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



## Kaila (Nov 2, 2022)

I know that many of you do not have any Medicare Part D, and do not need one.

Those of you who have Medicare Advantage plans (Part C) or other types of broad medical insurance,
do not need any Part D, for drug coverage;

But for people who have traditional Medicare, with or without a separate Medigap (Companion) plan;
 in order to have any coverage for most medications, one must purchase a stand-alone Part D.

The prices increase every year, so one way to avoid high monthly premium costs, would be to opt to have a yearly deductible, like many other types of insurance,
rather than one of the no-deductible Part D plans.

Does anyone have one of those?


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## perplexed (Nov 2, 2022)

Yes I have part D with  deductible, ours actually went down for 2023 (the premium) and the deductible went up.


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## Kaila (Nov 2, 2022)

Thank you for the reply, @perplexed 
Would you share which company, if you feel comfortable doing that?
Did you have the choice between levels for your deductible, or do they have just one standard deductible with corresponding premium?


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## perplexed (Nov 2, 2022)

Your welcome!Sure we have wellcare value script, no they set the deductible and like I said it it going up AGAIN in 2023. Just be careful if your meds are in the upper tiers I think 3 and up is when the deductible starts. We were fine until my husband needed an eye med and  well we had to meet the deductable on that one. (very hard) It is a game of chance KWIM?If I can help you further just ask .


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## Kaila (Nov 2, 2022)

perplexed said:


> Your welcome!Sure we have wellcare value script, no they set the deductible and like I said it it going up AGAIN in 2023. Just be careful if your meds are in the upper tiers I think 3 and up is when the deductible starts. We were fine until my husband needed an eye med and  well we had to meet the deductable on that one. (very hard) It is a game of chance KWIM?If I can help you further just ask .


Thank you very much for your friendly post and your helpful info.
I have, honestly, felt very perplexed on this subject!

Do you have to get your prescriptions from one designated pharmacy, or can you choose?


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## Owlivia (Nov 2, 2022)

Policy offerings are so different from state to state.  My deductible will be about $500 next year.  I have not yet checked the Medicare site to go over my options.  It will be easier to choose once I input my prescriptions and see the results from the different companies.

One thing I have done is not use insurance for one of my eyedrops.  Insurance cost over $600 for one little bottle. GoodRx cost about $58.00, same drug, same pharmacies.

What burns me is that this is a Generic drug which I have been on for twenty years.  It's so popular and the drug companies are gouging people due to its main drug use for so many people-there are no alternatives, so no competition.  

I used to pay less than $5.00 per larger bottle, but generics don't always mean they are cheaper. 

If you have the option to look at GoodRx and others like them, price your prescriptions and see if that will affect your insurance choice.

I will probably look at the Medicare site next week, instead of leaving it until two days before the cutoff!


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## Kaila (Nov 2, 2022)

Thank you very much, @Owlivia 
I will definitely go over that info and your ideas!


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## perplexed (Nov 2, 2022)

Kaila said:


> Thank you very much for your friendly post and your helpful info.
> I have, honestly, felt very perplexed on this subject!
> 
> Do you have to get your prescriptions from one designated pharmacy, or can you choose?



 We are all perplexeds at times lol lol ,Part D and medicare can be a bit overwhelming on our plan you can choose I think on all plans you can choose as far as I know . Make sure you choose a preferred pharmacy preferred by your plan it may make what you pay  for your meds cheaper.

Just a thought try good Rx even if you get a part D. I find that on some meds are cheaper on Good Rx (I use a coupon there and take to pharmacy) is cheaper than our part d co pay.If I can help you further just ask.


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## Kaila (Nov 3, 2022)

I appreciate all of that, too!
Thank you!


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## perplexed (Nov 3, 2022)

your welcome!


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## Happy Heart (Nov 3, 2022)

Owlivia said:


> Policy offerings are so different from state to state.  My deductible will be about $500 next year.  I have not yet checked the Medicare site to go over my options.  It will be easier to choose once I input my prescriptions and see the results from the different companies.
> 
> One thing I have done is not use insurance for one of my eyedrops.  Insurance cost over $600 for one little bottle. GoodRx cost about $58.00, same drug, same pharmacies.
> 
> ...


We have saved thousands of dollars by using Canadian pharmacies instead of paying for U.S. distributors.  It makes no sense to use Part D to get $10.  off a $1,200 prescription when it can shipped for $50!


