Medicare Part D question

Thread starter #1

Milkman

Retired Moderator
I will be eligible for Medicare next May. My employer will provide a Hartford Medicare supplement that covers the 20% that Medicare doesn’t cover. However this supplement plan doesn’t include Part D (prescriptions).

I take some expensive meds so I want to get a really good part D plan for.

Which company offers the best?
 

Oldstick

Senior Member
The Part D plan comparison tool on the Medicare website is usually pretty good. Not sure if it is available all the time or only near the open season. You can enter all your meds and dosages then they will tell you pretty close to what each plan will pay, including about when you will hit the "donut hole" and when you will come out of it, etc.
 
Thread starter #3

Milkman

Retired Moderator
The Part D plan comparison tool on the Medicare website is usually pretty good. Not sure if it is available all the time or only near the open season. You can enter all your meds and dosages then they will tell you pretty close to what each plan will pay, including about when you will hit the "donut hole" and when you will come out of it, etc.
Thanks
Is the donut hole where you pay less or more?
 

Oldstick

Senior Member
From what I have seen from my in-laws, it is appropriately named. You go financially into the "hole" when the Part D payments reach a certain point in the year. They significantly drop down on what they will pay for each prescription. Then after they let you suffer for a while and figure you have paid enough of of pocket, they might bring you back out of the hole and start paying better for the rest of the year. Not sure if the $$ thresholds are the same for all the part D plans or not.
 
Note that the way Medicare administers Part "D," - - if you do not sign up for part D at the same time you sign up for Parts A and B (hospitals and doctors) there is a premium penalty when you DO sign up for part D. The calculations for the penalty are on the Medicare website. If is not a very large penalty, just a few bucks for every year you have Medicare A and B, but don't have D, but you have to pay those few bucks EVERY MONTH once you do sign up.

THere is no penalty for changing from one plan to another during "open season."
 

rayjay

Senior Member
We went through a local broker called Affordable Medicare Solutions. My wife did a good job of due diligence before we contacted the local people and in the end I think we went with the one that looked like the best deal on the Medicare comparison. You need to make sure your expensive drugs are on the plan's formulary.
 

Oldstick

Senior Member
We went through a local broker called Affordable Medicare Solutions. My wife did a good job of due diligence before we contacted the local people and in the end I think we went with the one that looked like the best deal on the Medicare comparison. You need to make sure your expensive drugs are on the plan's formulary.
Good advice. And don't assume anything, you should check out everything you take, whether expensive or not. My FIL had one particular generic drug his plan classified as a "specialty" putting it into the $30-40 co-pay per refill category. Most all the other plans had it in the cheaper "generic" tier. Even his pharmacy expressed surprise that it was in the higher category. We questioned the plan (I think it was SilverScript) on this, thinking it was an error, even tried to have his doctor submit one of those "exception" appeal forms. But to no avail.

He still came out ahead overall, once you factor in the plan premiums, but it was hard to convince him that was true.
 

shdw633

Senior Member
Are you still employed? I ask because I would not want the supplement if I could still have the insurance that you are currently on, just because it does not have a donut hole.
 
Thread starter #10

Milkman

Retired Moderator
Are you still employed? I ask because I would not want the supplement if I could still have the insurance that you are currently on, just because it does not have a donut hole.
Are you asking me ?
 
Thread starter #12

Milkman

Retired Moderator
I am still employed and plan to retire next May. As stated in the OP they will provide supplemental but not part D
 

jimbo4116

Retired Moderator
Good luck, I threw my hands up and quit trying to understand Medicare. My wife's FEHB plan picks up everything hospital and doctor bill wise that Medicare doesn't. Which is more like 50% to 60% than 20%. I get a statement from Medicare but I don't think a room full of accountants can figure it out.

Don't forget about the Part B premiums to Medicare.

