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

Answered by 9 licensed agents

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

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

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.

Answered by James Carlson on March 27, 2025

Agent Licensed in MN

Answered by James Carlson Medicare Insurance Agent

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

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

Answered by Joseph Meyers on March 25, 2025

Broker Licensed in MI & TN

Answered by Joseph Meyers Medicare Insurance Agent

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

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

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

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

Answered by Jill Belvin on March 24, 2025

Agent Licensed in TX, AZ, FL, MI & NJ

Answered by Jill Belvin Medicare Insurance Agent

Tags: Medicare Part D Prescription Drug

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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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