Medicare Part D

[jw8447]

I currently have a Medicare part B supplemental plan and a Part D drug plan. Can I drop the Plan D for 2025 and then re-enroll for a plan D for 2026? 

[ftz3951]

why are there some states that have a $0 plan if you have no current need and most others a minimum?  Sems a little unfair

[GailL1]

@ftz3951 

I cannot tell you specifically but there would have to be something in your area that goes against the lower premium because they all work their cost the same way.

So it could be one of these or a combination of them

• that you have smaller insurers and they just can negotiate for the price of the meds as much as the real large insurers
• that your state has added some additional coverage rules to the policies sold in your area and they have to comply
• you don’t have a lot of preferred pharmacies in the area and thus the negotiations with then doesn’t get the price as low as in other areas.

You should pick your free-standing Part D coverage based on the meds which you take.  If none or only a few of a Tier 1 level generic, then you can opt just to buy the lowest cost plan and then buy your meds at a discounter and not use the insurance at all or rarely if you are prescribe something else during the year that’s covered.

You do this only to avoid the late sign up penalty for Medicare Part D - which will last forever.  

[ftz3951]

""that goes against the lower premium"?  Dunno what you mean by this.

as far as NYS goes, I'm sure the lobbyists have worked something good out.

"free-standing Part D coverage ". By this I assume you mean from whatever plans are available, not that there is another choice Medicare itself makes available? 

Based on my math, it looks like with the "forever penalty" that Medicare generously makes available, I may be good for 5 years, as long as nothing serious develops.

D is $464/yr. Plus annual deduction of $590.  That's just downright insurance company gouging the elderly.  Disgraceful.
B is  $3000/yr.  That makes sense.  That replaces my union insurance, although my union insurance was way better coverage and included Rx.

Sorry, I know you're just the messenger. 

[GailL1]

@ftz3951 

That just means that the insurers cannot get their prices lower because of some reason, like the ones I mentioned.

$ 464/ year is less than $ 39 per month and if you need a plan that has a wide formulary - that’s a good price.  You would pay more in premiums if the plan had no deductible.  Remember, you pay no more in 2025 than $ 2000 out of pocket and that does include the deductible.

Per CMS the 2025 Part D base beneficiary premium is $36.78.

Medicare D plans are insurance plans and since the Inflation Reduction Act added a lot for those who have high med cost, we all have to do our share - that’s what insurance does - share and share alike.  

If that is your lowest premium plan and you don’t use any or even a couple of tier 1 generics - then figure up what’s better for you the premium or the penalty.  But if you need another drug - that might be a problem - but it is your decision.  Some plans don’t count the Tier 1 generics in their deductible. and some say Tier1 and Tier 2 so scrutinize the plan closely.

[ftz3951]

situ being that who knows how wide a formulary I might need in the future.  For now, nothing.
But here's an interesting read at Bogleheads for those in 8 states.

[GailL1]

Thank for the Bogleheads link - Those states are interesting as to why they rose so drastically in premiums - they are all BLUE states so maybe Wellcare just figured they had money 🤓. since they pay real high property taxes.

But there are people on this board that had the same thing happen with SilverScripts - I think that is Aetna.  They went from zero premiums (2024) to $ 17.XX in Florida and many of those people are now switching to Wellcare for the zero premium and no cost for their tier 1 drugs available in their area.

I do know that insurer did have a lot of work to do on their plans for 2025 due to all the changes in the program for next year.  Their cost has gone up so it had to be done.  

I heard from some agents and brokers on their commission decreasing or disappearing all together with some insurers. 

Maybe some insurers had more exposure in their formulary to the higher tier drugs and are having to pick up more of the cost.

I am not an agent or broker - I just read the news releases from CMS.  

CMS.gov- Final CY 2025 Part D Redesign Program Instructions - Fact Sheet  

Not all insurers accepted the Premium Stabilization Demonstration - it is designed for only 2025 but CMS left the door open for additional years depending on what happens with premiums after 2025.

They do like to brag - 

CMS.gov Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable as CMS Implement...

For information that is easier to decipher try

KFF.org 08/01/2024 - What to Know About Medicare Part D Premiums 

This premium fluctuation hasn’t stopped - it’s just been postponed.

Good thing we buy these year at a time - don’t like the one you got for next year, don’t worry - you get to do it all over again next November.

[ftz3951]

"They do like to brag -"  indeed.

Thanks for the clicks.

Perhaps next year the unlucky 8 will have a $0 for those who can deal with it.

But I rather think that some louse in the NY State House got an extra slice of pie at Thanskgiving.

[GailL1]

NY has an assistance program that is rather robust - but I don’t see how that would have affected Part D premiums - 

NY Dept of Health - EPIC and Medicare Part D  

But the state pays their Part D premiums and covers other drugs too. 

Other than that I don’t know of any differences at the State level.  

[DirkB349973]

The Wellcare part D plan I use was $0.50/month in 2024 and is dropping to $0/month for 2025. I believe the fine print said you must be enrolled in a medigap plan to remain eligible. My medigap plan is not with Wellcare so I don't think it matters who provides your gap plan. 

[GailL1]

@DirkB349973 

Can you give me the name of the the Wellcare Part D plan that says this. Or quote from the plan if possible  I have tried to research it and can’t find anything like that -  It actually does not sound feasible or even legal.  

They actually have absolutely nothing to do with each other causes the only medigap plans that had some prescription drug coverage were discontinued in 2010 - Even if a beneficiary has one of these old Medigap plans, they need to pick up a Medicare Part D free standing plan because the drug coverage is minuscule within the Medigap plan.

Anyway would really like to know what you are referring to in your post.

TIA

[GailL1 · Accepted solution]

NO - one way or another you have to have Medicare part D coverage.

If you have Traditional Medicare with a Medigap supplemental plan, you must have a Medicare Part D free-standing plan.  If not, you will pay a late sign up penalty that last forever when you do enroll in one.

If you take no or only a few cheap generics then just pick the cheapest Part D plan fror your area and then just buy your meds where ever is the cheapest whether or not that is the insurance plan.  This will avoid the premium tax penalty for not signing up.  There may be one that has 0 (zero) or a very low premium - and if you care gonna buy your meds elsewhere it really won’t matter if they are covered in the plan.

But you need to have one.