Good Luck, Again
 

shdw633

Senior Member
I am still employed and plan to retire next May. As stated in the OP they will provide supplemental but not part D
Ok, there are quite a few things changing in Medigap insurance in 2020. All the changes benefit the government as they are trying to stop Seniors from going to the doctor so much so they are increasing all the fees and deductibles in an attempt to have them stop going so much. As such, you may want to look at other Medicare Supplements other than what your employer is willing to give you as many of them provide a Part D coverage. Separate Part D coverage will cost you a monthy premium starting around $52 a month and go up from there depending on your income, same for your medicare monthly premium, it too will be based on your yearly income. I hate to say it but the more you make the more you pay for the premium so it may be beneficial for you to take a Medicare Supplement that has the Part D as opposed to taking your employers and having to get a Part D on your own. This is a link to Part D explanation.

https://www.medicaresupplement.com/part-d/

I sold these policies for Humana from 2008 through 2010. The donut hole is changing in 2020 as they are look to close the donut hole. Here is a link to the changes.

https://www.gomedigap.com/medicare-coverage/medicare-2020-changes/

Your best friend through this process is the internet. Find out the Medigap players in your area and find out what they have to offer. Most you will find are the same, with them throwing in eye care, over the counter discounts, gym memberships, etc to try to get you to sign with them. Best you can do is just take your time and look them all over. Bad news, you're going to pay something while in the donut hole, good news is it will most likely be no more than 25% of the actual cost of the medication you are on, whereas in the past you paid for the whole amount until you came out the other side of the donut hole. You also can enroll 3 months prior to your birthday through 3 months after your birthday, so you have plenty of time to search these all over and talk with the different reps that service your area. Don't be afraid to have them come out and explain their plans to you, it is worth your time to understand these plans completely so that you aren't surprised when things like the donut hole come up.
 
I get a statement from Medicare but I don't think a room full of accountants can figure it out.

Good Luck, Again
I agree with that 100%. It's seems like they send the statements only every three months and they are often still behind on your actual claim history even then. And VERY poorly designed as far as clarity to the end customer.
 
Thread starter #16

Milkman

Retired Moderator
Shd663
Thanks for your advice.

The supplement will be provided at no cost. It’s in addition to my pension. Other retirees have told me it was good coverage except it doesn’t have part D. HR says they pay over $200 per month per retiree for the plan.
Knowing that do you think I should still purchase a different plan that includes D?
 

shdw633

Senior Member
Shd663
Thanks for your advice.

The supplement will be provided at no cost. It’s in addition to my pension. Other retirees have told me it was good coverage except it doesn’t have part D. HR says they pay over $200 per month per retiree for the plan.
Knowing that do you think I should still purchase a different plan that includes D?
Without seeing the plan it's tough for me to say exactly but that being said the fact that they are paying $200 a month for the plan when other plans out there can basically be gotten for $0 premium it would lead me to believe your company is offering you a better plan and you should look for just a Part D coverage, but again, I stress that I don't sell or work for any of these companies any longer and am not an agent so please take my advice with a grain of salt. I am going through this with my mother which is another reason I'm a little more up to date with the changes. The nice thing about these plans is you can have them forever or can change them yearly. Based on what you stated I would look for the Part D. Keep in mind that most insurance companies that sell the Part D also sell the whole coverage so you will be able to compare your policy with theirs to confirm that you have a superior plan
 
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Thread starter #18

Milkman

Retired Moderator
Thanks
I am going to a meeting at the local country club next Saturday to listen to a sales presentation
 
Thread starter #19

Milkman

Retired Moderator
Thanks
I am going to a meeting at the local country club next Saturday to listen to a sales presentation
I went to the presentation yesterday. The lady that spoke is a 20 year owner of an agency that sells Medicare related products. She wasn’t selling anything yesterday.
She gave lots of information about various scenarios and how not everyone has the same situation and needs.
She has an office in Conyers. I will probably set up a meeting early in 2020 as I get in the window of eligibility.
 
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