The New Year
You’ve finally got the hang of things with this Medicare “stuff”. At least you think you do. You walk into your local pharmacy to pick up your Eliquis prescription on January 8, for example, and BAM, the cashier rings you up and says “that will be $488.00”.
And your brain says “What? My agent said that I’m going to pay $15.80 per month for my plan?”
Welcome to Part D plans.
In this example, the person signs up for a plan with a large carrier that has a monthly premium of $15.80. That’s the amount he will pay each month to have the plan in place. Does that mean that there are no further costs? Of course not. If that were the case, no one would be complaining about Part D costs!
In this case, the plan also has a $445.00 deductible that applies for Tier 3, 4 and 5 medications. This plan also calls Eliquis a Tier 3 medication. This plan also will charge this person $43.00 per 30 day refill for Eliquis.
And, since the deductible is $445.00 and the 30 day charge is $43.00 if you add those two costs together, you’ll equal the $488.00 that was rung up at the register.
So, there are a few key points to always understand about Part D plans.
- The deductible for your plan is an annual one. Prepare yourself for it resetting each January 1;
- Always pay attention to your plan documents (the Annual Notice of Change) that is provided to you in the Fall of the prior year. That’s when you’ll learn what your new deductible is, the new Tier rating for your medication, the possible discontinuation of your medication coverage, possibly your pharmacy is no longer preferred, etc.
- Learn more about the Part D deductible here on our YouTube channel.
So, nothing went wrong, you were enrolled into the proper plan, you’re just dealing with your deductible “out the gate” in the new year.
Some folks will then argue “I should have enrolled into a plan with a low or no deductible”. Not so. When you select your plan, you are enrolling based on actual medications taken, actual dosages that you consume, the pharmacy that you select and your zip code. The planfinder system with Medicare.gov will sort based on lowest out of pocket costs for the year based on those parameters. You may find yourself paying $700 more annually, for example, if you choose a plan with no deductible. So, don’t fall into that trap in thinking.
So, pay your deductible at the counter, know that it will happen each year and call it a day.