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Part of a logical evaluation of individual Medicare Part D costs and benefits ought to include an estimate of what I would pay for prescriptions without a plan. I've searched and can't find a place where I can submit a list of drugs and doses and learn:

1) What they would cost without a Medicare Part D plan?

2) What do they cost with a Medicare Part D plan? (Yes, even this can be confusing.)

It is clear that the current benefit of participating in a plan is the difference between the cost under (1) above minus co-payments and premiums. To this must be added the risk that an expensive drug might be prescribed at any time, bearing in mind that 'tier pricing' and the 'donut hole' do a lot to protect the insurer's investment in the client's business.

Do any Retired Fools out there have a favorite place to get "uninsured cost" figures?

Thanks,

baumgrenze
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Part of a logical evaluation of individual Medicare Part D costs and benefits ought to include an estimate of what I would pay for prescriptions without a plan. I've searched and can't find a place where I can submit a list of drugs and doses and learn:

Your current drug usage may be irrelevant. Suppose you need a transplant of almost any sort. The anti-immune drugs are very expensive.

CNC
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Check out the LBYM Drugs discussion board.

http://boards.fool.com/expensive-meds-make-that-call-3080052...

Most pharmacies will give you a quote on any prescription drug. You can easily compare costs in your area with a few phone calls. Walmart has $4 for 30 day or $10 for 90 days on many generics. In my area grocery stores have mostly copied Walmart prices (and competing strongly due to more store locations). Some say Costco has best prices. I like Walgreens for their 24 hr service.

I use the Humana Part D that works with Right Source for direct mail of 90 day prescriptions, but also Walmart for short term needs.

I would suggest you total your premiums and your copays expected in comparing insurance vs no insurance. Remember if you don't sign up for Pt D, you will be charged a penalty if you sign up later. So if you break even with your regular meds vs no insurance, then you are covered if something comes up later.

Also note that Medicare Advantage plans often include prescription coverage. But copays can be higher making it expensive if you get sick. If you are well and don't need much from the medical community, it can be the low cost way.
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I thought I'd addressed this with the sentence below:

To this must be added the risk that an expensive drug might be prescribed at any time, bearing in mind that 'tier pricing' and the 'donut hole' do a lot to protect the insurer's investment in the client's business.

I'm personally interested in how much extra I pay each year for prescription drugs under the plan I use. I wonder just how many subscribers really save money.

I also wonder if this is not just a subset of our wonderful, private-enterprise based health insurance system. One where what we get for our premium dollars is really access to pharmaceuticals at a 'negotiated' price (higher than what Health Canada pays the drug manufacturers, to be sure) and protection from a catastrophic expense such as anti-rejection drugs. Many of our premium dollars are spent on costly idiosyncratic overhead items.
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BaumgrenzeJohn asks,

Do any Retired Fools out there have a favorite place to get "uninsured cost" figures?

The cheapest place I've found is Costco's Pharmacy. If you don't live near a Costco, they even have a mail order service.

They have their prices posted online.

http://www.costco.com/ (Click on the Pharmacy link at the top of the page. Then you'll see a Price Checker tab after that.)

I've found that about half the time the full "cash" price at Costco is less than the copay with my Medco drug plan. (Medco is basically a complete fraud.)

intercst
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CountNoCount warns,

Your current drug usage may be irrelevant. Suppose you need a transplant of almost any sort. The anti-immune drugs are very expensive.

That may be true, but the most popular transplant immunosuppressant drug CellCept has been off-patent for several years -- dropping the average cost from $20,000/year to $2,000.

You can check it on the Costco price checker.

intercst
Pharmaceutical Investor
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Thank you!

The Costco link was just what I wanted.

baumgrenze
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You sound like you might be thinking along the lines of "I won't buy insurance until I need it". IMO, that doesn't work any better for health care than it does for life insurance or fire insurance on your home.

