Medicare and the Donut hole

[Giggles]

Does anyone know what the donut hole is all about? I am wondering if I can get enough coverage with my Medicare alone along with Part D OR does my husband have to provide insurance to me through a group plan through his employer for the rest of his life! Poor guy!!! Does medicare provide enough coverage for stuff? I have always thought the group plan through my husband is always the better way to go in terms of copays and coverage. Any thoughts?

Jennifer 36 years old with CF and CFRD

PS: I posted this in Off topic by accident, too

 

[Giggles]

Does anyone know what the donut hole is all about? I am wondering if I can get enough coverage with my Medicare alone along with Part D OR does my husband have to provide insurance to me through a group plan through his employer for the rest of his life! Poor guy!!! Does medicare provide enough coverage for stuff? I have always thought the group plan through my husband is always the better way to go in terms of copays and coverage. Any thoughts?

Jennifer 36 years old with CF and CFRD

PS: I posted this in Off topic by accident, too

 

[Giggles]

Does anyone know what the donut hole is all about? I am wondering if I can get enough coverage with my Medicare alone along with Part D OR does my husband have to provide insurance to me through a group plan through his employer for the rest of his life! Poor guy!!! Does medicare provide enough coverage for stuff? I have always thought the group plan through my husband is always the better way to go in terms of copays and coverage. Any thoughts?

Jennifer 36 years old with CF and CFRD

PS: I posted this in Off topic by accident, too

 

[Giggles]

Does anyone know what the donut hole is all about? I am wondering if I can get enough coverage with my Medicare alone along with Part D OR does my husband have to provide insurance to me through a group plan through his employer for the rest of his life! Poor guy!!! Does medicare provide enough coverage for stuff? I have always thought the group plan through my husband is always the better way to go in terms of copays and coverage. Any thoughts?

Jennifer 36 years old with CF and CFRD

PS: I posted this in Off topic by accident, too

 

[Giggles]

Does anyone know what the donut hole is all about? I am wondering if I can get enough coverage with my Medicare alone along with Part D OR does my husband have to provide insurance to me through a group plan through his employer for the rest of his life! Poor guy!!! Does medicare provide enough coverage for stuff? I have always thought the group plan through my husband is always the better way to go in terms of copays and coverage. Any thoughts?
<br />
<br />Jennifer 36 years old with CF and CFRD
<br />
<br />PS: I posted this in Off topic by accident, too

 

[Nightwriter]

I guess first you have to figure out how much you pay for your husband's premiums, your drug copays and deductables. Then go to the Medicare website, click on Search Tools then go to Compare Part D policies. Then you plug in your meds and see what the costs come to...

The problem is the companies change the copays all the time. And if your drug isn't on the list, then they can charge a really high copay. I think you can get your doctor to say that it is a medical necessity and then you might be able to get it without the higher charges. The larger companies seem to have bigger covered drug lists.

No one likes Part D. It is expensive and confusing. And with this donut hole, a lot of people are forced to skip medications because it gets expensive. Let me explain how the donut hole works:

The donut hole or gap begins when a patient's total drug cost reaches $2510. But with CF drugs you will reach that quickly. Here's why -- they add together what Medicare pays for the drugs, what the patients pays, plus deductables.

Then you pay 100% of drugs for the next $3616 until it reaches $5726. You are allowed to pay for generics to keep costs down -- but a lot of CF drugs are not generics. After reaching $5726 then catastrophic coverage kicks in and you pay 5% of all drugs from then on for that year.

So in other words, during the gap you will pay more than $3000 plus whatever you paid before the you fell into the donut hole.

You also have to pay Part D premiums which are higher than what senior citizens pay.

Also, you have to factor in the premiums for a Medigap (supplemental) policy if you have one (which you should) to cover the 20% copays for the covered inhaled drugs that fall under PartB (which covers 80% of covered inhaled drugs)

Your other question is whether Medicare covers enough stuff. Except for the horrible Part D, it actually covers a lot. And with a Medigap policy, most things are covered 100%. These days, most private insurers do whatever Medicare does. If Medicare doesn't cover it, neither do they. And with private insurers paying so little on claims, most doctors will take Medicare because they know exactly what they will be getting paid.

If your husband's policy is reasonably priced, and covers what you need -- I would stick with that. You can use their drug coverage (and everything else) plus use Medicare as a secondary policy. Then you wouldn't need a Medigap policy.

 

[Nightwriter]

I guess first you have to figure out how much you pay for your husband's premiums, your drug copays and deductables. Then go to the Medicare website, click on Search Tools then go to Compare Part D policies. Then you plug in your meds and see what the costs come to...

The problem is the companies change the copays all the time. And if your drug isn't on the list, then they can charge a really high copay. I think you can get your doctor to say that it is a medical necessity and then you might be able to get it without the higher charges. The larger companies seem to have bigger covered drug lists.

