In our business, we hear the words THEY SAID this or that a lot. "They" means someone they know. I get it; it is easy to ask a friend for advice when you need to tackle something that is complicated. Don't assume just because someone else is on Medicare that they are an expert.
Would you ask a cardiac surgeon about the appropriate valves or pipes to use in your kitchen if they had just remodeled their kitchen? Of course not. Yes, they are experts in installing and replacing valves and pipes to keep YOU up and running, but...your kitchen needs a different kind of expert for valves and pipes.
The Wrong Expert Can Cost You
Where am I going with the analogy? Many of our clients consult with the wrong folks on very important questions. Unfortunately, the folks they ask may not have the expertise or license to answer the question. They offer advice as a courtesy to help. Then, folks who think they are helping take that information as a proven fact and make their decisions. Then, they need help correcting a problem that happens from not consulting with an expert.
Case in point. A client was prescribed FARXIGA. A rather pricey daily maintenance medication that was on their formulary for the year. However, it required a $500 deductible before the plan co-pay would kick in at $47 a month thereafter. The pharmacist asked for the $500 as their computer stated was the amount owed in exchange for the drug. The pharmacy tech said it looked like the insurance would not cover the drug at all. The pharmacy tech was trained to read the pharmacy system but was not an expert at understanding Medicare plans. The client assumed the pharmacy was right and left them in a huff. They were so mad and told all their friends their insurance was terrible. Yada Yada.
The challenge was simple, and the solution was equally simple. The client assumed the pharmacy was an expert in Medicare. The client forgot an important thing. They forgot they had a Medicare expert to consult. All they had to do was call the folks who knew them, their prescriptions, and their plan the best. Their Certified Medicare Planner™.
YUP, that's us. We could have helped them solve the challenge and concern while they were still in line at their drugstore. What solutions can you glean from this situation?
- Learn and understand your plan's annual deductible for prescriptions and how the plan works after the deductible is met each month thereafter. We can help you understand how your plan works.
- Are prescription costs still high after the deductible? Canadian pharmacies have medications ready to ship at a lower cost of many co-pays, not using insurance. Alternative suppliers should be discussed as options.
- Go back to your doctor who knows your condition and can engage a clinical pharmacologist (PharmD) about the drugs available as alternatives to safely treat your condition.
Every story can have a silver lining if you just know where to look. By the way, our client finally called our office after several days of frustration. Her solution was the suggestion of a new primary care doctor who specialized in her needs and had a PHARM D in their office for an immediate consultation.
Just call us- your Medicare experts. We can help make your Medicare journey 123Easy.
By David Schaeffer
Founder of American Retirement Advisors, David has spent decades helping retirees and pre-retirees build secure financial futures. His straightforward approach to retirement planning has guided hundreds of families toward confident, well-prepared retirements.
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Easy Eddie's Take
David's story about the FARXIGA prescription happens more often than you'd think. Most people are surprised when they learn that pharmacy staff, while knowledgeable about medications, aren't trained on the specifics of Medicare Part D coverage rules or how deductibles work across different Medicare plans. Here's what's important to understand: Medicare Part D plans for 2026 can have deductibles up to $590, and once you meet that deductible, your copays kick in just like David described.
A lot of people ask me, "Can I get help understanding my Medicare prescription coverage before I get to the pharmacy?" Absolutely. That's exactly what a licensed Medicare agent or Certified Medicare Planner does. They know your specific plan's formulary, tier structure, and coverage gap details. The Centers for Medicare & Medicaid Services requires these professionals to stay current on all plan changes, so they can walk you through exactly what you'll pay before you ever leave your house.
The good news is that understanding your Medicare Part D benefits doesn't have to be confusing. Once you see how your plan's deductible and copay structure works, managing your prescription costs becomes much more predictable.