Bring your pill bottles: why a drug review beats a premium quote

Ask someone which Part D plan they are on and they will usually tell you the premium. Ask what they spent on prescriptions last year and most people have no idea.

That gap is where the money is.

Why the premium is a bad proxy

A Part D plan has four moving parts, and only one of them is advertised:

1. The monthly premium
2. An annual deductible, which some plans charge and some waive on lower tiers
3. Copays or coinsurance for each drug, set by its formulary tier
4. An annual out-of-pocket cap, after which covered drugs cost nothing for the rest of the year

Plans differ enormously on point 3. The same medication can be a preferred generic on one plan and a non-preferred brand on another. The difference is measured in hundreds of dollars a year — far more than any realistic premium gap.

Stack that with deductible structure and pharmacy pricing, and the plan with the lowest premium in the county routinely finishes mid-table on total cost for someone taking four or five medications. Occasionally it finishes last.

An illustration of the shape

Cost factor	Plan A	Plan B
Monthly premium	Low	About three times Plan A
Annual deductible	Applies to all tiers	Waived on lower tiers
Your maintenance drug	Non-preferred tier	Preferred tier
Your specialty drug	Step therapy required first	On formulary, no step therapy
Your pharmacy	Standard	Preferred
Where the cost lands	In copays, all year	In the premium, predictably

Plan A wins on the mailer. Plan B frequently wins on the bank statement.

This is illustrative, not a quote — the only way to know which applies to you is to run your own list.

What “your actual list” means

Not “a blood pressure pill and something for cholesterol.” We need:

• The exact name — brand or generic, as printed
• The strength — 20mg and 40mg of the same drug can sit on different tiers
• The quantity — 30-day versus 90-day changes the arithmetic
• All of them, including the ones you take occasionally
• The pharmacy you actually use

Photographs of the labels work perfectly. Approximations produce approximate answers, and approximate answers are how people end up on the wrong plan.

The two things people miss

Extra Help. Formally the Low Income Subsidy, it reduces or eliminates Part D premiums, deductibles and copays for people within certain income and asset limits — and the limits are more generous than most people assume. It is automatic if you have Medicaid, Supplemental Security Income or a Medicare Savings Program. Otherwise you have to apply, and enormous numbers of people who would qualify never do, for the entirely ordinary reason that nobody mentions it.

We screen for it in every review. There is nothing in it for us.

The penalty if you take nothing. Going 63 days or more without creditable drug coverage after your Initial Enrollment Period adds a permanent surcharge to your Part D premium when you eventually enroll. If you take no medication today, the right move is usually the least expensive compliant plan in your area, held purely as protection. It is far cheaper than the penalty applied for the rest of your life.

Run it yourself, or send it to us

The Part D total cost estimator compares three plans on annual total cost in your browser — premium, deductible and copays combined, with the out-of-pocket cap applied. It needs the copay figures from each plan’s summary of benefits.

If you would rather not do that part, a drug cost review runs your list against every plan in your county, at your pharmacy, at actual tiers, and screens for Extra Help. It takes about twenty minutes and costs nothing.

It is the single highest-value twenty minutes in Medicare, and most people never have it.