I about fell out of my chair when I read the information from Aetna.

I've been on the Aetna SilverScript Choice plan. In 2024 the monthly premium was $5/month. In 2025 it went to just over $40/month. Next year will be just over $90/month.

My drugs are inexpensive - I don't even reach my plan deductible.

Anyone have insight explaining these huge increases?

Anyone have suggestions for a quality plan that is less expensive. (I will reach out to a consultant I've been using but I'm sure he's swamped with work and it might be a number of days before I hear back.)

I have Wellcare PDP. Premium is zero.

Didn't the government lower the Medicare out-of-pocket cap for prescriptions for next year as well as making more drugs covered?
That would explain the increase.

My wife's Humana plan thru USAA using Walmart's pharmacy increased every year until now. The monthly dropped from $43.4 to $37.70. The only change I see is Tier 3, 4 & 5 a slight decrease in insulin cost. Tier 1& 2 is zero cost in 2025 & 2026.

quote:

Originally posted by 12131:

I have Wellcare PDP. Premium is zero.

Wife and I also have that. Zero is good.

I'm also starting on Wellcare for zero.

Medicare drug plans have open enrollment every year from October 15 to December 7.

Every year during that time, I log on to Medicare, ensure my proscriptions information are correct then I search for available plans in my zip code.

The system sorts the available plans according to total costs for the year (premiums + copays). Beginning in 2025, after you pay out $2000 in premiums and copays, the remainder of your prescriptions are free for the rest of the year.

There’s no downside to switching drug plans every year.

I also have had Wellcare PDP for several years. Besides the higher deductible in 2026, looks like copays are going up $5 for lower tiers, monthly up from zero to $8.60, and they’ll no longer provide ANY coverage for 30-day mail order prescriptions. First time I’ve seen that latter restriction; guessing it means any one month script is only covered if you get it at a local pharmacy? Still need to check for any pharmacy or formulary changes.

quote:

Originally posted by Rey HRH:
Beginning in 2025, after you pay out $2000 in premiums and copays, the remainder of your prescriptions are free for the rest of the year.

In 2026 this bumps to $2,100 (just got the book)

If thats the same plan I have with Wellcare mine is going from a $0.00 premium to something like $8.00 or $9.00 per month. I'm have the same problem. The only drugs I take are cheap, my drugs won't even cover the cost of the premium.

quote:

Originally posted by 12131:
I have Wellcare PDP. Premium is zero.

Interesting to see that Wellcare went up $8 or $9 and Aetna went up $50 per month.

I tried to run numbers on the Medicare website but they don't have the 2026 data loaded yet. I'll certainly be looking at Wellcare and other options once Medicare data is updated.

2026 numbers for everything Medicare should be out tomorrow, Oct 1.

quote:

what's driving the large preminum increase

Me....according to my EOB, cost for my cancer drugs were billed at $15,170.00 last month.

Aetna is a terrible company. I can't wait to see the price increases when annual enrollment begins next month for us at work.

We used to have Express Scripts and all prescription costs were pretty reasonable, which was like the only good thing about our crap health insurance plan offered then they switched to CVS "Care" (ha!) Mark which is part of Aetna and prices doubled, tripled and quadruped in some cases.

Greed. Profit margins need to be maintained when there is talk of government intervention.

quote:

Originally posted by pace40:

Me....according to my EOB, cost for my cancer drugs were billed at $15,170.00 last month.

And that's why you pick a plan based on overall benefits not just premiums and prior Rx needs. Nobody plans on cancer, or other major work and drugs. But sure enough, hospitals are full and shit happens.

Going naked on drug plan, as one person I know suggested, is an enormous gamble to save a very few bucks.

Anthem has dropped their Rx plan so I am researching new ones. I was on the phone with Medicare a little while ago. Medicare says there are 5 available in this area. So far I've gotten the prices on premiums and drug prices for my scripts with 3 of them. None of them cover one of my scripts. My meds are inexpensive except for that one and I don't know if I will meet my deductible either. I'll keep looking. What a PITA!

quote:

Originally posted by 12131:

I have Wellcare PDP. Premium is zero.

Wife and I have WellCare Value Script (PDP). No change in premium, remains $0.00. It appears that the only change for 2026 is a $25 increase in annual deductible, from $590 up to $615.

We'll stick with that plan.

I don't think Wellcare will work for me...

quote:

Originally posted by Georgeair:

And that's why you pick a plan based on overall benefits not just premiums and prior Rx needs.

Pretty good example of some great advice. Check not only drugs you take, but coverage for Tiers 3,4, & 5 just in case you find yourself needing them during the course of the year. One tier 5 drug could wipe you out.

ETA: Also be careful when looking at tier 5 drugs. Most plans say they are covered at your local preferred network pharmacy. Problem is that most tier 5 drugs are not available through your local pharmacy and can only be had through specialty pharmacies.

This message has been edited. Last edited by: pace40,

quote:

Originally posted by pace40:
I don't think Wellcare will work for me...

quote:

Originally posted by Georgeair:

And that's why you pick a plan based on overall benefits not just premiums and prior Rx needs.

Pretty good example of some great advice. Check not only drugs you take, but coverage for Tiers 3,4, & 5 just in case you find yourself needing them during the course of the year. One tier 5 drug could wipe you out.

ETA: Also be careful when looking at tier 5 drugs. Most plans say they are covered at your local preferred network pharmacy. Problem is that most tier 5 drugs are not available through your local pharmacy and can only be had through specialty pharmacies.

Wouldn’t your example above top out at $2100 for the year? Thought if the drugs are covered that’s the maximum before they switch to free? Or are some of those not in the formulary and thus not covered at all?