Medicare is confusing. There are aspects of Medicare that I view as unethical. Let’s take a look at drug coverage. This is the Part D of Medicare. By going to www.medicare.gov, you can see all the available drug plans, premiums, and drug costs. Let’s take one example – a drug that my husband needs for his cancer.
The lowest premiums + drug costs show up as AARP MedicareRx Preferred (PDP). By clicking on “View drugs and their costs”, I see: MONTHLY PREMIUM = $92.50; YEARLY DRUG & PREMIUM COST = $1,247.68; DEDUCTIBLE = $0.00. By doing a little simple math ($1247.68 divided by 12 months), I figured that the total cost (premiums + drug costs) would be a little over $100/mo. Seems clear, right?
Nope. That’s not it. It took me a long time to figure out that “Yearly Drug & Premium Cost” means only what’s left of the year, not the entire year. So, that $1247.68 represents May through December only when I’m viewing it in April. Let’s recalculate and divide the cost by 8 months. Now we get $155.96/mo. This is the least expensive pharmacy (CVS) for this drug on this plan. If you don’t have a CVS near you, you will pay more than double this amount using this plan.
OK, maybe $155.96 isn’t so bad? Let’s examine another avenue for getting the same drug, same amount: GoodRx. By using GoodRx, we purchase this drug for $80.19/mo. That’s almost half of the cost compared to using the very best Medicare Part Drug Plan. Why is this?? It makes no earthly sense that we can get a drug using a coupon far cheaper than using insurance. And on top of this, we can get the $80.19 price at Kroger Pharmacy which is convenient to us. If we used the Part D AARP drug plan at Kroger, it calculates out to $313.39/mo!
Back to the main question – why?? The very best Part D drug plan is no good to us. It makes most sense to simply not buy one. But here’s the government catch: If you don’t buy a Part D drug plan at age 65, and you want one, say, 5 years later (because it actually does help with a drug you need at that point), you will be penalized for every month you didn’t have the Part D drug plan for the rest of your life! There is a standard penalty calculation (don’t ask me what it is) that can amount to a significant punishment for life.
So, here’s what we did. We got the least expensive Part D drug plan (SilverScript at $6.80/mo for each of us for a total of $13.60/mo) as a “placeholder”. It’s absolutely no use to us. My husband’s chemo is a non-covered drug and the other two meds we use are way less expensive by using GoodRx. We bought the SilverScript only to avoid future penalties, IF in the future we ever find it might actually help us. That’s a gamble. And just as an insane side note: If we use the SilverScript drug plan for the aforementioned drug, we will pay a whopping $2,823.31/mo after we pay a $480 deductible! I call that unethical. I believe that these prices have nothing to do with reality.
But again, back to the question of why. Why is Medicare so much more expensive than GoodRx? In a nutshell, it’s because by law, Medicare cannot negotiate drug prices. The drug manufacturers can essentially charge whatever they want. I think that is unethical in more ways than one. There is pending legislation to change that. This article presents some information: Drug Price Negotiations
In a future post, I will write about what decisions we finally made regarding Original Medicare vs. Advantage Plans and decisions regarding a supplement. Don’t forget – Medicare is a deep, dense jungle and you need a machete to make your way through it. The machete is information! Read, watch YouTube videos, ask questions, talk with more than one information source, and read some more!