For Medicare Part D, why would someone pick a plan with a high total cost?

Question

Brian Moore · Accepted Answer

When I’m helping someone with Medicare Part D, they might pick a plan with a higher total cost if it covers their specific meds at a lower out-of-pocket rate—especially pricier ones that’d hurt more under a cheaper plan. It’s a choice I’ve seen work for clients with chronic conditions needing brand-name drugs, where the broader formulary and lower copays justify the premium. Now, with the Inflation Reduction Act’s $2,000 cap, that strategy’s less critical and not used as much since the max exposure’s locked in either way.

Answered by Brian Moore on March 26, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Karen Marriner · Answer

I don't ever recommend selecting a Part D plan based on premium alone. The only rational way to identify the optimal Part D plan for a client is to base it on the meds they are talking regularly. Once I have the medication list, I enter it into my planning tool so I can see total cost, meaning premium + out of pocket costs. Sometimes, depending on the meds, the premium can be as low as 1.80/mo or it can be 115/mo. You must look at total spend and not premium alone!

Answered by Karen Marriner on March 27, 2025

Agent Licensed in CA

Answered by Karen Marriner Medicare Insurance Agent

Lt Col Tim Brown · Answer

Companies charge different amounts for their plans. I wouldn't pay more if there is a cheaper one and the medication is on that drug companies formulary. This year if your on 20 different medications, the maximum that you can be out of pocket for medications is $2,000 for the year.

Answered by Lt Col Tim Brown on April 28, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

James Carlson · Answer

The deductible is included in the 2K max.  More important, when expensive and hard to get meds are prescribed, the more costly plan is likely to pay.

Christopher Palazzini · Answer

It depends. There is a Part D premium and a cost of drugs. That number combined equals the total cost. When picking a drug plan that is the number to look out for. Who has the best total cost. That number includes any premiums, cost of medications and deductibles.

Answered by Christopher Palazzini on March 25, 2025

Broker Licensed in FL, CA, GA & 6 other states

Answered by Christopher Palazzini Medicare Insurance Agent

Joseph Meyers · Answer

Part D plans with higher monthly premiums are normally more beneficial in having coverage for expensive specialty drugs. You may also save on copays and deductibles

Rose Cahill · Answer

Medicare Prescription Drug pricing is very complex. My word of advice as someone who works with Medicare clients every day, don't ever shop Part D prescription drug plans by the plan's premium. A higher premium plan in some cases may be your best option.
In order for you to find the best plan for your prescription drug coverage, I suggest working with an advisor or use a self-help tool that takes into account the many variables that go into calculating your estimated total annual drug cost. These variables include not only your specific medications, dosages and quantities, but also the monthly premium for the plan, any deductibles in the plan, the plan's co-pays by Tier and the government's $2000 maximum out of pocket calculation. For people who have lots of prescriptions and expensive prescriptions, the plans with higher premiums will likely be a better fit since some high premium plans have no deductibles, and this makes a difference.
If you find prescription drug pricing complicated, it is! Be sure to do the analysis before choosing your plan. Choose the plan that provides you with the lowest estimated annual drug cost!

Gregg Matheny · Answer

I don’t know. My thought is that you should look at how much the premium is for that part D plan, and compare that with the predicted yearly total cost for all your meds. If the lower premium plans have a high medication cost it may not be worth it for the upfront savings. Most brokers, including myself, have a tool in which we will plug in your medications And see what those would cost on each individual part D plan. I like to look at all of my costs to see the big picture.

Answered by Gregg Matheny on March 26, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Jim Willis · Answer

Every plan has different coverages and a different formulary. You need to study the PDP and compare it to your prescriptions.
Most people are better off with a Medicare advantage plan covers their drugs with the plan.

Morgan Greer · Answer

The most common reason for paying a "high cost" Part D plan is because it's expansive formulary covers the expensive drugs that you take. When considering Part D, it's important to make sure your drugs are on the formulary, otherwise, you have to pay out of pocket for them without any price reductions. Choosing the right Stand alone Prescription Drug plan, or choosing a Medicare Advantage Plan + Drug Coverage (MAPD) is a crucial task. I'm here to help you make sure you know all of the costs and options when it comes to this big decision.

Answered by Morgan Greer on March 25, 2025

Agent Licensed in KS & MO

Answered by Morgan Greer Medicare Insurance Agent

Fred Manas · Answer

Someone might choose a Part D plan with a high total cost if they are taking expensive medications and the plan offers lower copays or better coverage for those specific drugs, even though the monthly premium is higher. Essentially, they might prioritize potentially saving on drug costs overall, even if it means a higher upfront premium cost. 
Here's a more detailed explanation:
Lower Copays/Better Coverage:
Some plans may have higher monthly premiums, but they offer significantly lower copays for certain medications, potentially saving the individual a lot of money in the long run. 
High-Cost Medications:
If someone takes medications that are in the higher cost tiers (brand name vs. generic, specialty drugs), a plan with lower copays for those drugs can be a good value, even with a higher monthly premium. 
Income-Based Premiums:
Some individuals may pay a higher premium based on their income, regardless of which plan they choose. 
Value-Oriented Approach:
Some individuals may be willing to pay more for a plan if it offers better coverage or lower out-of-pocket costs for the specific medications they need, even if it means a higher monthly premium. 
Avoiding Late Enrollment Penalties:
If someone is delaying enrollment in Part D, they may have to pay a late enrollment penalty in addition to their monthly premium, which could make it more cost-effective to enroll in a plan with a higher premium now.

Mike Henry · Answer

Depends on your medications. You have to look at the overall total benefit to yourself   Low premiums don’t necessarily mean it’s the best plan. Premiums plus cost benefit

Wild Bill Anderson · Answer

It’s a fact! Drug plans are not equal. What’s the difference?
1. Number of drugs covered.
2. Deductible or not before the plan starts to pay.
3. Copay or percentage of drug cost?
4. What drug stores take it.
5. Monthly premium.
Example: A new client told me his drug plan did not cover 2 of his drugs.  That means there is no cap on what those drugs could cost annually.  He was going to pay a little over $15,000 annually.  We found a drug plan that cost him $100 more per month but his drug plan cost for the year went down to $475.
He had to pay more per month but saved over $14,000 in drug cost!
Sometimes it pay to pay more to save a bundle over the year!

Jill Belvin · Answer

On Medicare Part D you look at both plan cost combined with prescription drug copay cost to determine what plan would be most beneficial.

Cathy Reeck · Answer

Beneficiaries need to verify that their drugs are on the formulary. Is their a drug deductible? What are the copays for their specific drugs? IF you medication is not on the $0 premium RX plan,that becomes a VERY expensive mistake. One that will cost them more than a high premium.

Answered by Cathy Reeck on March 18, 2025

Broker Licensed in GA, AZ, MD & NC, PA, SC & TN

Answered by Cathy Reeck Medicare Insurance Agent

For Medicare Part D, why would someone pick a plan with a high total cost?

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For Medicare Part D, why would someone pick a plan with a high total cost?

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