Anyone have Part D with high deductible, to lower cost?

I'm kind of confused about a Part D deductible. As I said, I'm with Kaiser; one of my brothers is with Humana. He also pays nothing for his supplement or for Part D.

In addition we both get a debit card from our supplemental insurance for healthy foods. Mine from Kaiser is $150/quarter; brother's is $90/month. He's low-income but I'm not, so thinking the difference is simply a difference between insurers.

What I can't understand is why so many people are paying for their supplemental insurance and paying for Part D. Are y'all in a very high income bracket or maybe have chosen coverage that has a premium? Is there a cost for the supplement and for Part D in different states or parts of the country?

My annual physical is free. Labs are free. Vaccines are free, including the new two-part shingles vaccine. A routine office call is $5, I think. The highest co-pay I've had in the past 10 years was $40, and that was for a specialist. The highest co-pay now is $25.

I pay $9/month for separate vision/dental/hearing coverage that does have deductibles, which I'm going to drop because the providers that Kaiser has contracted with provide p*ss poor service with high deductibles, and I can get glasses and go to the dentist for far less than what they charge after the insurance pays. $9/month is only $108/year, but it's my $108.
 

I'm kind of confused about a Part D deductible. As I said, I'm with Kaiser; one of my brothers is with Humana. He also pays nothing for his supplement or for Part D.
Maybe you have one of the "Advantage Plans". They work differently.
I can get glasses and go to the dentist for far less than what they charge after the insurance pays
On the average that is true for any insurance. It has to be for them to be in business.
 
Another thought: Does the OP mean "co-pay" rather than "deductible"?

Deductible would mean reaching a certain point of out-of-pocket expense before meds would be covered. OTOH, a co-pay is the amount of the scrip paid by the subscriber before the insurance pays the balance.
 
To answer the question that was posted to the OP, (I'm the OP :cool:

I definitely do/did mean Deductible.

For any type of insurance (car, house, etc) that a person might consider purchasing,
accepting a deductible is a possibly good option, to significantly lower the monthly premiums and therefore, the annual cost of having the insurance.

For those of us who do not have any other Drug coverage,
and who do not prefer or do not want a Medicare Advantage plan, for various reasons,
(of which there are many possible reasons, that are often discussed in other threads, including our doctors are not usually in their Network, and no prior approval is needed for most traditional Medicare appointments, no delay for urgent specialist care or treatments, etc...)

we might want to purchase a stand-alone Part D, to add to Traditional Medicare, which some of us have and prefer, in our own situations.

So, my reason and topic, for starting this particular thread was to seek ideas and plan suggestions for those of us who might purchase Part D, or switch Part D plans,
during November, which is the time designated each year for making a decision and for doing that.

All comments are welcome in this thread, of course, :)

but that is the reason the focus was on what type of plans for Part D, have Deductibles.

I am definitely not high income, btw. Anyone who is high income, and wants to buy a Part D, would buy one of the Part D plans with no deductible, and the most comprehensive drug coverage available, and they would not be trying to lower their monthly premium. Just fyi, to possibly answer some of the other questions that arose in this thread. :geek:

(Also, btw, those vaccines are also free, for traditional Medicare, as well, and starting in Jan 2023, the 2-part shingles one will be added to the free list)
 
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I have an advantage plan now but didn't have in the past, and Part D was still included at no cost.
Perhaps you had a Companion (or Medigap) plan at that time which included it, (some do and some don't, I think)
or maybe you had some other program in your State, or something else. I don't know.
But some of us do not.

Monthly premiums for stand-alone Part D vary between as low as $11.
and as high as $104.
and Deductibles for those, vary from the max allowed at approx. $515. , down to zero.
Some (but not all) low-income people, can get their State to pay something toward the premiums.
 
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We have original medicare which we pay for and we pay for our medicare supplement. We are no way in a high income bracket we just prefer medicare over a medicare advantage plan.

I have known too many people who had a medicare advantage plan and after a hospital stay learned it was not to their advantage. They told me it is great until you have to go to hospital so I did my own research and decided to stay with our original medicare. We also like choosing our own doctors and not having to get prior approval for a specialist on original medicare.We do have to purchase a separate part d.

If those of you who have medicare advantage plans are happy with yours I think that is great.
 

How much is the Part D penalty?​

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.
Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.37 in 2022, $32.74 in 2023) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
The national base beneficiary premium may change each year, so your penalty amount may also change each year.

Example

Mrs. Martinez has Medicare, and her first chance to get Medicare drug coverage (during her Initial Enrollment Period) ended on July 31, 2019. She doesn’t have prescription drug coverage from any other source. She didn’t join a Medicare drug plan by July 31, 2019, and instead joined during the Open Enrollment Period that ended December 7, 2021. Her Medicare drug coverage started January 1, 2022.

2022

Since Mrs. Martinez was without creditable prescription drug coverage from August 2019–December 2021, her penalty in 2022 is 29% (1% for each of the 29 months) of $33.37 (the national base beneficiary premium for 2022) or $9.68 each month. Since the monthly penalty is always rounded to the nearest $0.10, she will pay $9.70 each month in addition to her plan’s monthly premium.

Here's the math:

.29 (29% penalty) × $33.37 (2022 base beneficiary premium) = $9.68

$9.68 rounded to the nearest $0.10 = $9.70


$9.70 = Mrs. Martinez's monthly late enrollment penalty for 2022



2023

In 2023, Medicare will recalculate Mrs. Martinez’s penalty using the 2023 base beneficiary premium ($32.74). So, Mrs. Martinez’s new monthly penalty in 2023 will be 29% of $32.74 ($9.49) each month. Since the monthly penalty is always rounded to the nearest $0.10, she will pay $9.50 each month in addition to her plan’s monthly premium.

