Medicare Part D Plans

kings53man

Hello,

Does anyone has experience with Medicare Part D plan SilverScript SmartSaver (PDP) offered by AETNA (Texas)?
I have original medicare and this year I am actively researching the plan for 2024.
I have Humana for 2023 but the cost is increasing a lot for 2024 so looking for an alternative.

All my current meds are covered under tier 1 - can't review formulary and don't know my future needs - average health.

I see another plan from Wellcare - premium just 50 cents monthly but drug costs more - so overall costs more than above.

Any other suggestion will be highly appreciated as I don't know how to compare the plans offered and premium prices are all over.

Thanks.

MikeM

https://www.medicare.gov/plan-compare/?utm_campaign=20231101_oep_mpf_pfa_mamc&utm_content=english&utm_medium=email&utm_source=govdelivery#/compare-plans?plans=2024-H5521-323-0&plans=2024-H9615-019-0&plans=2024-H2775-106-0&fips=36117&year=2024&lang=en

Try this from the medicare site. I'm in NY state and have had Aetna for 3 years going on 4 in 2024. Each year I compare options and they are as good or better than others. I have the zero pay plan because I have no health concerns or prescriptions other than a statin to control cholesterol.

edit: I do self-medicate with beer, but Aetna won't pay for that on any of their plans

msf

It looks like you're comparing three 2024 Medicare Advantage plans (plan IDs from URL):

Aetna Eagle Plan H5521-323-0 (no drugs)
MVP Medicare Gold Giveback with Part D H9615-019-0 (giveback = $30 credit each month)
Wellcare No Premium Open H2775-106-0

The Medicare.gov link to compare doesn't work, but one can reach the same place (for Erie County, e.g. Zip 14201) by going to Medicare.gov, searching for 2024 Medicare Advantage plans, selecting these three plans, and then comparing.

I suspect that you're looking at a different Aetna plan - an MAPD plan including drug coverage. In any case, the OP is looking for standalone Part D plans.

Something to watch out for is a trend toward charging coinsurance (percentage cost share) instead of co-pays (fixed dollar amounts) for drugs in tiers 3 (preferred brand) and 4 (non-preferred brand). While I don't use any brand name drugs either, the idea of coinsurance still scares me.

The good news is that starting in 2024 once you reach catastrophic coverage (about $3,333) drugs are 100% covered. And in 2025 that threshold drops to $2,000. So the percentage coinsurance concern is significantly mitigated by 2025.
https://www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit/

kings53man

Thanks for you comments - I am just looking for Medicare Part D. I am on original medicare with A & B.

MikeM

The 1st question this asks is "do you want info for just a part D plan or an advantage plan. My results, if that's what comes up on this link, is incidental to the posters question.

msf

Insurance is a matter of shifting risk. The more risk you want to shift to the insurance the insurer, the more you have to pay.

If you are certain that you will only need tier 1 drugs, and are willing to assume the risk that you are wrong (i.e. pay a lot more if you need other drugs), then the Wellcare Value Script PDP is cheapest. Lowest premium ($0.50/mo), and tier 1 drugs are "free" (no deductible).

Even if you want to insure against needing tier 2 (non-preferred generics), Wellcare is still the cheapest ($5/mo for tier 2 drugs through preferred providers).

If you want to protect yourself (partially) against paying a lot for tier 3 (and higher) drugs, then the Aetna SilverScript SmartSaver plan comes out a little better. For a yearly premium that's around $110 higher ($9.80/mo vs. $0.50/mo), you get a deductible that's $265 less ($280 vs. $545). Is it worth paying $110 more for the possibility that your total cost will be around $145 less ($265 - $110) in case you need brand name drugs?

That's not a rhetorical question. You have to decide what the odds are and whether the gamble makes sense. IMHO the hundred bucks one way or another isn't enough to fret over. What's more important is what is in each formulary and which tier each drug is placed in (some generics show up in tier 3 in some formularies).

