription coverage issues

[alarmguy]

For a Part D plan, look up WellCare. At $96/year, they are a HECK of a lot cheaper than the Aetna plan I had at almost $200/month!
The employer from whom I retired put me on to them. Cover all the same drugs and excellent service.

Last year, my part D Wellcare was $0.00 a month
And they paid $14,000 for my prostate cancer drug

I went back to an advantage plan for 2026 but if I stayed with A, B, N, D the drug premium was going go up 300% to $3.30 a month.
Not a typo three dollars and thirty cents a month

The Wellcare basic drug plan D is unbeatable if you are going to stick with traditional Medicare

However, with all the above said going back to an advantage plan, I’m saving over $3000 a year and probably closer to 5000 if I don’t need any major treatments

 

[alarmguy]

Amy idea how the premiums compare? I currently pay $290.10/mo for my Saphire Blue coverage, and the Wife the same.
Drug coverage from Humana is the real ripoff @ $115.90/mo.

I have no out of pocket expenses or co-pays with either plan. $0.

So you both paying $7500 a year for Medicare
I’ll get back to you on Monday
As far as my advantage plan, the cost is $2400 and they pay for my dental and vision as well as my drug coverage

If I stayed with Medicare ABND my cost would’ve been $4200 for the year and I would not have had to pay any additional except the small co-pays at the doctor if I wanted no co-pays at the doctor another $300 a year for plan G plus I would have to pay my own vision and dental and why I went back to advantage

 

[Al]

I have had supplemental plan and now have an Advantage plan. The supplemental prescription was no better than the advantage plan.
Hopefully I will soon be able to stop taking Eliquis.

 

[Al]

As far as my advantage plan, the cost is $2400 and they pay for my dental and vision as well as my drug coverage

My medicare plan is Free and both me and my wiff get an $90/month re4bate from SS.
We have HighMark Merit Plan

 

[alarmguy]

My medicare plan is Free and both me and my wiff get an $90/month re4bate from SS.
We have HighMark Merit Plan

When I quote cost for any medical plan, you have to include the $200 a month Medicare part B takes out of your Social Security check
So the cost for my advantage plan is that $200 a month which is 2400 a year that I normally would pay for part B

You could say my plan is free, but nothing is free because in any of these plans, you’re paying $200 a month unless you’re on Medicaid.

So your plan is not free. It’s $200 each for you and your wife every month which equals $400 and then you’re getting a $90 credit back.

I do understand what you’re saying I try to be clear for others. You really have to take what you pay every month for Medicare.
The bottom line is whether you have a supplemental plan or an advantage plan you are paying $200 a month for Medicare part B
Actually, depending on income, it could be much more than that $200 a month

So my advantage plan, doesn’t cost anything more than the $200 a month taken out for Medicare part B

 

[Oliveoil2]

Medicare Advantage is another way for people to continue to pay for private healthcare and all the pre authorization mess to boot. Not me.

 

[Cropduster172]

Not to knock this off track, but I turn 64 in a couple weeks so will start my Medicare shopping journey. I have been told Advantage plans are not so good, as they generally have been screwed up by greed due to the way treatment is coded for more money in the insurance company pockets. I know my SS will be paying for part of my coverage, but wondering what you old(er) guys and gals have found to work best. I have cardiac care issues with a few necessary medications.

There's a reason the Medicare Advantage plans are marketed so heavily on afternoon TV shows like Steve Wilkos, Judge Judy, etc...

 

[alarmguy]

Medicare Advantage is another way for people to continue to pay for private healthcare and all the pre authorization mess to boot. Not me.

Choice is good!
I absolutely love it and it cost me three to $400 a month less than government healthcare

 

[alarmguy]

There's a reason the Medicare Advantage plans are marketed so heavily on afternoon TV shows like Steve Wilkos, Judge Judy, etc...

Of course, private companies make money through marketing.
Private companies are much better than government at containing costs, corruption, and misuse of funds = profits

I never saw anyone argue that the world companies should be run by governments because it’s more efficient. And about came the fall of the USSR.

I’m not arguing for or against, I am arguing for choice and choice is good.

 

[Al]

When I quote cost for any medical plan, you have to include the $200 a month Medicare part B takes out of your Social Security check
So the cost for my advantage plan is that $200 a month which is 2400 a year that I normally would pay for part B

You could say my plan is free, but nothing is free because in any of these plans, you’re paying $200 a month unless you’re on Medicaid.

So your plan is not free. It’s $200 each for you and your wife every month which equals $400 and then you’re getting a $90 credit back.

