Aetna Silver Scrip plan increase

[GlennWest]

Just got notice of changing plan. Goes from $9.80 to $44.80 monthly. Ouch. 

[2gypsies]

Yep... I'll be searching for a new plan.... hopefully, cheaper.

[GlennWest]

Good luck. Post what you find. Lowest I found was 30ish. My deductible went up 310.00.  Maximum out of pocket went down to 2000.00. Rabbit hole gone also. that a plus. On some expensive blood thinners right now. Questionable how long be on it though.

Edited October 10 by GlennWest

[Kirk W]

Is that a Part D, drug plan? We have Well Care, part D here in TX. 

[GlennWest]

57 minutes ago, Kirk W said:

Is that a Part D, drug plan? We have Well Care, part D here in TX. 

Yes part D. Went up due to new government laws. Rabbit hole gone and lower out of pocket cost. Just wished deductible hadn't gone up much. Cost went way up for this though. Don't understand that Well Care. How can cost be nothing

Edited October 11 by GlennWest

[Blues]

3 hours ago, GlennWest said:

Lowest I found was 30ish. My deductible went up 310.00.  Maximum out of pocket went down to 2000.00. Rabbit hole gone also. that a plus.

It's a donut hole, not a rabbit hole.  Although I can see why someone would associate Medicare with rabbit holes.

Where did you look for an alternate drug plan?  I believe you're in the Wilmington, NC, area.  Wellcare (which Kirk mentioned) is available there for a $0 premium (but I used a random Wilmington zip code).  But be aware that it's possible that a plan with a higher premium would ultimately be cheaper depending on what drugs you take.  Everyone, every year, should go to Medicare.gov to shop for Part D plans by entering all of their drugs into the website and getting the total cost for the next year:  drug costs (copay, coinsurance, etc.) plus premium.

My Aetna SilverScript in Texas is suffering the same rise yours is:  $9.80 to $44.80.  Since I don't take any drugs, I'm flying blind and will just pick the one with the lowest premium and hope like hell I don't get prescribed a drug that's expensive on that plan but would be cheap if I'd picked a plan that costs $20/month.  I hate the uncertainty of picking a Part D prescription drug plan.

And for you, what's the cheapest plan in terms of total cost right now might not be the cheapest plan in terms of total cost if you quit taking the expensive blood thinner.  To pick the right drug plan, we have to predict the future.  What a great system. 

As for how Wellcare can offer coverage for $0?  The general suspicion is that they're buying customers.  Cold-calling people about Medicare Advantage plans is no longer allowed, but if you have a Part D plan from Wellcare, they can market their Advantage plans to you.

[GlennWest]

I looked at Well care advantage plans. Entered my cardiologist and he not in their network. Also no hospice coverage. Don't need it now but odds will on day.I run into this with any advantage plan I research. Don't see why anyone would get it. Think I will call Well Care today. Don't understand pricing. Can't be 0.00 and get coverage. oh still in Texas currently. This Afib got me stationary till I find what treatment I need. Got tests all month

Edited October 11 by GlennWest

[Kirk W]

18 hours ago, Blues said:

Wellcare (which Kirk mentioned) is available there for a $0 premium

That is what we have. We were with Silver Script back in 2021 and were paying $6.90 per month each. When they went up to $11/month each we reconsidered and went to WellCare at $1/month each. In 2023 that premium was lowered to $1/month each and in 2024 it went to $0.50/month each. Wellcare is a wholly owned subsidiary of Centene Corporation, a leading healthcare enterprise. Mine is not the Advantage but Part D,

18 hours ago, Blues said:

Everyone, every year, should go to Medicare.gov to shop for Part D plans by entering all of their drugs into the website and getting the total cost for the next year:  drug costs (copay, coinsurance, etc.) plus premium.

