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That sort of explains why so many people forgo having the Part D drug plan. I guess a lot of people don't even spend that much a year on prescriptions?

That is the purpose of insurance.
This always turns my lights on, so forgive my ramble here, but I've got to say it....

Insurance of all types exists for one prevent financial catastrophe that could lead to insolvency (bankruptcy). It is a financial product only. This includes insurance against unexpected death, your house burning down, becoming permanently disabled while working or, the grandaddy of all insuance, an auto accident when many are injured and you're found liable (neglegent). All of these events are rare and most will live a lifetime without incurring any. But it only takes one that without insurance, would likely lead to bankruptcy.

Part D is there in the event you are diagnosed with some dread condition that requires very expensive medication. For example, you travel overseas, return and develop a very sore throat, headaches and swollen neck. You see your Dr. who diagnoses toxoplasmosis. The drug of choice for this is Daraprim taken for about 2 months. The cost is about $45,000/month. The risk of this, or something like it, happening to you is small...but it only takes once.

To your questions

A Part D plan can be had for as little as $20 or so per month (depends on the state) for very basic but true catastrophic coverage, up to $Hundreds per month for a plan with very little in copays. If you use Medicare as your primary insurance, you must carry a part D plan. If you do not, there will be a permanent 1% penalty on your premium (actually on the average monthly premium of about $32) for each month you go without Part D coverage.

If you enroll in a Medicare Advantage Plan, most will provide their own prescription drug coverage so you do not need a separate Part D plan.

If you are covered by a drug plan through an employer or spouse employer plan, you can delay getting a Part D plan.

The premium for your Part D plan can be withheld by Social Security from your monthly SS check. Most, however, don't do it this way as it requires coordinating this premium and future possible changes through the SS bureaucracy, which can be problematic.

A single payer sounds good at first....until you have to live inside of one. It removes consumerism from the equation and inserts government bureaucrats or their contractors. You wouldn't like it.

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