I do understand what you’re saying I try to be clear for others. You really have to take what you pay every month for Medicare.
The bottom line is whether you have a supplemental plan or an advantage plan you are paying $200 a month for Medicare part B
Actually, depending on income, it could be much more than that $200 a month

So my advantage plan, doesn’t cost anything more than the $200 a month taken out for Medicare part B

Well EACH of us are getting $91 off per month. And consider that with the supplemental you are paying $9,000+ per year for two people in addition to the to the medicare payment.

 

[Al]

Medicare Advantage is another way for people to continue to pay for private healthcare and all the pre authorization mess to boot. Not me.

You don't need pre-authorization, and you can see any doc you want. There are copays for specialists but not for non-specialists.
If you are happy paying $9,000 for year great. Not me.

 

[fantastic]

I've heard the Mark Cuban script has saved some folks on prescriptions but like was already mentioned if possible put all of your medicines into your gov't Medicare website so it will show you which companies will reduce your cost or not.

 

[alarmguy]

Amy idea how the premiums compare? I currently pay $290.10/mo for my Saphire Blue coverage, and the Wife the same.
Drug coverage from Humana is the real ripoff @ $115.90/mo.

I have no out of pocket expenses or co-pays with either plan. $0.

I think the problem in forums is what people pay. The posts are not specific enough to know what they pay.
SO it's hard to talk what premiums are. This is why.

I can say I pay nothing for my Advantage Plan, which includes everything I listed in previous posts in this thread. Dental, Vision, Drugs Low out of pocket expenses etc.
However I do pay for this plan. The payment is what Medicare takes out of my Social Security check which is $202 a month for Part B medicare. SO my cost is $2,400 a year for an Advatange plan.

However if you stay with medicare Part A and Part B many/most people buy supplemental insurance (plan G or N) to cover what Medicare does not cover at that $202 a month and they pay (to start) an extra $200 a month on top of the $202 a month for a total of $400 a month or $4,800 a year and that cost goes up GREATLY as you get older. That does not include dental and vision and drugs.

(also note, rates and available plans vary GREATLY depending on what state you are in. No politics but in high cost states state government interference in the system greatly increases costs. Also the cost of living in those areas. just ask @demarpaint who kind of lives not too far from where I did when I escaped NY)

SO you also buy in addition to plan G or N supplemental you need plan D for drugs. Many states this is very low cost if you are lucky ... WellCare has a great drug plan. If you are in a state that they are in, check it out, WellCare https://www.wellcare.com/en/explore-plans/prescription-drug-plans

 

[alarmguy]

Rubbing salt in a wound, why not? I'd kick someone if they were down. I have the last of the PPO plans available in my area that is paid for from what they withhold from my SS. I'm considering looking at the HMO plans for possibly less out of pocket costs. At a quick glance your coverage is a lot better than the garbage offered in NY that's for sure!!!

Yeah, in NY I would make sure all the good hospitals and doctors near you are in a plan before jumping ship.
I only say that because in an insane high cost area like Long Island they may not. I do not know this for fact.

I mean, myself as you know have been in Advantage plans now for 4 years (ALWAYS HMO's) and Medigap N for one year. Im back to Advantage.
The thing here is in lower cost South, EVERYONE takes Advantage plans, however even here sometimes you can find a network that does not take a specific company Advantage plan. They negotiate on a yearly basis with the health networks. I say BIG DEAL, this is NO different than my wife's company health plan. Actually hands down my Advantage plans have been much better cost wise and she works for an international company.

Also for you the customer of an Advantage plan. It is a ONE year contract to provide for your health care. You do not have to renew it as it will renew automatically unless .... however but you can switch Advantage companies yearly with NO underwriting if you want. A couple clicks of a mouse on the medicare site (they take care of it for you automatically and you are in the new plan when the effective date takes place on the 1st of the new year) Even then, if you decide you do not like that new plan that just took effect, you have until the last day of March to switch to yet another plan, all with the click of a mouse.

If the company you have your Advantage plan with decides not to offer that plan next year (meaning cancel it) you choose another plan OR you are free to go back to Medigap Supplemental plan without underwriting, guaranteed acceptance. With, again, a click of your mouse on the Medicare website. Another thing about social media... you may remember what a BIG DEAL they make/made about people finding out their Advantage Plan is being cancelled for the next year. Oh my gosh, the stupidity of the so called reporters OR baloney to create ad clicks. If your Advantage plan is ever cancelled it's the best thing that can happen to many people. You are free to go into ANY Medicare plan with no underwriting, guaranteed acceptance. Perfect chance to go back to Medigap plan G if you want.

