I just compared the 2025 Part D plans available in my area (Atlanta) using my list of prescriptions and info from the Medicare.gov site. I picked 3 pharmacies that are in-network for all the plans. The total estimated drug and premium costs for the same drugs ranged from $1,700 to $3,700. Since I’m mainly focused on total out-of-pocket costs and not deductibles, is there any reason not to just go for the lowest-cost plan? Am I missing something about the more expensive plans? Appreciate any insights.
Higher-cost plans might cover other drugs that aren’t on your list, especially pricier brand-name medications. But if your prescriptions are covered and the lower-cost plan meets your needs, it makes sense to pick it.
@Kai
That makes sense. Thanks!
I have the same question. Navigating through deductibles, caps, and formularies can be such a mess. It feels like if you’re rich or poor, it’s easier, but if you’re in the middle, it’s tough.
Ignoring deductibles is leaving out an important factor. The max deductible for 2025 is $590. Spread that out over a year, and you might find that a plan with a $49 premium and no deductible could be cheaper overall than a plan with no premium but a $590 deductible.
Insurance plans vary in a lot of ways—like how many drugs they cover, the tier levels for different meds, whether there’s a deductible, and things like prior authorization or quantity limits. That’s why it’s important to check each year, especially with all the changes for 2025. If a lower-cost plan fits your needs, go for it.
Keep in mind that Medicare has capped out-of-pocket prescription costs at $2,000 for 2025, so almost every plan now includes a drug deductible.
The Medicare.gov site is pretty good at showing the cheapest Part D plan based on your total costs. But also consider factors like step therapy, quantity limits, and dispensing restrictions. You can see these details under the Plan Details section on the site.
@Finley
I’m on WellCare, and they mentioned a 30-pill limit, but then said if my doctor writes a 90-day prescription, they’ll fill it. So confusing.
Noor said:
@Finley
I’m on WellCare, and they mentioned a 30-pill limit, but then said if my doctor writes a 90-day prescription, they’ll fill it. So confusing.
You might need your doctor to request an exception if there’s a quantity limit. But if Medicare.gov shows coverage for a 90-day supply, that’s a good sign.
Higher premiums often mean a more extensive list of covered drugs. That could be why the more expensive plans exist.
I’m new to Medicare, starting next month, and was advised to go with WellCare because it’s $0 per month. My three prescriptions will cost around $45 each month, which is cheaper than what I’m paying now.
We should be thankful for the government subsidies because without them, premiums would’ve been around $170+. With the $2k out-of-pocket max, plans are going to adjust and likely increase costs in the coming years.