# Medicare Part D:  Yes or No, and why or why not?



## treeguy64

I need to decide if I'm going to pop for Part D.  It'll cost me $26/mo.  I take no prescription drugs on a regular basis, but I've read up on how they stick it to you if you go without a drug plan for many years and then need one.  It can launch you into the stratosphere on your monthly rate based on penalties you accrue year after year before you actually sign up.  I can afford Part D, easily, but I am curious if you guys bought into it at 65, and if you did, has it been helpful?  Was it the right thing, for you?  These days, I buy my generics at WalMart for $4/fill.  I guess with Part D you are hedging your bets that you may need some very, very costly meds, one day, in the future.  Any and all info/insight is greatly appreciated.


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## terry123

I have a Medicare advantage plan with Humana which includes a drug plan. Most of my meds are tier one and tier two and are free with my plan.  I have one med I take as needed which is maybe every 2 months and costs me 4.00.    If you don't take many meds then the Walmart price is reasonable.  I take 3 BP meds as I have a problem with brain aneurysms and the BP has to be kept in check so I don't have another massive stroke so my plan works for me.  Its also nice not to have to have a supplement.


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## Ken N Tx

Join Part D!!!!! I was like you and did not take any drugs, paying for it not about $53 a month!!!!


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## dpwspringer

treeguy64 said:


> I need to decide if I'm going to pop for Part D.  It'll cost me $26/mo.  I take no prescription drugs on a regular basis, but I've read up on how they stick it to you if you go without a drug plan for many years and then need one.  It can launch you into the stratosphere on your monthly rate based on penalties you accrue year after year before you actually sign up.  I can afford Part D, easily, but I am curious if you guys bought into it at 65, and if you did, has it been helpful?  Was it the right thing, for you?  These days, I buy my generics at WalMart for $4/fill.  I guess with Part D you are hedging your bets that you may need some very, very costly meds, one day, in the future.  Any and all info/insight is greatly appreciated.


I didn't go with Part D initially because I resist taking drugs and figured it wouldn't cost that much when I did. After finding out how much they started inflated prices (x4 or more) if you get a script without insurance I signed up for Part D. Since then I have found out about GoodRX which might change that dynamics, but I don't know for sure... but my feeling is you can't afford not to have Part D because you never know...


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## Don M.

Insurance is a waste of money...UNTIL you have an illness...and then, without it, the costs are sky high.  Far better, IMO, to pay a moderate amount every month/year, and then, when/if something happens, you don't have to go broke.  It's like house or car insurance....money down the drain, unless/until you have a house fire, or bad car wreck.


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## GreenSky

I suspect a Part D plan can be purchased for about $20/mo.  While it may be wasted money today, it may be a financial lifesaver if you get sick.

Rick


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## Butterfly

I wouldn't risk being without it.


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## terry123

A friend of mine has a Part D plan and pays $28.00 a month. He doesn't take any meds but is afraid to not have it!


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## IKE

Butterfly said:


> I wouldn't risk being without it.



Same here.


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## chrisgjim

Go to Medicare.gov and you can find a plan for around $20/month, make sure you list Walmart as one of your pharmacies, they seem to have the best price for people like you.  Or you can call Medicare at 800 633 4227.  Here is the key, call them during none business hours, their open 24/7.  Tell them your on no prescriptions and they will find the best plan for you.  You DO NOT want to go without a drug plan Ken n from TX is exactly right.
If you do not want to call and you would rather do it yourself I have a video that will walk you through the process.  https://www.youtube.com/watch?v=lSwD62Haqq4


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## UncleDoug

As someone who has had to take expensive medication for years, there was never any question for me: I buy the best Part D coverage I can (usually the most expensive), every year.  I also save thousands of dollars every year.

You are absolutely right about the possible cost of "late enrollment penalties."  The official word on how they are calculated:



> *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" ($35.63 in 2017; $35.02 in 2018) 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 increase each year, so your penalty amount may also increase each year.



More, with examples, here.