I carry Part D and have only used it once. I've used Wal-Mart's low cost generic program a few times. I don't take any meds regularly except Cialis, which isn't covered by Part D because Congress decreed old people should not have sex. But I carry Part D because I never know when I may be diagnosed with something that requires expensive medication. I have friends who are in that situation and thankful for any help they can get with medication costs, which in one case runs over $2000/month.
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Medco is basically a complete fraud.

Let's keep in mind that insurance is not about someone else pays your bills, but rather that you pay into the pool a predictable amount when you are healthy, and the pool then pays your bills when you are ill.

If you break even on the deal, you are doing well.

But then count on Congress to use premiums paid by the middle class to supplement services provided to the poor. Overall either Congress supplements from other tax sources, or expect to be in the red net.

As always, the basic problem is that eventually you run out of other people's money. Then it becomes a pay your own way system, and one that protects your household budget from major bumps.
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I don't take any meds regularly except Cialis, which isn't covered by Part D because Congress decreed old people should not have sex.

Curiosity: How much is Cialis at Walmart? Costco?

CNC
... May be getting old enough to want/need it. ... next year. 8^)
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"I don't take any meds regularly except Cialis, which isn't covered by Part D because Congress decreed old people should not have sex."



Correction....should not have tax payer subsidized sex.

It's already going broke .......

t.
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pauleckler writes,

<<Medco is basically a complete fraud.>>

Let's keep in mind that insurance is not about someone else pays your bills, but rather that you pay into the pool a predictable amount when you are healthy, and the pool then pays your bills when you are ill.

</snip>


I understand the concept of an insurance pool.

My problem with Medco is that they charge my insurance company 3 or 4 times the cash price at Costco, and my co-pay is 30% on some of the prescriptions.

What Medco charged the insurance company used to be secret until they were charged with a massive nationwide fraud. As part of the settlement, they now have to disclose prices to their customers.

http://www.badfaithinsurance.org/reference/LMCOPBM/0016a.pdf...

There's more disclosure from Medco today, but the same price gouging. That's why the cash price at Costco is often less than the co-pay with Medco.

intercst
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Part of a logical evaluation of individual Medicare Part D costs and benefits ought to include an estimate of what I would pay for prescriptions without a plan. I've searched and can't find a place where I can submit a list of drugs and doses and learn:

1) What they would cost without a Medicare Part D plan?

2) What do they cost with a Medicare Part D plan? (Yes, even this can be confusing.)


Go to the following Medicare link to answer your questions:

https://www.medicare.gov/find-a-plan/questions/home.aspx
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I'm in the minority, I'm sure, but we are 72-73, and have NOT used Part D, except when I had it for 6 months when I turned 65. I dropped it as too costly at the end of that year vs Hannaford's (grocery chain with pharmacy), which covers my BP meds and most other generics we use, for a nominal $7/year fee plus $9.99 for 90-day supplies of each drug. No copays, either.

The catches are:

1) If I were to want Plan D now, I'd have to pay about $18.00/month just in penalties, PLUS whatever the plan I choose costs, to restart it.

2) I also found it very annoying to have to look on line every year to verify that whatever plan I have in Part D is still the best (rates vs coverage).

Yes, it is a gamble, but the Plan D options in our state are just too expensive for what they offer.

We DO carry Medigap insurance to supplement our Medicare plans. That has proven to be very worthwhile, with 3 surgeries in the recent years, each costing us nothing.

Vermonter
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Like most insurance Part D is a gamble. If you don't need it, you consider yourself lucky to have good health. If you need it due to a condition that requires a costly brand name drug it is a financial lifesaver. I've never used mine either. Only prescription since I went on Medicare three years ago was a one-time generic filled by Wal-Mart for $4. OTOH, I have a friend who requires a brand name drug daily and it saves him quite a bit. It will be more as the donut hole phases out in the next few years. Then there is the friend whose cancer drug was $4,000/month. He would tell you Part D was wonderful. Everyone has to make their own choice based on their financial situation and to some extent how lucky they feel.
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