Medicare Part D options
Medicare Part D options
My wife was on Anthem Part D, but the forecast for her premium and out of pocket for 2022 is well over $4,000. She was given these options and all less money total out of pocket for 2022:
1. Mutual of Omaha
2. Silverscript Choice
3. AARP Meidcare RX Walgreens
4. Humana Walmart Value RX
5. Elixir RX Secure
6. Wellcare Classic
7. Cigna Essential RX
8. Silver Script Smart RX
We live in Colorado. Anyone have any experience good or bad with the above companies?
Thanks
Dave
1. Mutual of Omaha
2. Silverscript Choice
3. AARP Meidcare RX Walgreens
4. Humana Walmart Value RX
5. Elixir RX Secure
6. Wellcare Classic
7. Cigna Essential RX
8. Silver Script Smart RX
We live in Colorado. Anyone have any experience good or bad with the above companies?
Thanks
Dave
"Reality always wins, your only job is to get in touch with it." Wilfred Bion
- bertilak
- Posts: 10711
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- Location: East of the Pecos, West of the Mississippi
Re: Medicare Part D options
I have been happy with Humana. Rates were competitive with others, at the time (about 3 years ago) -- have not bothered to check again.
I use their mail-order pharmacy for regular, long-term, drugs. I use a local pharmacy for emergency prescriptions (e.g. cat bite antibiotics).
I use their mail-order pharmacy for regular, long-term, drugs. I use a local pharmacy for emergency prescriptions (e.g. cat bite antibiotics).
May neither drought nor rain nor blizzard disturb the joy juice in your gizzard. -- Squire Omar Barker (aka S.O.B.), the Cowboy Poet
Re: Medicare Part D options
Make sure to enter all teh scripts that she is currently taking in Medicare's online site. Then I'd pick the cheapest one that is convenient, i.e., local pharmacy to you is on their Preferred provider list so eligible for the cheapest in-network prices. For maintenance meds, definitely consider Mail Order.
The beauty of Part D is that you can change every year for a cheaper plan. (And since formularies change frequently, it is worth checking the Medicare site every open enrollment.)
https://www.medicare.gov/plan-compare/# ... 21&lang=en
The beauty of Part D is that you can change every year for a cheaper plan. (And since formularies change frequently, it is worth checking the Medicare site every open enrollment.)
https://www.medicare.gov/plan-compare/# ... 21&lang=en
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Re: Medicare Part D options
I have Mutual of Omaha (RX Premier) for 2021 and will likely sign up again for 2022 (95% sure now, tbd in a few weeks). But in general terms, I think all the alternatives you listed are just fine too. They all carry a (2022) star rating between 3 and 4 and they are all pretty decent in size and network coverage. I look at this as a one-year decision anyway, and expect to change Part D nearly yearly over time.
With regard to M of O in particular, here is what I can say so far. For context, I'm on two modestly expensive maintenance drugs (one expensive generic and one expensive branded) and three infrequently-needed generics:
-Their pharmacy benefit manager is Express Scripts. I've had no issues or delays with claims processing and no surprises on price, formulary or network during 2021
-Their formulary seems deep enough to me, although it's hard for us amateurs to know for sure
-Their 2022 premium is going up a whooping 49%, although it's only the total cost I care about and for my meds they are still one of the cheapest alternatives. Premium is actually right around the national average anyway, even after the unusual increase.
-They dropped the pharmacy I was using (effective 2022) from preferred status (back to standard), but the cost differential in my case was pretty trivial so I guess I don't care, or I'll just transfer it all to one of their many alternatives
-They dropped one key drug that I use sporadically from their formulary for 2022, but only 3 of my 23 total choices covers that drug anyway. I will substitute or pay out of pocket and won't view it as much of a negative
-One maintenance drug I take requires step therapy with most Part D, but not with M of O. A minor plus, but very minor.
-Their basic copays are competitive for all the tiers in their formulary.
-They made no material changes in their formulary during the 2021 plan year.
-The aggregate cost of M of O, premium plus out of pocket, still beats GoodRx for me (your results could differ).
