P. Moeller: I now take five cheap generic drugs that most plans cover and for which I could pay a low premium. I can sign up for a drug plan with only a $12 premium, higher copays and an estimated annual drug cost for my medications of only $590. That’s about half of the same company’s “Plus” plan, which has a monthly premium of $66, lower copays and an annual drug cost of more than $1,000 for me. But what if next March or September I am diagnosed with something that requires top-tier pricey drugs? How does one address that possibility when choosing a plan? Am I missing something obvious? Or is this truly a hidden factor that people only learn about if it occurs?
Phil Moeller: Anyone named P. Moeller [no relation that I know of] goes to the head of the line when I answer questions!
Of course, there is no way for you to know how different insurance plans would charge you for drugs you don’t even know if you’ll need. So the best you can do is general research on how Part D plans cover you in what’s called the donut hole.
All Medicare drug plans have catastrophic protection. It doesn’t totally cap your exposure, but after you’ve spent $4,850 on covered drugs in 2016, you’re on the hook only for small amounts or 5 percent of the cost per prescription, whichever is greater.
Realistically, I’d go with a low-premium plan and comfort myself with the knowledge that it still provides catastrophic coverage. If your drug spending changes enough, you can pick a new plan in 2017 during next year’s open enrollment season.