That is the best way to get the most for your money and the only way I know of to be sure. There are also companies that will assist you in those determinations such as AON and VIA, In such cases the company does not have 100% of the possible policies since they make there money by commissions from the companies that they send people to. They do represent by far the majority of companies and they make the process somewhat easier, but you might be able to do some better with the Medicare site. 

Edited October 11 by Kirk W

[GlennWest]

Timing not great for me. On Eliquis now. That is very costly. Have to have insurance to cover this. Blood pressure meds cheap. Don't know how long be on Eliquis. Open enrollment now. Bummer

[2gypsies]

Kirk.... have you checked WellCare for 2025?  Wondering if it's still -0- for you.

I know all these plans prices are based on what meds you take.  I haven't made an effort to check ours yet.

[Kirk W]

I just checked and I had posted it wrong. We have been paying $0.50/month each this year and were notified that for 2025 it will be $0.00. 

The wife does the insurance stuff and I failed to verify my facts with her. 😀

Edited October 11 by Kirk W

[chindog]

GlennWest, I'm glad you posted this topic.  I have Aetna Silver Script for my part D, and would not have even noticed the price increase until it was too late.  Checked on available plans, and I'm changing to Well Care.

[Randyretired]

14 hours ago, GlennWest said:

I looked at Well care advantage plans. Entered my cardiologist and he not in their network. Also no hospice coverage. Don't need it now but odds will on day.I run into this with any advantage plan I research. Don't see why anyone would get it. Think I will call Well Care today. Don't understand pricing. Can't be 0.00 and get coverage. oh still in Texas currently. This Afib got me stationary till I find what treatment I need. Got tests all month

Hospice care is covered under Medicare even for advantage plans. No difference for Medicare or Medicare Advantage plans

[Blues]

15 hours ago, Kirk W said:

They do represent by far the majority of companies and they make the process somewhat easier, but you might be able to do some better with the Medicare site. 

That's not the Medicare site.  It's the website of a health insurance agency.

Quote

This website is owned and operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; ...

Contact will be made by a HealthPlanOne, LLC or insurance agent(s)/producer(s) or insurance company(s) you consented to receive information from.

 

 

 

Edited October 12 by Blues

[Blues]

16 hours ago, GlennWest said:

Don't understand pricing. Can't be 0.00 and get coverage.

Yes it can, and I explained why.  And Kirk actually has the $0 plan, and I will probably be changing to it myself.

16 hours ago, Kirk W said:

There are also companies that will assist you in those determinations such as AON and VIA, In such cases the company does not have 100% of the possible policies since they make there money by commissions from the companies that they send people to. They do represent by far the majority of companies and they make the process somewhat easier

There won't be a lot of agents representing Wellcare Part D plans because Wellcare announced that it isn't paying commissions on Part D plans any more.  Even worse, agents get commissions on renewals, and Wellcare is not going to pay renewal commissions, even on policies that are already in existence and on which they've paid renewal commissions in the past.  So if you want a Wellcare plan, you're likely to have to get it on your own.

The good news with respect to Part D plans is that the medicare.gov website has a tool to use to input your drugs to find the plan that will have you paying the least over the course of a year if you factor in the premium plus your out-of-pocket expenses (e.g. copay, deductible) for the drugs you take.  So people really can do this for themselves; you can do the research and sign up for the Part D prescription drug plan on the Medicare.gov site.

I follow a health insurance agents' forum, and one agent ran the numbers for Eliquis using the Medicare.gov site, and the total out-of-pocket for a United Health plan with a premium of $100/month would be about $1,600 (premium plus cost of drug).  With a Wellcare plan with a premium of $0, the total out-of-pocket would be about $350 more; even though Wellcare's premium is $0, it has a deductible, and imposes 25% coinsurance instead of UH's $47 copay.  So the $0/month plan ends up actually costing more than the $100/month plan for someone who takes Eliquis.

Some others chimed in with similar results for drugs like Mounjaro and Xaralto, and one person pointed out that UH wins over Wellcare for Repatha (cholesterol injection) because Wellcare doesn't cover it at all.