I have done all the above!!
End of 2024 I was notified that Aetna was not offering my Advantage Plan for the following 2025 year. You have a few months notice to start shopping new plans. Well guess what? This took place right smack in the middle of me finding out I have cancer. SO what the heck being sort of slammed mentally with a cancer diagnosis, and new to the area, not knowing the networks nor where I might end up, with a click of my mouse I selected going back to a Medigap plan, A,B,N,D I fugured the extra $140 a month for Medigap N and D plus paying my own dental and eyecare would equal around the same cost if I went Advantage

In hindsight, It would not have mattered. So for 2026 I am back to an Advantage plan. As EVERY medical establishment in the Wilmington area takes my plan it was a no-brainer and I enjoy once again, not paying extra monthly above what Medicare takes out $202 a month. Even more important to me, my plan also covers Duke Medical network up in Durham Raleigh area should (gulp) it ever comes back. They were a great resource when first diagnosed and this is an important part. IN 2024 while I was undergoing all these tests and scans, it was my Aetna Advantage plan paying for it all, including a state of the ART pretty new PSMA Scan. There was NOT ONE HOLD UP getting approvals for anything. I didnt even know those approvals were taking place. Appts were made approval (for example) my PSMA Pet Scan approval that I didnt even know what taking place came in within 8 business days which was still about 10 more days then the actual appointment for the scan. I only found out because I got a letter in the mail that it was approved. The health network takes care of all that. That also goes for even if you work for a company and have a health plan.

Ooooohhhhhh boy ... another long post!
Bottom line, sure, there is freedom to choose if you want Medigap, A,B,G,D instead of an Advantage plan nothing wrong with that at all. The cost over time will be an extra, $200, $300, $400, $500 a month PLUS the $202 Medicare takes out of your Social Security Check. The thing is, the people who knock Advantage plans, had the same Advantage type coverage and worse, when they had company health insurance before they retired.

Options are good!

 

[alarmguy]

@demarpaint
Not to rub salt in a wound, as you know I escaped from New York almost 20 years ago now.
Check out my new Advantage plan
https://www.humana-medicare.com/BenefitSummary/2026PDFs/H1036335001SB26.pdf

And the cost of this plan?

Nothing more than the $202 a month Medicare takes out of my Social Security Check for Part B. Actually the plan is $1 a month less, so they only take out $201 a month.

 

[alarmguy]

I've heard the Mark Cuban script has saved some folks on prescriptions but like was already mentioned if possible put all of your medicines into your gov't Medicare website so it will show you which companies will reduce your cost or not.

Yes, the Medicare site is wonderful. I suspect not many people use it to the fullest if at all. Even reading some comments in here makes me wonder and these threads are a cut above the general population I would think.

 

[fantastic]

Yes, the Medicare site is wonderful. I suspect not many people use it to the fullest if at all. Even reading some comments in here makes me wonder and these threads are a cut above the general population I would think.

Too funny
I think we'll point them in the right direction so that's a good outcome.
The Medicare site has an import tool for recent filled scripts to boot...easy!

 

[alarmguy]

The Medicare site has an import tool for recent filled scripts to boot...easy!

This I wasn’t aware of. Pretty cool so far I’ve been lucky not to need any lifetime prescriptions. May be better said descriptions that are absolutely necessary.
Though I suspect I’ll take a 5 mg statin the rest of my life and not because of high cholesterol, but because of the genetic high Lipo A
So the theory is even though my cholesterol is well, Well within normal perimeter to actually excellent the feeling of my cardiologist is there is no such thing as too low

 

[fantastic]

This I wasn’t aware of. Pretty cool so far I’ve been lucky not to need any lifetime prescriptions. May be better said descriptions that are absolutely necessary.
Though I suspect I’ll take a 5 mg statin the rest of my life and not because of high cholesterol, but because of the genetic high Lipo A
So the theory is even though my cholesterol is well, Well within normal perimeter to actually excellent the feeling of my cardiologist is there is no such thing as too low

It's fairly new feature.

Last time we chatted I was up to $10k and end of year was a bit under $12,000 for medicine. I only paid a few hundred out of Pocket.

 

[daniel327]

Just goes to show your blanket statement is ridiculous.

Modern Medicine is proven to help period. And vaccines have cured. Take the landmark Polio vaccine for example. My kids don't have a clue what chicken pox is as another. You seem to have an issue with the distribution system or the companies behind them.

Congratulations on making a post (almost) totally devoid of facts. (I have no clue what knowledge your kids don't have).