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Does anyone have this policy?

SilverScript SmartRx (PDP)

Aetna Medicare | Plan ID: S5601-200-0

If so, what are your thoughts? I take only one prescription medication, and if I use their mail-order service there is no cost to me other than the monthly premium, which is half of what I'm currently paying. If I get the pills at Wal-Mart the cost to me is only $1/month. What am I missing here?

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I have SilverScript for my Part D. I usually go to CVS but recently went to a WalMart and paid only $1 for Rx. 

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13 hours ago, kb0zke said:

If so, what are your thoughts?

The best choice of plan is very impacted by what medications you take and where you domicile. While I have only a little prescription medications, Pam has a large number of maintenance medications and for that reason we pay a higher premium for hers in order to keep the co-pay cost of her medications down. My monthly premium is half what hers is but if she were on the same plan her out of pocket costs would more than double. 

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2 hours ago, Kirk W said:

While I have only a little prescription medications, Pam has a large number of maintenance medications and for that reason we pay a higher premium for hers in order to keep the co-pay cost of her medications down. My monthly premium is half what hers is but if she were on the same plan her out of pocket costs would more than double. 

Since you're experienced at doing this, I assume you are considering "total annual cost" not just "out of pocket costs for Rx."  All to many seniors, unfortunately, don't appear to evaluate the cost of their options on an annualized basis and the answers aren't always obvious. 

For example, expensive Part D plans may keep your Rx costs low but that might result in a participant remaining the Coverage Gap for the entire year rather than transitioning to the Catastrophic stage where the drug prices are quite low.    Money spent on higher premiums doesn't change the  out of pocket thresholds for transitioning from one stage to the next.  

One really arcane fact that I doubt many understand is that when you are in the Coverage Gap the price you actually pay for an name brand Rx is only a portion of the cost that gets credited to your out of pocket expenses for the year.  For example, my wife is on several high-priced meds and when she is in the Coverage Gap the amount credited to her out of pocket costs is roughly twice what she actually pays.  The net result is that she goes through the Gap much faster than might be expected and transitions to Catastrophic rather early in the year.

If she was on a plan with higher premiums she would still get the same "discount" but her total out of pocket costs would be less and she might not get to the catastrophic stage until much later in the year.

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Part D needs a complete overhaul.  It was an abomination when first enacted and it hasn’t improved over the years.  Needs to be redone from the ground up.  

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2 hours ago, docj said:

Since you're experienced at doing this, I assume you are considering "total annual cost" not just "out of pocket costs for Rx."  All to many seniors, unfortunately, don't appear to evaluate the cost of their options on an annualized basis and the answers aren't always obvious. 

I'm not sure exactly what you are meaning, but one has to add the cost of premiums to any drug costs in order to evaluate what plan serves best. For example, the plan that I have would cost Pam $45 for 3 months of the same drug that she currently pays $24 for(in both cases a 90 day supply). She currently has 6 different prescription drugs and since each insurance company sets their own tier levels for the various drugs and in some cases one of her drugs is tier 1 in one plan and tier 2 in the cheaper plan. The key is to add the total spent for drugs in any form, including all premiums, deductibles, and copay expenses on each plan and compare them. My cheap plan puts 2 of Pam's drugs that are tier 1 on her plan as tier 2 on mine, thus the copay would be much more. Since I only have 2 maintenance prescription drugs and bot are common generics, I benefit from the lower premium coverage. Here is the definition of "out of pocket costs" according to healthcare.gov.

Quote

Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

 

Edited by Kirk W

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55 minutes ago, Kirk W said:

I'm not sure exactly what you are meaning, but one has to add the cost of premiums to any drug costs in order to evaluate what plan serves best. 

We're saying the same thing--what matters is the annual cost of the plan including premiums and the cost of Rx.  All I was trying to say is that high premiums/lower drug cost isn't always the best decision.  You have to look at the specific drugs being prescribed.

Edited by docj

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And docj, you have to look at the plans yearly as they change.  Also work with your Doctor as he may be able to get you on a less expensive drug or combo.   I was on one drug that was a combo of two drugs.  The cost of the co-pay fro 3 months was close to $400.  The Doctor put me on the two drugs separately,....one was free and the other was $18 for 3 months.

