Clients looking to avoid PDP while PDP IRMAA is $80+ per month

[yorkriver1]

Any of you have this kind of client?
Both are T65 within next 2 months. Income will remain IRMAA level for the future.
No Rx being taken. They have been informed about the lifetime penalty. They will be doing a kind of spreadsheet analysis, are aware of AEP. I mentioned the Rx penalty is adjusted annually.
Do you have clients who will just opt out entirely?
I have one at this time for the past 9 years, still happy with their high deductible Plan F and no PDP.
The T65 couple are aware of the potential risk, but there may be a cost/benefit timeline.

 

[fed up]

PDP plan at close to $1000 per year, $2000 for a couple might be hart to swallow until the first $1000 prescription bill rolls in

 

[LostDollar]

@DS4

Here's your chance to present your side of this question again. I don't think I can easily find the thread where you commented before. I do think your ideas would provide a useful contrast to what I expect to be the more common viewpoint expressed in replies here.

 

[LostDollar]

@somarco

Since this is not in Senior Forum, wanted to be sure you saw it too because I think you also have a slightly different angle on this one.

 

[somarco]

I had a few opt out of PDP about a dozen years ago when the lowest premium was around $18/month. They could not justify paying that when they were not taking any medication.

Some of them came back 5 or 6 years later when their health changed and they needed brand name drugs that were expensive. By then the PDP + LEP pushed them to +$60 per month and they were still not willing to belly up to the PDP bar.

Some of them are getting their meds from Canada, a few qualified for a PAP or other financial assistance.

 

[LostDollar]

I had a few opt out of PDP about a dozen years ago when the lowest premium was around $18/month. They could not justify paying that when they were not taking any medication.

Some of them came back 5 or 6 years later when their health changed and they needed brand name drugs that were expensive. By then the PDP + LEP pushed them to +$60 per month and they were still not willing to belly up to the PDP bar.

Some of them are getting their meds from Canada, a few qualified for a PAP or other financial assistance.

Please don't forget your "Cheap PDP" plus "DiscountCard" comments too.

 

[vic120]

if their IRMA is that high they have enough to pay it

I am willing to bet the Part B Supp PDP and IRMAA is better then buying on exchange at 64 years old

I have had at least one that just didnt want to pay and it was really because was offended over being charged more because of their income don't remember what happened to that one

I had some balk at it but then ended up paying,. and they were happy they did later on

What is the income now for that Irmaa., is it still near $750 K joint

at that income don't cry to me over $1000 when others struggle to pay for their meds

and IF you don't pick a PDP don't cry to me later because of the penalty or you have to wait till AEP to get one

 

[yorkriver1]

@somarco

Since this is not in Senior Forum, wanted to be sure you saw it too because I think you also have a slightly different angle on this one.

Hey, must have been in a fugue state when I posted on Health generally instead of Medicare. I am grateful for the replies which are actually pretty helpful in other agent/client experiences to relate to my client for their consideration.

 

[LostDollar]

Hey, must have been in a fugue state when I posted on Health generally instead of Medicare. I am grateful for the replies which are actually pretty helpful in other agent/client experiences to relate to my client for their consideration.

Here you go. I found the thread I was thinking about. I think it probably has the level of discussion you were hoping to generate in this one:
https://insurance-forums.com/community/threads/irmaa-pdp.109430/page-5

 

[yorkriver1]

I had a few opt out of PDP about a dozen years ago when the lowest premium was around $18/month. They could not justify paying that when they were not taking any medication.

Some of them came back 5 or 6 years later when their health changed and they needed brand name drugs that were expensive. By then the PDP + LEP pushed them to +$60 per month and they were still not willing to belly up to the PDP bar.

Some of them are getting their meds from Canada, a few qualified for a PAP or other financial assistance.

I found issues with one brand RX very popular today for on and off label use. They have no program to assist at any income level for that drug if the Medicare recipient has any kind of insurance. Medicare eligibles can apply to them if they have no insurance, and of course there is no doubt some % of federal poverty level involved. I say this because for a narrow band of refuseniks this could help. Not for my mid level IRMAA client, however. They are not on that Rx, just a commentary about what could happen if they were to be prescribed an expensive name brand. Probably Canadian pharmacy for them, as you pointed out. My awareness of the one Rx in particular is from a client who forgot about the coverage gap. Had to gently remind of the things we had discussed. Can be hard with the T65's first insured from about now to the end of the year, as they have to be reminded about what will happen in a full 12 month cycle.