This is why everybody every year needs to go to the medicare.gov site and enter their drugs to find the least expensive total cost when factoring in premium PLUS out-of-pocket costs for drugs.  It would also be very helpful to have a tuned-up crystal ball to predict which drugs you'll end up taking during 2025, because that could change everything.

The plan finder lets you get pricing at various pharmacies, and you should definitely do that, because the cost can be very different at different pharmacies. 

It's a horrible system, and in my opinion indefensible and actually cruel, but it's what we've got.  At the very least, check your current plan against other options during open enrollment.  Last year, I saved a friend of mine something like $1,000 by moving him to a different Part D plan.  I'm certainly going to go through the process for him again this year.  And he likes his Walgreens pharmacist so I'm diligent about finding a plan that has Walgreens in its network.

7 hours ago, 2gypsies said:

I know all these plans prices are based on what meds you take.  I haven't made an effort to check ours yet.

A clarification:  the plans' prices aren't based on what drugs someone takes.  The premium for a given Part D plan is the same for everyone in a given area.  But what a person pays over the course of the year will differ depending on the out-of-pocket expenses imposed by the plan. 

[Kirk W]

8 hours ago, Blues said:

That's not the Medicare site.  It's the website of a health insurance agency.

It is now. Not sure what happened but it is edited and corrected now.   

Medicare Part D selections

I still don't really understand how the finances of Well Care work that they make a profit, so if you do, I'd be interested. I did some research on it but didn't learn very much.

If you look at Well Care, I'll add a little information that we have found so far. With the drugs that we take it matters what pharmacy fills your prescriptions. For example, a drug which cost $45 copay at Walmart was only $14 at CVS,

Edited October 12 by Kirk W

[Jaydrvr]

Glenn, have you looked into buying your meds internationally? I've been buying several of my meds from multiple countries through Canadian pharmacies at dramatically discounted prices for 20 plus years. Here's a link, for example. Hope it helps. Jay

 

https://inhalersonline.com/products/eliquis/

[GlennWest]

Cigna is 20.00 monthly and lowest cost on eliquis. Think I will go with them. 

[Blues]

5 hours ago, Kirk W said:

I still don't really understand how the finances of Well Care work that they make a profit, so if you do, I'd be interested.

Maybe they don't need to make a profit on their drug plan, because the purpose of the drug plan isn't the provision of drugs, but something else. 

With the new rules about cold-calling for selling Advantage plans, there's a great deal of value in having a person to whom you can market your Advantage plans, and everybody who signs up for the $0 Wellcare plan becomes one of those people. 

And that's not an insignificant point because the government changes the rules on how Advantage plans can be marketed for a reason.  And those of us enticed by the $0 premium plan throw ourselves right back into that fire.

There's also the possibility that they want as huge a customer base as possible, maybe looking for a buyout?  Or, hell, the data of all their customers might be valuable to a particular buyer of the company.

And it's not like they don't make any money on their $0 premium drug plan.  If you look at my example of Eliquis under Wellcare and United Health, Wellcare is actually making more money on it than United Health is.  It's just not as obvious, because it's coming from copays and deductible instead of the premium. 

So for people who don't take any drugs, the $0 Wellcare can be a good deal.  But if their health changes and they start being prescribed drugs?  It might not be a very good deal at all.  Sure, you can change your plan at the end of the year, but there's the meantime you have to deal with. 

Anyway, that's the conjecture about why Wellcare is offering these $0 drug plans.  I was okay with paying $10/month to stay out of Wellcare's clutches, but not $45. 

But wait--in my area Wellcare has a $0 premium plan and a $3.30 premium plan.  What's the difference?  The copay/coinsurance, and only a teeny bit.