-They really push mail order, but doing so would not save me anything on the particular meds I take (again your results could vary)
Sounds like you ran your meds through the Medicare.gov tool, and that's your best starting point. Accuracy tends to improve in the days following today's opening date though. That tool gave me 23 total choices, and then allowed me to quickly dismiss 15.
With regard to the other plans you mentioned in your post, here are my specific reasons as to why I eliminated them from my consideration. Of course, it is very possible NONE of these reasons will apply to you:
I eliminated these from consideration because they did not cover two of my drugs, one of which is very standard, and as a result my net costs were too high (more than double my cost for M of O): Silverscript Choice, AARP Medicare Walgreens, Humana Value RX, Elixir RX Secure, and Wellcare Classic. I considered Cigna Essential, but decided against it because my net cost differential from M of O was trivial and Cigna required step therapy on one drug I take (not a huge deal, but I'll pay an extra few bucks to avoid the clerical hassle once per year). SilverScript Smart RX was eliminated from my consideration because of high total cost. Again, these issues really only apply to my specifics, but that's really all I care about.
Of all the plans I reviewed, only 1 got eliminated for quality reasons. One company (not one that is on your list) was sanctioned by Medicare for much of last year. That plan was my first choice, but I see no reason to take the risk in poor services for such a trivial savings.
With regard to M of O in particular, here is what I can say so far. For context, I'm on two modestly expensive maintenance drugs (one expensive generic and one expensive branded) and three infrequently-needed generics:
-Their pharmacy benefit manager is Express Scripts. I've had no issues or delays with claims processing and no surprises on price, formulary or network during 2021
-Their formulary seems deep enough to me, although it's hard for us amateurs to know for sure
-Their 2022 premium is going up a whooping 49%, although it's only the total cost I care about and for my meds they are still one of the cheapest alternatives. Premium is actually right around the national average anyway, even after the unusual increase.
-They dropped the pharmacy I was using (effective 2022) from preferred status (back to standard), but the cost differential in my case was pretty trivial so I guess I don't care, or I'll just transfer it all to one of their many alternatives
-They dropped one key drug that I use sporadically from their formulary for 2022, but only 3 of my 23 total choices covers that drug anyway. I will substitute or pay out of pocket and won't view it as much of a negative
-One maintenance drug I take requires step therapy with most Part D, but not with M of O. A minor plus, but very minor.
-Their basic copays are competitive for all the tiers in their formulary.
-They made no material changes in their formulary during the 2021 plan year.
-The aggregate cost of M of O, premium plus out of pocket, still beats GoodRx for me (your results could differ).
-They really push mail order, but doing so would not save me anything on the particular meds I take (again your results could vary)
Sounds like you ran your meds through the Medicare.gov tool, and that's your best starting point. Accuracy tends to improve in the days following today's opening date though. That tool gave me 23 total choices, and then allowed me to quickly dismiss 15.
With regard to the other plans you mentioned in your post, here are my specific reasons as to why I eliminated them from my consideration. Of course, it is very possible NONE of these reasons will apply to you:
I eliminated these from consideration because they did not cover two of my drugs, one of which is very standard, and as a result my net costs were too high (more than double my cost for M of O): Silverscript Choice, AARP Medicare Walgreens, Humana Value RX, Elixir RX Secure, and Wellcare Classic. I considered Cigna Essential, but decided against it because my net cost differential from M of O was trivial and Cigna required step therapy on one drug I take (not a huge deal, but I'll pay an extra few bucks to avoid the clerical hassle once per year). SilverScript Smart RX was eliminated from my consideration because of high total cost. Again, these issues really only apply to my specifics, but that's really all I care about.
Of all the plans I reviewed, only 1 got eliminated for quality reasons. One company (not one that is on your list) was sanctioned by Medicare for much of last year. That plan was my first choice, but I see no reason to take the risk in poor services for such a trivial savings.
Last edited by DetroitRick on Fri Oct 15, 2021 11:58 am, edited 1 time in total.
- Voltaire2.0
- Posts: 279
- Joined: Thu Sep 26, 2019 10:12 am
Re: Medicare Part D options
I use CIGNA. Real people answer the phones and they work with you to get answers. ExpressScripts is their preferred mail order pharmacy, and they're good, too.