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## Alligatorob (Nov 4, 2022)

perplexed said:


> We are all perplexeds at times lol lol ,Part D and medicare can be a bit overwhelming on our plan you can choose I think on all plans you can choose as far as I know . Make sure you choose a preferred pharmacy preferred by your plan it may make what you pay for your meds cheaper.
> 
> Just a thought try good Rx even if you get a part D. I find that on some meds are cheaper on Good Rx (I use a coupon there and take to pharmacy) is cheaper than our part d co pay.If I can help you further just ask.


So far I have found Part D to be nothing more than a ripoff.  I pay for it and an AARP supplemental and can always find cheaper options elsewhere.  I am thinking of dropping it.


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## perplexed (Nov 4, 2022)

Alligatorob said:


> So far I have found Part D to be nothing more than a ripoff.  I pay for it and an AARP supplemental and can always find cheaper options elsewhere.  I am thinking of dropping it.


I have to agree part d  was not thought out too well, it certainly does not pay too well on the upper tiers and if you buy the lower costs part d's and need the upper tier meds your forced to pay that high deductible but it is a catch 22 because we either get one if we are on medicare and if I am not mistaken if we don't get a part d in a certain time frame and get one later there is a penalty for life. If one of you knows different please correct me.


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## Owlivia (Nov 4, 2022)

When I called the insurance company to find out the price of the prescription (their website  was wonky and not working well)  the rep told me the price was even more than indicated, it was over $600 for a little 5ml bottle.

She tried to convince me that I should use the insurance as that would cover my deductible for the year, around 450(?) at that time.

I told her after I bought all my prescriptions and refills for the year I wouldn't reach 450,  let alone 600, she couldn't get my logic.

I have used GoodRx for this prescription for a few years now, about 56 per 5 ml bottle.


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## Happy Heart (Nov 4, 2022)

We were told that Good RX excludes people with government insurance.  The pharmacist refused to allow us to just use their card so we had to find other alternatives.


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## Alligatorob (Nov 5, 2022)

Are there any consequences to just dropping part D?  Could you get it back some time in the future if the need arises?


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## Kaila (Nov 5, 2022)

Alligatorob said:


> Are there any consequences to just dropping part D?  Could you get it back some time in the future if the need arises?


This is a very important question; I don't know the answer, but I think you can get it back. IF you unenroll during the open time.
  I have been trying to research it.
So far, I can only see for sure, in the policy information, that if we go without any part d for over 63 days, then we can't get it back immediately and there is some penalty for the interruption, but I see nothing about any huge penalty or repercussion, or that we cannot get one after that.
I will continue to research on it, and if others have the answer and a good source, then please let the rest of us know.
Part D has not turned out to be as helpful as I thought it would be, either.  Might not be worth the money for many of us, I don't know for sure, myself.
My thanks to every one of you who are adding to this thread, for all of us to consider the options.


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## Kaila (Nov 5, 2022)

perplexed said:


> if I am not mistaken if we don't get a part d in a certain time frame and get one later there is a penalty for life. If one of you knows different please correct me.


I dont know the answer, but I did not have any Part D for several years while first on Medicare, and then I got one.  Had no trouble with that. But that could possibly be because I might have been covered by some other type of limited drug plan that excused me from the penalty fee, that I didn't even know existed.

I dont think there is any longterm or life penalty, for dropping it, but I hope that I or someone else can find more definite info on this aspect, to help all of us with our individual decisions.

If you just want to drop your current Part D, and not replace it at this time,
then you ARE required to go thru the steps to do that.  Such as write a signed request to your company to end it, or call them.

If you just stopped paying, without un-enrolling, that is not allowed, and might result in some significant consequences.

Because if you are in a Plan Part D now, and you do nothing, it automatically renews, and you are supposed to be in it and pay the premiums till next years open enrollment period.


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## Kaila (Nov 5, 2022)

If you enroll in a new-to-you Part D, 
then you do not have to go thru any other steps to end your current one, if I understand correctly what I have read in multiple sources, including Medicare.gov


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## Kaila (Nov 5, 2022)

Alligatorob said:


> I pay for it and an AARP supplemental and can always find cheaper options elsewhere. I am thinking of dropping it.