Our personal experience:  Medicare/our Part D insurer erroneously charged my wife a late enrollment penalty because she didn't enroll when she was first eligible (she wasn't required to, because she was still teaching and had "creditable prescription drug coverage" through her employer.  As a result, she has been charged a 55% surcharge on her Part D coverage and it is taking months (and endless hassle) to sort it out.  Medicare uses a private contractor to handle appeals related to these penalties  -- and you can imagine how motivated and efficient those guys are.  :zz:

My advice is to buy Part D coverage as soon as you are eligible.  If you don't take many meds, now, go ahead and buy one of the cheaper plans (lower premiums but almost certainly higher deductibles and/or co-pays and fewer drugs on the formulary).  You can change to more comprehensive (higher premium) coverage each year, during autumn "open enrollment," if your needs change.

Your needs can change dramatically.  In 2018, I'll be paying $100/month for Part D coverage -- and I'll be grateful for the option to do so.

  ~Doug


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## Ruth n Jersey

I'm 72 and don't have Part D. I don't take any medications at this time. I wish I had gotten it when I was first eligible if only for the peace of mind it would bring. I think what stopped me was the fact that I could have chosen a plan and then been put on some expensive drug that wasn't on the plan . I then would have to pay out of pocket for the drug until the next enrollment period to change to the plan that did have that drug. That may have changed since I looked into it. And then there is the donut hole that you have to pay full price out of pocket until you are eligible again. I researched this a few years ago so this all may have changed. My hubby is on several drugs and gets them at Walmart for $4.00. So far we are ahead of the game but that could change in a flash.


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## UncleDoug

Ruth n Jersey said:


> I'm 72 and don't have Part D. I don't take any medications at this time.



You're a very healthy 72-yr-old!  Congrats!


> I think what stopped me was the fact that I could have chosen a plan and then been put on some expensive drug that wasn't on the plan . I then would have to pay out of pocket for the drug until the next enrollment period to change to the plan that did have that drug.



That's a potential problem, but it really doesn't come up all that often.  When it does, there are provisions for both "formulary exceptions" and "tiering exceptions."  If you need a drug that is not on the carrier's formulary, you request a formulary exception.  Here's what CMS (the agency that runs Medicare & Medicaid says about that:

Exceptions requests are granted when a plan  sponsor determines that a requested drug is medically necessary for an  enrollee.  Therefore, an enrollee's prescriber must submit a supporting  statement to the plan sponsor supporting the request.


See Exceptions.



> And then there is the donut hole that you have to pay full price out of pocket until you are eligible again. I researched this a few years ago so this all may have changed.



In 2017, the "coverage gap" ("donut hole") begins when you (via deductibles -- if any -- and co-pays) and your insurer have _together_ paid $3,700 for prescription drugs. While you are in the coverage gap, you usually pay 40% of the plan’s cost (that's their negotiated cost with the pharmacy/manufacturer/distributor, _not_ the retail price) for brand-name drugs and 51% of their cost for generic drugs. That continues until your out-of-pocket costs hit $4,950 (this year).  After that, you're in the "catastrophic coverage phase" and from then until the end of the year, you pay only a small co-pay for covered medications.

See The Medicare Part D Coverage Gap (“Donut Hole”) Made Simple (not official, but very good info).

Also, it's a really good idea to call your State Health Insurance Assistance Program, for good answers to most questions!


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## OneEyedDiva

I'd literally be paying thousands of dollars a quarter for medications if not for my RX plan via the state retiree benefits plan which is excellent. If you ever have to take something that is expensive and can't sign up for part D before that, you could take quite a hit. If you never have to take meds, you may feel you wasted your money. It's like car insurance. Nobody thinks they'll be in an accident and maybe they never will be, but most people would not want to be driving around without car insurance.


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## retiredtraveler

Butterfly said:


> I wouldn't risk being without it.



Of course not. As we age, the chances we get a serious illness, such as cancer, goes up exponentially. One could have a heart attack, stroke, serious accident in the next hour. What would happen if you got into a serious auto accident and needed all sorts of meds. Think that couldn't happen (directed at those who don't think they need insurance) ?


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## Butterfly

retiredtraveler said:


> Of course not. As we age, the chances we get a serious illness, such as cancer, goes up exponentially. One could have a heart attack, stroke, serious accident in the next hour. What would happen if you got into a serious auto accident and needed all sorts of meds. Think that couldn't happen (directed at those who don't think they need insurance) ?