Here are some links for plans in Houston (likely similar throughout Texas):

Wellcare Value Script:
Plan: https://www.medicare.gov/plan-compare/#/plan-details/2024-S4802-155-0
Formulary: https://fm.formularynavigator.com/FBO/67/11_6T_Enhanced_PDP_Comp_Form_24181.pdf

Aetna
Plan: https://enroll.aetnamedicare.com/s/shop?tfn=&ZipCode=77001&CountyFIPS=48201&PlanYear=2024&step=PlanList&ref=am.com&PlanID=S5601-197
Formulary: https://www.aetnamedicare.com/documents/individual/2024/formularies/FORM_2024_24023SS3NGz_EN.pdf

The Humana plans have premiums of around $50/mo (two plans) and over $100/mo (one plan).

What I don't like about either the Wellcare plan or the Aetna plan is that they charge coinsurance (24% or 25%) for preferred brand name drugs. That can get expensive very quickly. But only if you wind up using brand name drugs.

Blue Cross MedicareRx Choice has a $25.60/mo premium and a $545 deductible (applies to tiers 3 and above), but a fixed monthly copay for tier 3 (after deductible) of $46-$47. Is it worth paying $300 more per year (above the Wellcare plan)? That depends on the odds of needing brand name drugs.
https://www.bcbstx.com/medicare/tools-resources/forms-documents/pdp-plan-documents

shipwreckedandalone

I wonder if you can bundle (perhaps lower costs) in a MediGap plan: BCBS MediGap Supplement, BCBS Part D and BCBS Dental? IOW's like an Advantage concept. One card for all needs.

Crash

WellCare Value Script PDP. That's mine. It bites. It truly bites. I don't yet need anything more expensive. My doctor helps a LOT with samples. The time may come when I bail out on this Part D Plan. It sucks year-old goose-eggs that have spent the winter in the snow.

Something I bumped into: if I understand correctly, the HUGE, MONSTROUS, GARGANTUAN co-pay for the Tier 3,4 and 5 drugs is a one-time thing, each year. Thereafter, it's not so egregiously awful, but still big-time expensive to buy those drugs. I just won't do it.
(Trulicity = $450 co-pay. That's not a typo. Doesn't matter if it's for 1 month or 3 months. Either way, it ought to be f*****g ILLEGAL.)

msf

There are a few Medigap plans that offer additional benefits, like dental, vision, and hearing. I think I read somewhere that these amount to 5% of Medigap plans, but the fraction may not be even that high and I don't know how to find such plans easily.

The added benefits may be included automatically or may be available via optional riders (as opposed to separate policies). Medicare Advantage plans likewise may bundle benefits in either of these ways.

Some Medigap plans may also offer dental or vision benefits as a rider or “add-on” to the standard Medigap policy. These benefits may provide coverage for routine dental and vision care, such as dental cleanings, eye exams, and eyeglasses. With add-on coverage, you can turn it down but you usually cannot purchase without buying a Medigap plan at the same time.
...
[Another variant] is the dental, hearing, and vision Medigap insurance bundles. In this case, when you purchase the Medigap policy, you get added dental, vision, or hearing whether you want it or not.

https://www.senior65.com/medicare/article/what-medigap-plan-covers-dental-vision-and-hearing

The term of art is "innovative benefits" or "innovative plan". See, e.g.
https://www.medicarefaq.com/medicare-supplements/innovative-plan-f/

The number of innovative plans seems to be trending downward.
https://www.commonwealthfund.org/blog/2021/small-share-medicare-supplement-plans-offer-access-dental-vision-and-other-benefits-not

Note that a Medigap plan, no matter how innovative, cannot include Part D coverage, unless it was grandfathered before 2005:

Medigap plans sold after 2005 don’t include prescription drug coverage. So, if you enroll in Medigap for the first time, it won’t include drug coverage.

https://www.medicare.gov/health-drug-plans/medigap/basics/how-medigap-works