You find the Supplement Plan not helpful as well?
I assume you mean the Medigap Plan, that they used to call Medicare Supplement, to help pay for deductibles and co-pays for Medicare covered services.
Did you find that, not worth the monthly premiums as well?


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## Alligatorob (Nov 5, 2022)

Kaila said:


> You find the Supplement Plan not helpful as well?


Only the prescription drug one, part D.  The supplemental part B plan is fine.  I have separate AARP plans.  Only considering dropping the drug plan.  Just like Medicare part D I have been paying for the supplemental for a few years and gotten nothing out of it.  Always cheaper to get the prescription drugs another way.


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## perplexed (Nov 5, 2022)

I found this on medicare.gov. I hope it helps.
https://www.medicare.gov/drug-cover...-coverage/how-to-drop-your-medicare-drug-plan


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## Kaila (Nov 5, 2022)

While researching today, I found info that there *IS* a penalty fee, permanently added to your monthly premiums for Part D,
*if you do not take ANY Part D plan when you are first eligible for one.  (*Unless you have some other type of ongoing drug coverage at that time)

*It is a percentage of the base premium levels multiplied by the # of months you did not have any drug coverage.
In some case, might not a large amount, but will be added to your part d premiums forevermore.*

~~~~
*I still do not know for sure,
but this same penalty fee MIGHT likely also be applied,
if you drop your Part d, without enrolling in a different Part D plan, and then have none for over 2 months.

Therefore, it seems to me, that if you have one now, and want to drop it, but might possibly want to get one in the future (or get that one back) 
then it is best to enroll in a different Plan D, instead of dropping it altogether.
Then you could change plans every year, during the mid.Oct-early Dec. open enrollment period.

There are cheap ones you could switch to, instead of simply dropping yours.*

@Alligatorob @perplexed @Owlivia

I hope this helps, too!


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## Georgiagranny (Nov 5, 2022)

I'm with Kaiser-Permanente. Part D is included in my plan. There is no extra cost; no deductible and rarely a co-pay.

Actually, there's no cost to me, period. Not for the supplement, not for Part D. Medicare Advantage.


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## perplexed (Nov 5, 2022)

Happy Heart said:


> We were told that Good RX excludes people with government insurance.  The pharmacist refused to allow us to just use their card so we had to find other alternatives.


The way it was explained to me was you can't use both at the same time.


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## Georgiagranny (Nov 6, 2022)

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.


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## Alligatorob (Nov 6, 2022)

Georgiagranny said:


> 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.


Georgiagranny said:


> 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.


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## Georgiagranny (Nov 6, 2022)

Alligatorob said:


> Maybe you have one of the "Advantage Plans".  They work differently.


I have an advantage plan now but didn't have in the past, and Part D was still included at no cost.


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## Georgiagranny (Nov 6, 2022)

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.


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## Kaila (Nov 6, 2022)

To answer the question that was posted to the OP, (I'm the OP 

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.  

(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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## Kaila (Nov 6, 2022)

Georgiagranny said:


> 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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## Happy Heart (Nov 20, 2022)

Here is an interesting alternative to high drug prices:  https://www.beckershospitalreview.c...brand-name-drugs-market-accept-insurance.html


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## perplexed (Nov 20, 2022)

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.


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## rwb (Nov 20, 2022)

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.

​


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## Kaila (Nov 24, 2022)

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.


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## Owlivia (Nov 25, 2022)

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.


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## Kaila (Nov 25, 2022)

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!


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## Owlivia (Nov 25, 2022)

You're welcome.  I know I can sometimes be wordy and methodical.


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## Kaila (Nov 26, 2022)

Owlivia said:


> 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! I think some of my posts are over-the-top, to most people!


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## Kaila (Nov 26, 2022)

@Owlivia 
I am re-reading your _wordy post 
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!_


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## Jace (Nov 28, 2022)

I re(a)d there are 766 Medicare Part D plans nationwide..Wow! No wonder you're
comprehension!


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## Kaila (Nov 28, 2022)

Jace said:


> 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.  



It becomes far less daunting, after reading the many helpful tips in this thread.
Always nice to see you add your comment and input, @Jace  !


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## Jace (Nov 28, 2022)

@Kaila..this was for U
I couldn't deal with it,
If I had to.
I have K-P, all inclusive, (with pharmacy included)


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## Kaila (Nov 28, 2022)

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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