It’s common wisdom that you need to have insurance to lower health costs, even for something like the generic blood pressure medication Olmesartan (Benicar) — and that uninsured people generally pay a lot more. But what if that’s not true? What if you pay less by putting away your insurance card? It might make you wonder what would happen if you didn’t have insurance.
We have written before about how paying cash for healthcare can be cheaper than using your insurance card. We don’t recommend that people go uninsured, but it is thought-provoking to know that your insurance policy may give you access to higher prices, not lower ones. Here’s one set of experiences.
My medication costs for the year 2022, totaled $842.11, according to my Aetna/CVS Plan D Medicare drug plan statement (see screenshot). Of that, Aetna paid $145.57 and I paid $696.54 for medications. Beyond that, I had a $7.20-a-month premium for coverage, for $86.40 annually, making a total of $782.94.
This is a point of interest not only for people who are insured by Medicare. It is widely thought that Medicare is extremely inexpensive or free. Medicare is anything but that; here’s my post about how much Medicare costs. It is also true that with commercial insurance plans, the insured person’s out-of-pocket spending could be much higher than what’s expected.
Buying without using insurance
The Aetna statement is not completely accurate: I filled two prescriptions this year at Mark Cuban Cost Plus Drugs by mail-order — not using my insurance at all — because the prices under my Aetna plan with Medicare Part D insurance for these two generic drugs would have been much higher than what I paid at Cost Plus Drugs.
These were the two prescriptions I filled at Cost Plus:
- Benicar 90 days for $19.20 plus $5 shipping. With insurance I would have paid $76.20 (without bargaining) under my Aetna plan at my local pharmacy. In fact, they wanted to charge me $76, but I offered them $45 and they accepted that. The next refill, I went to Mark Cuban Cost Plus and got it for $19.20 plus shipping.
- Benicar / HCTZ 90 days for $30 plus $5 shipping. With insurance I would have paid $204 under my Aetna plan at my local pharmacy. That’s right, $68 a month vs. $10 a month. (A friend told us he had seen a range of $6 to $771.99 for this medication.)
Mark Cuban Cost Plus Drugs, the online prescription seller bankrolled by the zillionaire Mark Cuban, makes generic drugs available at low costs to people who choose not to use their insurance. Some people may be able to ask the insurer to reimburse for costs, but my insurer won’t. You ask your doctor to send the prescription to Cost Plus, set up an account, give mailing and payment information and wait for the medication to land in your mailbox.
Premium and deductible both up
So my outlay beyond the $782.94, including the two Cost Plus drugs, was $842.14. And the insurer paid $145.57. I paid nearly 6 times what the insurer paid.
If I’d had a higher premium, would I have paid less out of pocket? Hard to say, but this does not look like a good bargain.
One other wrinkle: I take Synthroid, a brand-name thyroid replacement, for hypothyroid condition. Because of that, I pay $70 for 90 tablets of 100 mcg thyroid replacement hormone, and Aetna pays $70.01 (after the deductible is met, that is). If I chose the generic, it would be cheaper. Synthroid, as a brand name drug, is not available at Cost Plus. There is a patient assistance program run by the manufacturer, AbbVie, for Synthroid; most patient assistance programs exclude people on any federal or federal-related health insurance plan, including Medicare, Medicaid, Veterans Administration and Tricare for military members.
For 2023, the plan’s premium rose to $10.90. with a deductible of $505 for drugs in tiers 2-5. In 2022 the premium was $7.20 with a deductible of $480 for Tiers 2-5.
That’s the lowest premium Aetna has on its Part D drug plans. Aetna also offers a $40.70 monthly premium with the same $505 deductible, or a $67.90 premium with a $0 deductible.