Here's the math:

.29 (29% penalty) × $32.74 (2023 base beneficiary premium) = $9.49

$9.49 rounded to the nearest $0.10 = $9.50


$9.50 = Mrs. Martinez's monthly late enrollment penalty for 2023

How do I know if I have to pay a penalty?​

After you join a Medicare drug plan, the plan will tell you if you have to pay a penalty and what your premium will be. In general, you'll have to pay this penalty for as long as you have a Medicare drug plan.

What if I don't agree with the late enrollment penalty?​

You may be able to ask for a "reconsideration." Your drug plan will send information about how to request a reconsideration.
Complete the form, and return it to the address or fax number listed on the form. You must do this within 60 days from the date on the letter telling you that you have to pay a late enrollment penalty. Also send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.

Do I have to pay the penalty even if I don't agree with it?​

By law, the late enrollment penalty is part of the premium, so you must pay the penalty with the premium. You must also pay the penalty even if you've asked for a reconsideration. Medicare drug plans can disenroll members who don't pay their premiums, including the late enrollment penalty portion of the premium.

How soon will I get a reconsideration decision?​

In general, Medicare’s contractor makes reconsideration decisions within 90 days. The contractor will try to make a decision as quickly as possible. However, you may request an extension. Or, for good cause, Medicare’s contractor may take an additional 14 days to resolve your case.

What happens if Medicare's contractor decides the penalty is wrong?​

If Medicare’s contractor decides that all or part of your late enrollment penalty is wrong, the Medicare contractor will send you and your drug plan a letter explaining its decision. Your Medicare drug plan will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you'll get a refund.

What happens if Medicare's contractor decides the penalty is correct?​

If Medicare’s contractor decides that your late enrollment penalty is correct, the Medicare contractor will send you a letter explaining the decision, and you must pay the penalty.

 
Thank you to @rwb for that excellent and very informative post.

With the example given, she will be paying that additional monthly fee, endlessly, so we could do that math, too.
So perhaps it would be better to buy the very cheapest Part D, rather than none at all, unless you have other creditable drug coverage.

Even though I am not personally certain that having Part D is essential or directly financially beneficial for all of us,
it might help us more from some of its rules,
rather than with its partial help with some drug prices;
Such as, each year it includes more requirements of those insurance companies who sell it, to provide some additional help, to their subscribers, such as to cover the Shingrix vaccine, as of Jan 2023, and to cover more of insulin costs, and to have a limit for out-of-pocket costs per year, etc.
 
Each year except once, I have changed my Part D from one company to another. Last week I entered my prescriptions in the Medicare site to see costs for each prescription from each company. I used that info plus the monthly premium to make my decision.

My choices were few if I was to keep the monthly premium low. It was trickier to see that amongst the companies some considered my drugs to be Tier 1 while another it would be in Tier 3. What a big cost difference.

Then, I had to look at which pharmacies were in each plan, how far away I had to drive, and what was my previous experience with these pharmacies.

There is one pharmacy in particular where some of the workers are very rude and the prescriptions were given to me with the wrong instructions typed on the labels. I would not choose a Part D with that pharmacy as a Preferred Provider. I know that can change, but from the outset that is a no go for me.

So, I decided on a Part D that was a different one than I currently have. Two prescriptions should be at no or low cost. If I have to use GoodRx for the one, then I will continue to do so.

The new Part D is cheaper per month than my current plan, only by 80cents, but my current plan is going to cost me more in prescription costs per year even with the lower premium.

Both the current company for next year and the new company for next year's plan have the same $505 deductible, but that's not including the benefit of the zero cost to me prescriptions.

Many of the plans had much higher drug costs, so I really had to choose between these two plans when it comes down to price, convenience, and where they put the drugs within the tier systems.

Hope you get the plan you want and need.
 
Thanks for sharing that entire process, with us, @Owlivia

Your post adds some extra ideas, that any of us might want to consider, as well!
 
You're welcome. I know I can sometimes be wordy and methodical. 🤓 🤣

That's a perfect way to be, with this topic! 🤓☺️😁

And it truly helped me.
I learned more about Part D, which quite possibly will help in the future, too.


And btw, 'wordy and methodical' describes myself, pretty well, too!:giggle: I think some of my posts are over-the-top, to most people!
☺️🙄🥴😄
 
@Owlivia
I am re-reading your wordy post 😄:geek::giggle:
several times, and I am still learning so much from those details in it. I truly thank you for that.

And thanks to all others who posted in this thread, as well!
Each one added some perspective and info, and viewpoint to consider!
 
I re(a)d there are 766 Medicare Part D plans nationwide..Wow! No wonder you're
comprehension!🤔
Yes, isn't that shocking?
Though, one of the first steps to addressing the conundrum, is to find the list of the ones that are available within the State you live.
That narrows down that nationwide list. Whew.
Probably only 20 to 30 of those. o_O:unsure::eek::oops:

:LOL::ROFLMAO::giggle:

It becomes far less daunting, after reading the many helpful tips in this thread.:geek:
Always nice to see you add your comment and input, @Jace !:):love:
 
Thank you for posting it for me, and for others.... @Jace 🤩

It surprised me when I had first learned how many differing Part D plans there are, which was not very long ago!

K-P is not an option available in my State, btw. Glad it works for you!
 


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