how do part d deductibles work??

I am really confused. I changed Part D medication plans this year and am now paying 105 dollars a month because this plan covers some meds that the old plan did not. The old plan went up this year from 45 to 95 so I was worried about going up to 105, it seemed insane, but it said that the deductible was only 130 dollars for the year, while the old plan was 500 for the year.

I thought you paid the deductible before you paid anything else. But this month I picked up two medications, and one was 8 dollars and one was 36 dollars, so what does that mean with respect to deductibles? I can't figure out if I did the right thing going with the more expensive plan, but I think it was because the really inexpensive ones didn't cover the drugs at all, and the old one that I had last year was more expensive for the arthritis drug?

But how does the deductible work?? The one medicine I picked up for 36 said on the package that the retail price was 129 dollars. Whatever that means.

I have no helpful information on this because I don’t know how it works myself.

I am thinking I don't understand the deductible concept anymore. I used to pay for the drugs first and met the deductible before they dropped in price to the copay. Just like a Medicare part B doctor deductible--they bill you for up to the deductible, you pay it, and you have met your deductible for the year.

I checked it out on microsoft copilot and apparently on my plan, deductible does not apply to generics and lower tier drugs:

"✔ Most generics bypass the deductible

Tier 1 and Tier 2 drugs typically have no deductible, meaning you pay only the copay from day one.
✔ Brand‑name and specialty drugs usually do hit the deductible

If your medication is Tier 3, 4, or 5, expect the deductible to apply."


That's why I only had the copay, as I am getting generics. Now I am wondering if I should have paid the higher monthly fee, but at 10 dollars a month, it's only 120 a year, and the difference in the deductible was considerable, and I think one of my drugs wasn't covered under the old plan.

So complicated.

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Originally Posted by Tybee

I checked it out on microsoft copilot and apparently on my plan, deductible does not apply to generics and lower tier drugs:

"✔ Most generics bypass the deductible

Tier 1 and Tier 2 drugs typically have no deductible, meaning you pay only the copay from day one.
✔ Brand‑name and specialty drugs usually do hit the deductible

If your medication is Tier 3, 4, or 5, expect the deductible to apply."


That's why I only had the copay, as I am getting generics. Now I am wondering if I should have paid the higher monthly fee, but at 10 dollars a month, it's only 120 a year, and the difference in the deductible was considerable, and I think one of my drugs wasn't covered under the old plan.

So complicated.

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It is too bad this is so complicated. Medicare brokers take an exam to qualify to sell this insurance, it aint easy.

It is indeed complicated. MY $16.40 per month plan pays my 2 generics in full with no co-pay or deductible applied. I get my other meds through Cost Plus for pretty small money.

Quote:

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Originally Posted by rosarugosa

It is indeed complicated. MY $16.40 per month plan pays my 2 generics in full with no co-pay or deductible applied. I get my other meds through Cost Plus for pretty small money.

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When I did the plan checking in October, I don't think I understood this. Oh well. Maybe I'll get it right next year. Water under the bridge, I guess.

Tybee: I think it is counter-intuitive and atypical of how deductibles generally work. Your mistake was probably in trying to think it through logically. :)

I wasn't factoring in the generics and tier questions properly. What a weird way to define a deductible, huh?