One matter to consider on all Part D plans is that all drugs are tiered. A "generic" may have a minimal copay or a high copay. Depends on the drug and in which tier the provider classifies it.
Every providers costs appear to be going up substantially for 2022.
One matter to consider on all Part D plans is that all drugs are tiered. A "generic" may have a minimal copay or a high copay. Depends on the drug and in which tier the provider classifies it.
Every providers costs appear to be going up substantially for 2022.
Re: Medicare Part D options
I am happily retaining Silver Script Smart RX. My RX are all common generics: I paid less than $80 for all meds this year. If I need something uncommon & expensive in the future, another choice might be better.
Ipsa scientia potestas est. Bacon F.
Re: Medicare Part D options
Thanks everyone, my wife did run it through the tool before I posted here.
Dave
Dave
"Reality always wins, your only job is to get in touch with it." Wilfred Bion
Re: Medicare Part D options
I just switched to SilverScript Choice from Express Scripts which is now Cigna.
My existing plan is being replaced by Cigna Extra RX at more than twice the monthly premium.
It's also worth checking the preferred pharmacies used by the plan you select.
My existing plan is being replaced by Cigna Extra RX at more than twice the monthly premium.
It's also worth checking the preferred pharmacies used by the plan you select.
Enjoying the Outdoors
Re: Medicare Part D options
delete
Last edited by TT on Tue Feb 06, 2024 3:50 pm, edited 1 time in total.
Live Life Simple and Less Soft
Re: Medicare Part D options
I just take the lowest cost plan (premiums + out of pocket total) that has an in-network pharmacy near me.
Re: Medicare Part D options
To give a little perspective here, $4,000 of out-of-pocket is just under the amount where you enter the donut hole without even considering the premiums.
So those who fall into the hole, and especially those who exit it are paying significantly more for their co-pays and premiums. But there are also a lot who may not need meds and they only pay the plan premium. I know people in both groups.
Re: Medicare Part D options
Most of the plans above she was quoted $1800-$2500.celia wrote: ↑Fri Oct 15, 2021 9:23 pmTo give a little perspective here, $4,000 of out-of-pocket is just under the amount where you enter the donut hole without even considering the premiums.
So those who fall into the hole, and especially those who exit it are paying significantly more for their co-pays and premiums. But there are also a lot who may not need meds and they only pay the plan premium. I know people in both groups.
Thanks.
Dave
"Reality always wins, your only job is to get in touch with it." Wilfred Bion
Re: Medicare Part D options
This sounds like she was not aware of the ‘preferred pharmacy’ on her current plan but was picking up her meds somewhere else. For her information, she should find out what her current preferred pharmacy is, especially if there will be more Rx orders this year. Have her call the current drug plan as listed on the back of her card.
Pharmacy chains have agreements with specific drug plans while other pharmacy chains have agreements with other drug plans. If she uses the closest pharmacy but it is not the ‘preferred pharmacy’ with her drug plan, she will pay more, which she is apparently doing. The ‘preferred pharmacy’ for each plan can change each year, so you need to check during open enrollment every year.
Another factor that impacts the co-pays is the order in which they are submitted for insurance claims (when the patient has meds on all 4 or 5 tiers). But this usually only impacts those who reach the donut hole as prices jump around when you enter and exit it.
- Mel Lindauer
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Re: Medicare Part D options
We have Wellcare, but I just switched from them to Cigna Extra RX for my wife (about half the cost) and
Silver Script Smart RX for me since I only take a couple generic drugs and the cost was the lowest there.
Agree with those who say to pay special attention to Preferred Providers, since we've been using CVS which is not a Preferred Provider for my wife's new Cigna plan (the nearby Walgreens is) but is a Preferred Provider for my new plan. Both Preferred pharmacies are close by, so it works out well.
Silver Script Smart RX for me since I only take a couple generic drugs and the cost was the lowest there.
Agree with those who say to pay special attention to Preferred Providers, since we've been using CVS which is not a Preferred Provider for my wife's new Cigna plan (the nearby Walgreens is) but is a Preferred Provider for my new plan. Both Preferred pharmacies are close by, so it works out well.
Best Regards - Mel |
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Semper Fi