It most certainly can happen, and DID happen to my husband.  He got up healthy one morning, and during the course of the day, was on the freeway minding his own business when an uninsured driver fell asleep at the wheel, crashed into him doing near 100 mph per police reports, knocking him off a freeway overpass and onto the ground below, causing terrible damage which left him requiring a host of expensive medications the rest of his life.  In the twinkling of an eye, he went from a healthy employed person to a totally and permanently disabled person.  Think you'll recover your medical expenses from the other driver?  Not when he is uninsured or underinsured and judgment-proof (too poor to collect anything from), you won't.


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## C'est Moi

Butterfly said:


> It most certainly can happen, and DID happen to my husband.  He got up healthy one morning, and during the course of the day, was on the freeway minding his own business when an uninsured driver fell asleep at the wheel, crashed into him doing near 100 mph per police reports, knocking him off a freeway overpass and onto the ground below, causing terrible damage which left him requiring a host of expensive medications the rest of his life.  In the twinkling of an eye, he went from a healthy employed person to a totally and permanently disabled person.  Think you'll recover your medical expenses from the other driver?  Not when he is uninsured or underinsured and judgment-proof (too poor to collect anything from), you won't.



Oh my goodness, Butterfly.   That's terrible.   I'm so sorry for your poor hubby.   And yes, life can certainly change on a dime.


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## Bullie76

It's tempting not to sing up if you are not taking meds. But it's insurance and that's why you buy it, to cover your behind in case you need it. When I turn 65 I plan to sign up for the cheapest plan available.


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## AZ Jim

You need to pencil it out.  Take all the drugs you take cost and consider the pt D premium, the deductible, the donut hole and you may be paying more than you can buy the prescriptions without pt D.  We save by not having pt. D.


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## Bullie76

AZ Jim said:


> You need to pencil it out.  Take all the drugs you take cost and consider the pt D premium, the deductible, the donut hole and you may be paying more than you can buy the prescriptions without pt D.  We save by not having pt. D.



I would save too based on what I'm taking now. I would also have saved a lot w/o homeowners insurance over the years as I've had zero claims, but not many are going to take on that risk. Might not be quite the same comparing the two but insurance is about covering risk. Who knows what expensive drugs we might need in the future. Having said all that, my mother didn't have insurance for prescription drugs and she did just fine. Lived to be 95 taking only inexpensive generic drugs. For me....I'm willing to pay $20-25/mo for protection. But we're all different......some are willing to take the risk and some simply can't afford it.


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## C'est Moi

We have prescription coverage as part of our retiree benefits from the company we worked for, so I suppose that's considered "creditable prescription drug coverage."   So I _assume _if we ever needed Part D we will not be penalized.


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## Don M.

AZ Jim said:


> You need to pencil it out.  Take all the drugs you take cost and consider the pt D premium, the deductible, the donut hole and you may be paying more than you can buy the prescriptions without pt D.  We save by not having pt. D.



Yes, Part D....along with auto insurance, and homeowners insurance, etc.,...IS a waste of money...UNTIL you develop a serious illness, and the doctors put you on drugs that may cost thousands of dollars a year.  Personally, I would rather pay a few dollars a month, and Never need to use the insurance...than try to save a few dollars, and wind up in bankruptcy.


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## Butterfly

Don M. said:


> Yes, Part D....along with auto insurance, and homeowners insurance, etc.,...IS a waste of money...UNTIL you develop a serious illness, and the doctors put you on drugs that may cost thousands of dollars a year.  Personally, I would rather pay a few dollars a month, and Never need to use the insurance...than try to save a few dollars, and wind up in bankruptcy.



I agree wholeheartedly.  The danger is also, of course, that if you forego Part D or other creditable coverage, then if you find in the future that you DO need part D, you
will pay a big fat penalty in order to get it.  Not worth the risk to me.  

We are all healthy until we are not and it can come out of the blue, and is more likely to do so as we get older.


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## mathjak107

Don M. said:


> Yes, Part D....along with auto insurance, and homeowners insurance, etc.,...IS a waste of money...UNTIL you develop a serious illness, and the doctors put you on drugs that may cost thousands of dollars a year.  Personally, I would rather pay a few dollars a month, and Never need to use the insurance...than try to save a few dollars, and wind up in bankruptcy.




nothing is ever a problem until it is a problem . my buddy used to brag about how little he paid for his advantage plan . that was until his wife got breast cancer and each chemo was 4500 bucks until he hit his max out of pocket .

it happened end of year and he had to come up with many thousands  for covering both years .  we only save until we don't .

the risk is the deck is stacked against us as we age .

my wife and i are pretty healthy . we have medicare , a drug plan and a high deductible f-plan . so we save a lot on the f-plan .  but our exposure each year is limited to 2k . that is what we would pay for a f-plan that is not high deductible . so far we have not come close to spending 2k in non covered expenses .

we believe in mitigating our health care cost damages , including long term care . at least we know there are no surprises .

many folks ignore mitigating things , then when crap happens and destroys their financial situation they blame the event and bad luck   rather than blame themselves for  a history of poor planning and decisions along the way .


