SIGforum
Medicare Part D (drug) plan => what's driving the large preminum increase
October 23, 2025, 06:45 AM
tsmccullMedicare Part D (drug) plan => what's driving the large preminum increase
quote:
Originally posted by tsmccull:
[QUOTE]Originally posted by pace40:
I don't think Wellcare will work for me...
[QUOTE]
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?
October 23, 2025, 06:52 AM
pace40quote:
Originally posted by tsmccull:
Or are some of those not in the formulary and thus not covered at all?
This^^^^
____________
Pace
October 24, 2025, 03:28 PM
fiasconvaI wrote this in another thread but thought I'd add it here too. Try going to Good Rx and Visory Health, Kroger's version of it, and put in the expensive drugs and see what they charge for them. It may save you money going that route rather than using your insurance.
"Even if the world were perfect it wouldn't be." ... Yogi Berra October 25, 2025, 08:58 AM
tsmccull^^^^^ This. Needed a topical skin cream a few years ago and my portion with Wellcare was $200+ initially and $300+ for a refill. Kroger’s insurance card dropped my share to $16 and $24, respectively.
November 09, 2025, 07:00 PM
ZSMICHAELThe drug companies are gonna win. I was fine until my cardio diagnosed me with afib. Xarelto and Eliquis were the only options and even with insurance were very expensive.Current list is 598 per month. These drugs greatly reduce your chances of having a stroke so they are worth it.
.
November 09, 2025, 08:21 PM
Rey HRHquote:
Originally posted by tsmccull:
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?
That’s another level of complexity I’m discovering for my wife and I. If it’s not covered in the plan’s formulary then it’s all out of pocket for you and doesn’t count to your limit. The twist is this year, one prescription not covered did trigger the $2,000 max. But in looking for next year’s plan, I came across the complexity I mentioned.
"It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946.
November 10, 2025, 01:47 PM
REdwin89quote:
Originally posted by ZSMICHAEL:
The drug companies are gonna win. I was fine until my cardio diagnosed me with afib. Xarelto and Eliquis were the only options and even with insurance were very expensive.Current list is 598 per month. These drugs greatly reduce your chances of having a stroke so they are worth it.
.
Glad the VA only charges 33.00 for 3 month supply.
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November 10, 2025, 02:08 PM
HRKquote:
Originally posted by ZSMICHAEL:
The drug companies are gonna win. I was fine until my cardio diagnosed me with afib. Xarelto and Eliquis were the only options and even with insurance were very expensive.Current list is 598 per month. These drugs greatly reduce your chances of having a stroke so they are worth it.
.
My Cardo diagnosed AFIB on me it came up during a procedure I was having. Never have had it in my life. We are looking at Watchman by Boston Scientific. Basically an implant into the area of the heart that AFIB uses to collect blood and that's where the clots come from.
Meeting with the surgeon in January to talk about getting it done, once in zero blood thinners needed.
https://www.facebook.com/WATCHMANBostonSciDecember 06, 2025, 06:50 PM
Scooter123As someone who has to pay 900 dollars a month for Eliquis I thank you for assisting in the 2100 dollar maximum yearly cap. BTW being on Medicare means that Seniors are not permitted to use any discounts or coupons.
I've stopped counting.
December 07, 2025, 08:31 AM
Fly-Sigquote:
Originally posted by Scooter123:
BTW being on Medicare means that Seniors are not permitted to use any discounts or coupons.
Does that include if we don't use the Part D? Can we choose to be a cash customer, and then use a discount? Or are we required to claim every Rx under Part D?
December 07, 2025, 11:05 AM
Tailhook 84With regard to Medicare Part D and coupons,
this article written on 24 Nov 2025 explains that you can use "either/or", but not together. Basically you can simply not use Part D for some meds and simply buy them at the pharmacy using Good Rx or similar coupons.
From the article: "GoodRx is separate from Medicare and while it can't be used with Medicare in a single transaction, it can be used as an alternative means of lowering drug costs. You use one or the other, but most pharmacists are happy to look at both prices and give you the cheaper one."
"The Truth, when first uttered, is always considered heresy." December 08, 2025, 08:31 AM
Fly-SigThanks, Tailhook.