If the all in cost are the same then arguably the plan with high premium is usually better because those plans tend to have the most robust formularies which is better to have in case you get prescribed a new brand name drug .This Part D cap seems to work oddly in my opinion. In the instance of those 3 expensive meds, Repatha, Ozempic, and Eliquis as an example, my area shows a premium for the cheapest plan at $1.80, and it does cover all those meds, and the way the cap is figured, if I am reading it correctly, apparently the $2000 cost (2025) would be all in january and zero for the rest of the year. (Or approx $167/mo x12 in 2025 with the smoothing option?) Seems good.
However, the plan which is $115.40 premium, covers all three and the cap is met in february so zero the rest of the year. So which is really better? Higher premiums all year with approx $1600+ oop, or way lower premium with $2000 oop?
I might be reading the site wrong and am not going to get into "show me, where..." back and forth, but it does look like it would be a good idea in my opinion to check out different plans with one's own meds. I think the Medicare site does a good job of showing the dollar amounts and timeframes.
The reason the no deductible plan with fixed copayment tier 3 plan is so strong as opposed to low premium plan with a 25% coinsurance for some people with expensive brand names is because of how the TROOP is calculated
Assume a plan has no deductible and a 47.00 tier 3 .For example Ozempic cost about 1000.00 so first month you get 590.00 credit for deductible (even if your plan has no deductible) towards the TROOP.You also get 25% of difference between the 1000.00 cost of the drug and the the deductible of 590.00 which is 410 x .25= 102.5 So in first month you have already met 692.50 towards the 2000 TROOP.next month you pay 47.00 for tier 3 ozempic but you are getting 25% of the cost of ozempic which is 250.00 and so forth so you reach the 2000 TROOP after paying 47.00 for 7 month for total of 329.00 OOP drug cost
Statistics: Posted by cashmoney — Thu Oct 03, 2024 9:45 pm — Replies 24 — Views 2103