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## Don M.

mathjak107 said:


> nothing is ever a problem until it is a problem . my buddy used to brag about how little he paid for his advantage plan . that was until his wife got breast cancer and each chemo was 4500 bucks until he hit his max out of pocket .we believe in mitigating our health care cost damages , including long term care . at least we know there are no surprises . Many folks ignore mitigating things , then when crap happens and destroys their financial situation they blame the event and bad luck   rather than blame themselves for  a history of poor planning and decisions along the way .



Same here.  We carry good insurance on Everything...house, cars, health care, Long term care, etc.  Luckily, my old company has a HRA which pays most of the premiums on our Medicare Advantage, Vision, and Dental plans, so those costs are minimal.  I've found that the best way to "survive" is to plan for the worst, and be grateful if it doesn't happen.  Disaster can be just moments away, and if a person doesn't prepare, they are left helpless.


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## ProsperosDaughter

I have Part D. My feeling on insurance is the more I buy the less I will need it; which is GREAT!


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## ClassicRockr

Is Medicare Part D better than Humana Walmart? We currently have Humana Walmart and it really seems like they pay very little for any prescription either of us need. For my upcoming, when wife and I decide the date, cataract surgery, Humana Walmart will pay very little for the eye drops I will need after the surgery. Three different eye drops and each will cost us around $400 or so. We checked and Humana Walmart will pay almost nothing. 

I get all of my prescriptions from the VA and my wife gets her Metformin free from a local grocery store pharmacy. 

We REALLY need help with this to know if we should stop our drug plan with Humana and go with something else, like Medicare D.


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## GreenSky

Humana Walmart is just ONE of the Part D plans someone can choose.  Each company and plan offers different benefits.  The Walmart plan is generally the lowest priced and does a decent job with generics but has (along with many others) a $405 deductible for brand name medications.

I just had one cataract done last week with another next week.  And yes, the drops are expensive.  If you can put it off until next year you can choose a more appropriate plan for your needs.

You can also give me a call and I'll be happy to discuss the options you might not know you have even now.

Rick


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## Colleen

Ken N Tx said:


> Join Part D!!!!! I was like you and did not take any drugs, paying for it not about $53 a month!!!!



Years ago, we went that route because we had "advice" from a so-called Medicare specialist. At the time, neither one of us took any kind of meds so we figured it was a good deal. Then a couple years later, my husband had a very serious fall from a ladder and shattered his left ankle. He had 4 surgeries within 10 weeks and had to get blood thinner shots in his stomach at $400 a shot, had pain meds, had numerous antibiotics, etc., etc......you get the picture. Since we didn't have drug coverage, the hospital had a "program" that we were eligible for and it saved us some money but that was an expensive lesson. 

That October (his accident happened in June), we signed up with Humana for $0/month that had a Rx plan. We got a letter from Medicare that we had the option to have Humana collect the penalty or have it taken out of our SS. We will be paying this penalty forever. It would have been better if we would have had a plan that included RX coverage, but we did know any better at the time.

We got bad advice and hope, just because you don't need RX coverage now, if in the future something comes along, you don't get caught paying a bigger price. Just my FYI.


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## GreenSky

Understand that you now have a Medicare Advantage plan that includes Part D.  You may have saved money but be aware you may have issues finding a doctor and/or have higher than expected costs for hospitalization.

I'm not knocking MA plans but if $0 premium is the motivating factor rather than your access to providers than it may be money not well saved.

Rick


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## beachguy

I did not have prescription coverage at one point about 2 yrs. ago (was about 63 then) instead of opting for part d, I have the Magellan  r x plan..I am on 9 different medications and it it very affordable, even when I get refills..cos`ts about the same thing you found...good luck dude


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## Butterfly

Being without rx coverage at all is just a risk that is not worth taking.