Ken

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2 hours ago, TXiceman said:

And docj, you have to look at the plans yearly as they change

For sure; fortunately we have access to a website that has a very good analysis tool.  For example this coming year I'll be changing from one AARP United Healthcare plan to another to take advantage of slightly better pricing on my particular meds.

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19 minutes ago, docj said:

For sure; fortunately we have access to a website that has a very good analysis tool.  For example this coming year I'll be changing from one AARP United Healthcare plan to another to take advantage of slightly better pricing on my particular meds.

Why not just get a better stand-alone prescription plan?  Or do you have an Advantage plan?

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19 hours ago, 2gypsies said:

Why not just get a better stand-alone prescription plan?

That's what I am doing. Each year I use the analysis tool to calculate which plan has the lowest annual cost for me and my wife.  These are stand-alone Part D Rx plans.  I thought I had been clear.  I have no interest in Advantage Plans.

Edited by docj

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23 hours ago, docj said:

For sure; fortunately we have access to a website that has a very good analysis tool.  For example this coming year I'll be changing from one AARP United Healthcare plan to another to take advantage of slightly better pricing on my particular meds.

When you stated you're switching from a United Healthcare plan to another it sounded like you were talking about your supplement policy. Sorry for the misunderstanding.  

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If you go to Medicare and enter in your Rx's they will give you a list of insurers with the primiums, costs of each drug at which ever pharmacy you chose and your annual total cost for each insured/pharmacy.  It also breaks down your monthly costs and shows you when you will go into the gap and catastrophic.

https://www.medicare.gov/plan-compare/?utm_campaign=20201104_oep_mpf_omcs&utm_content=english&utm_medium=email&utm_source=govdelivery#/?lang=en&year=2021 

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I have used my AARP Medicare supplement Plan F (medigap) for many years while RVing in a dozen states with no fuss or copays or deductibles in addition to VA full health care and eye and dental coverage when needed.  I have Humana plan D for scripts with only very small copay. So far all is good. Knock on wood.

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On 11/3/2020 at 4:13 PM, Kirk W said:

I'm not sure exactly what you are meaning, but one has to add the cost of premiums to any drug costs in order to evaluate what plan serves best. For example, the plan that I have would cost Pam $45 for 3 months of the same drug that she currently pays $24 for(in both cases a 90 day supply). She currently has 6 different prescription drugs and since each insurance company sets their own tier levels for the various drugs and in some cases one of her drugs is tier 1 in one plan and tier 2 in the cheaper plan. The key is to add the total spent for drugs in any form, including all premiums, deductibles, and copay expenses on each plan and compare them. My cheap plan puts 2 of Pam's drugs that are tier 1 on her plan as tier 2 on mine, thus the copay would be much more. Since I only have 2 maintenance prescription drugs and bot are common generics, I benefit from the lower premium coverage. Here is the definition of "out of pocket costs" according to healthcare.gov.

 

I need to change Medicare supplement drug plan, I find the insurance company I am currently with is not working for me.  Their customer service skills is not compatible with me.  Is their someone that I can call to get some help with this issue?  We are full time RVers with Texas as our domicile.

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There is a place on the Medicare Website for the purpose of locating the coverages you need. Just select part D, then answer the questions, then list the drugs that you take now, and it will come up with a list of insurance companies and plans, with the estimated total cost for you each year.

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When choosing a Prescription plan don't only go by the lowest cost; look at the Tiers your medications are in, also.  The higher the Tier the more you'll pay for your drugs.

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3 hours ago, 2gypsies said:

When choosing a Prescription plan don't only go by the lowest cost; look at the Tiers your medications are in, also.  The higher the Tier the more you'll pay for your drugs.

I think Kirk and I and others are talking about "total annual cost" which is the only thing that really matters.  The tiers you are talking about are irrelevant--the only thing that matters is what your total costs are for a year including premiums and all co-pays.

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Recommending supplements when someone is on prescribed medications can turn out deadly.   Unless your physician agrees, never take a supplement or OTC with medications with prescription meds.  Talk to your physician to make sure the suggested supplement won't interfere with how the body turns over the medication.  You don't  need to take anything, your body has a great detox systems in place and if they aren't working well, you need to be under the care of the liver or kidney physician.   In fact, taking something else could interfere with natural turnover rendering you either not having amount of medication in your body that you need or too much.

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