IRMAA & PDP
- Thread starter agentjhc
- Start date
- 29,511
Started a reply but it disappeared before I could finish or post.
Short version . . .
Too often agents reduce coverage decisions to simply dollars and cents (hard costs) and ignore variable costs.
They also ignore, and fail to consider, that almost everyone turning 65 will EVENTUALLY require more care and more drugs . . . in both situations their OOP costs for care and Rx.
I have 2 clients facing that now. One is facing surgery + chemo infusion over the next few months. The other will be leaving their group plan at year end and will (most likely) lose her PAP that allows her to get a $11k/month drug for $0. I am scrambling to come up with solutions and it is so frustrating.
The infusion client is not worried since her drugs fall under Part B, including one that is $6800 per dose.
The other 4 drug costs per dose are $14, $54, $1600 and $5500. All 5 med's will be given every 3 weeks for a total of 16 sessions.
This clinic accepts Medicare, many MAPD plans (mostly PPO) . . . does not accept Medicaid (which presumably includes "duals").
Getting well can be quite expensive.
Short version . . .
Too often agents reduce coverage decisions to simply dollars and cents (hard costs) and ignore variable costs.
They also ignore, and fail to consider, that almost everyone turning 65 will EVENTUALLY require more care and more drugs . . . in both situations their OOP costs for care and Rx.
I have 2 clients facing that now. One is facing surgery + chemo infusion over the next few months. The other will be leaving their group plan at year end and will (most likely) lose her PAP that allows her to get a $11k/month drug for $0. I am scrambling to come up with solutions and it is so frustrating.
The infusion client is not worried since her drugs fall under Part B, including one that is $6800 per dose.
The other 4 drug costs per dose are $14, $54, $1600 and $5500. All 5 med's will be given every 3 weeks for a total of 16 sessions.
This clinic accepts Medicare, many MAPD plans (mostly PPO) . . . does not accept Medicaid (which presumably includes "duals").
Getting well can be quite expensive.
Last edited:
- 6,468
Caveat, NOT an agent.
I am not an agent and I do not yet know and understand about these upcoming PDP changes and when they start.
However...
I know @Yagents is an experienced and knowledgeable Medicare market agent and I believe he also deals with a lot of high income individuals in 2 retirement states.
yagents did not comment about the PAST wisdom regarding IRMAA and PDP's.
He did suggest that FUTURE wisdom regarding IRMAA and PDP's might change for a SMALL GROUP of Medicare beneficiaries, such as op's client. yagents had made at least 2 comments along these lines prior to Bill Kiray making his video.
To me, the glaring, glaring omission in @Bill_Kiray 's video is its failure to comment on the possibility that upcoming PDP rule changes may change the approaches (at least some) agents will suggest to their high income clients for IRMAA and PDP strategies.
- 4,707
I don’t have Part D. I T65’d in June 2017. Using GoodRx my 3 Rx’s at Costco cost $25/ month. If I enrolled in Part D, IRMAA would be $71.30 = 12= $95.56. My two buddies are in the same boat, (Walnut grower & rice farmer). They declined Part D too. We all understand the risk of not enrolling, 1) LEP, and, 2) suddenly experiencing high drug costs until next AEP.
It is a prosperity /tax
And that is what I tell my clients
Most will never escape IRMAA
I’m subject to it not only because of what I earn but also my spouse
Retirement -doesn’t mean a thing we’ll always be subject to IRMAA
and I tell my clients we’re in the same boat
Suck it up and enroll in the least expensive drug plan so you have it when needed
I have yet to someone not enrolling
When you have that much income it’s not worth the hassle of not complying
None of my clients have ever tried to beat the added cost
but it may be how I present because I empathize- I pay the same too!
And things have happened where I received a “ thank you” call for having that
Darn drug plan
Each to his own way of belief\ thinking
And that is what I tell my clients
Most will never escape IRMAA
I’m subject to it not only because of what I earn but also my spouse
Retirement -doesn’t mean a thing we’ll always be subject to IRMAA
and I tell my clients we’re in the same boat
Suck it up and enroll in the least expensive drug plan so you have it when needed
I have yet to someone not enrolling
When you have that much income it’s not worth the hassle of not complying
None of my clients have ever tried to beat the added cost
but it may be how I present because I empathize- I pay the same too!
And things have happened where I received a “ thank you” call for having that
Darn drug plan
Each to his own way of belief\ thinking
How much is the car insurance each month and when is the last time you used it?
There's a 77% chance you will get in a car wreck. Your deductible is $1K then 100% coverage.
There's a 39% chance you will get cancer. Costs are unlimited without Part D.
You don't need Part D at max IRMAA to pay for the damn prescriptions unless there is a catastrophic diagnosis.
You need Part D at max IRMAA to protect your assets. That LEP can get pretty steep after a few years.
CRAP. Now I typed all this and realized I'm wrong as of 2025.
- 6,468
But yagents is talking about PDP becoming GI. When does that happen? and if it is happening, wouldn't that reduce your risk for the "high cost" medication to just one month's cost?
- 151
I was building this video as my advice for Agents who have clients in this type of situation today.
I've had a few of my personal clients - I still write a little personal business for friends and family - who have had Rx changes/additions mid year that have been staggering. That's my biggest concern for consumers who have High Incomes and are considering foregoing PDP.