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## Colleen

Butterfly said:


> Being without rx coverage at all is just a risk that is not worth taking.



Absolutely!


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## BobF

In recent month Pres Trump was complaining about how those European and others could get the same medicines for a few dollars where in the US pays big bucks.   I would think that the cost should be close to the same no matter where.    In order to design and develop new drugs or methods is likely to cost millions of dollars and and take years to do.    That cost must be share by all who choose these new products.

So how do some countries happen to have fractions of cost for the buyer.

I hope Trump finds out and announces his findings soon.


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## Don M.

BobF said:


> So how do some countries happen to have fractions of cost for the buyer..



For openers...consider this.  The Only two nations which allow the broadcasting of all these endless "Ask your Doctor" TV commercials are the U.S. and New Zealand.  The drug companies spend billions of dollars every year on this propaganda, and guess who winds up paying for it???  Those who are trapped into having to take these chemicals are paying for all these ads.  The people in the rest of the nations don't have to "subsidize" this nonsense.  However, getting our government to do likewise may be wishful thinking, give the huge amounts of money these drug companies donate to the politicians...which, again, comes out of the pockets of those taking the drugs.


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## Researchqueen

I cancelled Medicare Part D because it was a waste of money for me.  I use Goodrx for all my prescriptions and I save a ton of money.


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## Colleen

Researchqueen said:


> I cancelled Medicare Part D because it was a waste of money for me.  I use Goodrx for all my prescriptions and I save a ton of money.



Have you read the consequences of re-enrolling if you would be struck with an unforeseen illness or, Heaven forbid, cancer?? You would not be allowed to re-enroll until the enrollment period is in effect...plus you would be charged a penalty for every month you did not have coverage. 

I understand the reason you've opted out, but consider having a plan that Part D doesn't cost a monthly fee. We have Humana HMO and don't have a monthly charge. I don't mind paying $10 IF I need to see my doctor or $50 for a specialist. I take a BP pill that costs me $9 every 3 months.

We were advised (unwisely) several years ago to not take Part D because we didn't have any meds to speak of. Then my husband had a disastrous fall that shattered his ankle. He had to have blood thinner shots in his stomach for weeks so he wouldn't get blood clots. Each shot cost $400. If it wouldn't have been for the hospital working with a special program that assisted seniors like us, we'd still be paying for those shots. He had tons of antibiotic and all that came out of our pocket. There was a lot more, but you get the idea. We have had Part D ever since. My husband is too accident prone to not have it. We also get charged a penalty for all that time we didn't have it.

It's just not worth the risk.


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## GreenSky

There is a small financial risk to buying insurance.  There is a large risk for not having it when you need it.

Rick


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## GreenSky

Researchqueen said:


> I cancelled Medicare Part D because it was a waste of money for me.  I use Goodrx for all my prescriptions and I save a ton of money.


Maybe you've saved money. Most of my clients have plans for around $20/mo and tier 1 generics are generally zero copay.

Rarely will they be "upside down" vs going without insurance. 

While this is always a personal choice the risk is not worth the few dollars of savings.

Rick


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## debodun

I don't Need Part D. I am covered by my Medigap carrier which is a carryover from my job when I retired. I don't even have to pay for it.


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## mathjak107

debodun said:


> I don't Need Part D. I am covered by my Medigap carrier which is a carryover from my job when I retired. I don't even have to pay for it.


double check on that . medigap typically does not cover part d , advantage plans do but not medigap plans


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## debodun

mathjak107 said:


> double check on that . medigap typically does not cover part d , advantage plans do but not medigap plans



Well, whatever it is, I'm covered on meds. I have a co-pay, though. I wish I had dental ad vision coverage. I looked at plans for these and the premiums are more than if I just paid OOP.


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## GreenSky

mathjak107 said:


> double check on that . medigap typically does not cover part d , advantage plans do but not medigap plans



An employer "medigap" plan most likely is a PPO which will include Rx.  And since there is a copay I'd be willing to bet this is exactly the plan.

When I talk with people about insurance I get a lot of "I have a secondary" when they really have an advantage plan (typically HMO) or "I have a PPO" when they actually have a Medicare supplement.

Rick


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## JB in SC

My MIL's cancer drug was about $3000 a month, thankfully she had Part D. 

It only takes one serious illness to drain a person's retirement savings.


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