My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?
Answered by 12 licensed agents
I am diabetic and I am on a Medicare Advantage plan. Insulin costs are capped at $35/mo. Other meds, like Ozempic, are not inexpensive, but they are available.
Answered by William Lawler on April 3, 2025
Broker Licensed in MO, FL, IA & 12 other states
A knowledgeable broker, such as myself, will gather your prescription list and preferred pharmacy and help you compare standalone and Medicare Advantage drug plans. In my experience, these days, the MA plans are usually a little less expensive when compared with PDP plans all things being equal.
Answered by Charles Fletcher on April 4, 2025
Agent Licensed in WA, AZ, ID, NV & TN
Firstly, my recommendation is to stay away from the MA plans, as your healthcare will be limited as to choices on your health. Especially when there is NO UNDERWRITING involved in your Open Enrollment, get the best while you can and keep control of your health always. MA means giving the control and the choices to a private company who doesn’t even know you!!!
The Prescriptions and pricing are based on a Tier level through the Medicare Part D. Depending on the plan chosen, your drugs will have different pricing. For 2025, between Premium and covered drug costs, you will not have more than $2,000 out of pocket expense. This is a great improvement over previous years!
If they can be administered at your PCP’s or other Medical Professionals office, they would be covered under your Part B. So, do what you can there!
Answered by Norman Smith on April 11, 2025
Agent Licensed in FL & PA
Before making any decision, you should review both options. Check the cost of your medications with a standalone Part D plan and the Medicare Advantage plans with drug coverage.
When on Medicare, you have the option to select a Medicare Supplement with a Standalone Part D plan (prescription drug plan) or select a Medicare Advantage plan with prescription drug coverage.
The option you choose will depend on your budget and income. I would never recommend someone have just Medicare A & B with a Standalone Part D plan because then they would be responsible for all of the Part A & B deductibles and copays.
Once you decide which option is best for you based on your budget, you can search for the Standalone Part D or Medicare Advantage plan with drug coverage that is best for you based on your medications.
As a broker, it is my responsibility to help my clients find the perfect fit.
Answered by Diana Garner on April 18, 2025
Broker Licensed in KY, FL, IN, OH & TN
There's been some nice changes in the drug structures of Medicare, especially with diabetes medications. That's where meeting with a broker (someone like us) can help compare the drug plans in your county with the medications you take, to see what the better route to go is.
Answered by Michael Yost on April 10, 2025
Broker Licensed in OH, AL, AZ & 27 other states
I cannot say it is covered, and how much depends on what kind of medication you take and the Part D plan provided by the health insurance company. You should contact Medicare agents and make an appointment.
Answered by Satoshi Aoki on March 31, 2025
Agent Licensed in CA
The drug formulary for each of the carriers is typically the same whether the medications are bundled in on their Medicare Advantage plan offering or on a standalone part D plan that they offer. The difference in price is that with the Medicare Advantage plan the prescription coverage is bundled in and there is no additional premium. The standalone Part D plans have a monthly premium that you pay in addition to your annual drug deductible s and copays. It would make sense to look at both options to see if there is a significant difference in price either way. The choice to go on a separate Part D plan may also be influenced by whether or not all of your medical providers are in network for a particular Medicare Advantage plan.
Answered by Deb Haley on April 11, 2025
Broker Licensed in MA, CT, FL & 10 other states
What do you have now for insurance coverage? A stand alone drug plan and a Medicare Advantage plan with prescription drug coverage do the same thing. One is not better than the other. I would guide you based on more information needed.
Answered by Heather Borlenghi on April 21, 2025
Agent Licensed in GA, AL, AR & 15 other states
Either way insulin are now capped at 35 per month you do need to make sure the insulin you are taking is on the formulary of the plan. That is where an agent like myself can help guide you through the plans.
A part D prescription plan and a Medicare plan with prescription drug coverage is the same. Each company formulary is different. We can review if you like.
Answered by Adriane Williams on March 30, 2025
Agent Licensed in OK, AK, AL & 48 other states
Whether you chose standalone Part D (Original Medicare) or an Advantage Plan, it is important to remember there is no such thing as a plan that covers ALL medications. Each plan (PART D standalone or Advantage) will have its own special list (Formulary) of medications it will cover. The plan will break down the medications into tiers and that is what will determine your Co-Pay if any. I would recommend meeting with an independent agent and having them do a review to determine the best option. If you are new to Medicare you may be able to sign up now. Otherwise you will want to wait until AEP (October 15-December 7).
Answered by Bobby Coates on April 10, 2025
Agent Licensed in TX, AL, AZ & 21 other states
Different carriers cover differently so you should review your meds with a broker. This is at no cost to you ever and I’m happy to work with you to help you make the right choice. Contact me, Eva Peterson, 4089640345. Looking forward to speaking with you!
Answered by Eva Peterson on April 14, 2025
Agent Licensed in CA, FL & NV
Tags:
Medicare Advantage
Medicare Part D
Prescription Drug
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