Here they are for preferred generic, generic, preferred brand, non-preferred brand, and specialty at a "preferred retail pharmacy":

$0 premium plan:  $0  $5   25%   36%   25%

$3.30 premium:    $0   $5   22%   35%   25%

I'm no insurance expert, but it just doesn't seem rational to offer plans that are this close in premium and benefits.  Maybe the $3.30 is offered only because some people are suspicious of a $0 premium?  Wouldn't surprise me, but nothing surprises me at this point.

And speaking of surprises, Wellcare also offers a plan that costs $102.30/month, with the following copay/coinsurance amounts at a "preferred retail pharmacy":

$102.30 premium:  $0   $4   15%   50%   25%

Wow.  You pay $100/month for the privilege of a lower coinsurance amount on preferred brand drugs, but a much higher coinsurance amount on non-preferred brand drugs? 

How in the world is a person supposed to choose among these plans?  Well, you can get an agent to help you, but need to be aware they may not sell any Wellcare plans.  Or you can go to the Medicare.gov site and enter your drugs and find out which one is the lowest total out-of-pocket cost and pick that one.  And hope, if you chose the Wellcare plan with a $102.30 premium, that you don't get prescribed any non-preferred brand drugs during the next year because you're going to be kicking yourself for not taking the $0 or $3.30 premium plan every time they take $102.30 out of your bank account.

Medicare for all!!! 

[2gypsies]

18 hours ago, Blues said:

 

A clarification:  the plans' prices aren't based on what drugs someone takes.  The premium for a given Part D plan is the same for everyone in a given area.  But what a person pays over the course of the year will differ depending on the out-of-pocket expenses imposed by the plan. 

The plans are based on the prescriptions you take and different pharmacies have different prices. For instance, based on the drugs we take WalMart is the cheapest place to get them.... Walgreens, not so.  That's why when shopping for plans you need to plug in the drugs you take on the website and then you can compare what pharmacy will give you the cheapest price.

Edited October 12 by 2gypsies

[Kirk W]

15 hours ago, Blues said:

Wellcare is actually making more money on it than United Health is.  It's just not as obvious, because it's coming from copays and deductible instead of the premium.

Since the copay is paid to the pharmacy, that seems highly unlikely. There would have to be some sort of kickback for that to be the answer. We found that for us the copay was least when getting our prescriptions from CVS, who owns Aetna. Wellcare is a wholly owned subsidiary of Centene Corporation, a leading multi-national healthcare enterprise. I just found the following statement on the site Center for Medicare Advocacy

Unlike Parts A and B, which are administered by Medicare itself, Part D is provided through private plans.[3] That is, Medicare contracts with private companies that are authorized to sell Part D insurance coverage. These companies are both regulated and subsidized by Medicare, pursuant to one-year, annually renewable contracts. 

When you look closely at the premiums of most Part D plans, many of us take prescription drugs that in total would cost more per month than the premiums paid for the plans. Since insurance companies are for profit, that subsidy must be the answer.

 

[GlennWest]

On 10/11/2024 at 10:29 PM, Randyretired said:

Hospice care is covered under Medicare even for advantage plans. No difference for Medicare or Medicare Advantage plans

I went to Well Care Advantage and it stated NO Hospice. Only one I checked 

[Randyretired]

5 hours ago, GlennWest said:

I went to Well Care Advantage and it stated NO Hospice. Only one I checked 

Hospice is covered for advantage plans by Medicare not the advantage plan.  Unlike other coverage this is provided by Medicare for all plans, even advantage plans.  So people on advantage plans still have hospice but through Medicare not the advantage plan.

[Kirk W]

The Well Care that I have is not an advantage plan. It only Part D, prescription drug coverage for our Regular Medicare parts A & B. We do also have a supplement policy from Aetna. 

[GlennWest]

34 minutes ago, Kirk W said:

The Well Care that I have is not an advantage plan. It only Part D, prescription drug coverage for our Regular Medicare parts A & B. We do also have a supplement policy from Aetna. 

 

I was just researching as I have discovered that advantage plan would be terrible in my home town that I moving back to