No one likes Part D. It is expensive and confusing. And with this donut hole, a lot of people are forced to skip medications because it gets expensive. Let me explain how the donut hole works:

The donut hole or gap begins when a patient's total drug cost reaches $2510. But with CF drugs you will reach that quickly. Here's why -- they add together what Medicare pays for the drugs, what the patients pays, plus deductables.

Then you pay 100% of drugs for the next $3616 until it reaches $5726. You are allowed to pay for generics to keep costs down -- but a lot of CF drugs are not generics. After reaching $5726 then catastrophic coverage kicks in and you pay 5% of all drugs from then on for that year.

So in other words, during the gap you will pay more than $3000 plus whatever you paid before the you fell into the donut hole.

You also have to pay Part D premiums which are higher than what senior citizens pay.

Also, you have to factor in the premiums for a Medigap (supplemental) policy if you have one (which you should) to cover the 20% copays for the covered inhaled drugs that fall under PartB (which covers 80% of covered inhaled drugs)

Your other question is whether Medicare covers enough stuff. Except for the horrible Part D, it actually covers a lot. And with a Medigap policy, most things are covered 100%. These days, most private insurers do whatever Medicare does. If Medicare doesn't cover it, neither do they. And with private insurers paying so little on claims, most doctors will take Medicare because they know exactly what they will be getting paid.

If your husband's policy is reasonably priced, and covers what you need -- I would stick with that. You can use their drug coverage (and everything else) plus use Medicare as a secondary policy. Then you wouldn't need a Medigap policy.

 

[Nightwriter]

I guess first you have to figure out how much you pay for your husband's premiums, your drug copays and deductables. Then go to the Medicare website, click on Search Tools then go to Compare Part D policies. Then you plug in your meds and see what the costs come to...

The problem is the companies change the copays all the time. And if your drug isn't on the list, then they can charge a really high copay. I think you can get your doctor to say that it is a medical necessity and then you might be able to get it without the higher charges. The larger companies seem to have bigger covered drug lists.

No one likes Part D. It is expensive and confusing. And with this donut hole, a lot of people are forced to skip medications because it gets expensive. Let me explain how the donut hole works:

The donut hole or gap begins when a patient's total drug cost reaches $2510. But with CF drugs you will reach that quickly. Here's why -- they add together what Medicare pays for the drugs, what the patients pays, plus deductables.

Then you pay 100% of drugs for the next $3616 until it reaches $5726. You are allowed to pay for generics to keep costs down -- but a lot of CF drugs are not generics. After reaching $5726 then catastrophic coverage kicks in and you pay 5% of all drugs from then on for that year.

So in other words, during the gap you will pay more than $3000 plus whatever you paid before the you fell into the donut hole.

You also have to pay Part D premiums which are higher than what senior citizens pay.

Also, you have to factor in the premiums for a Medigap (supplemental) policy if you have one (which you should) to cover the 20% copays for the covered inhaled drugs that fall under PartB (which covers 80% of covered inhaled drugs)

Your other question is whether Medicare covers enough stuff. Except for the horrible Part D, it actually covers a lot. And with a Medigap policy, most things are covered 100%. These days, most private insurers do whatever Medicare does. If Medicare doesn't cover it, neither do they. And with private insurers paying so little on claims, most doctors will take Medicare because they know exactly what they will be getting paid.

If your husband's policy is reasonably priced, and covers what you need -- I would stick with that. You can use their drug coverage (and everything else) plus use Medicare as a secondary policy. Then you wouldn't need a Medigap policy.

 

[Nightwriter]

I guess first you have to figure out how much you pay for your husband's premiums, your drug copays and deductables. Then go to the Medicare website, click on Search Tools then go to Compare Part D policies. Then you plug in your meds and see what the costs come to...

The problem is the companies change the copays all the time. And if your drug isn't on the list, then they can charge a really high copay. I think you can get your doctor to say that it is a medical necessity and then you might be able to get it without the higher charges. The larger companies seem to have bigger covered drug lists.

No one likes Part D. It is expensive and confusing. And with this donut hole, a lot of people are forced to skip medications because it gets expensive. Let me explain how the donut hole works:

The donut hole or gap begins when a patient's total drug cost reaches $2510. But with CF drugs you will reach that quickly. Here's why -- they add together what Medicare pays for the drugs, what the patients pays, plus deductables.

Then you pay 100% of drugs for the next $3616 until it reaches $5726. You are allowed to pay for generics to keep costs down -- but a lot of CF drugs are not generics. After reaching $5726 then catastrophic coverage kicks in and you pay 5% of all drugs from then on for that year.

So in other words, during the gap you will pay more than $3000 plus whatever you paid before the you fell into the donut hole.

You also have to pay Part D premiums which are higher than what senior citizens pay.

Also, you have to factor in the premiums for a Medigap (supplemental) policy if you have one (which you should) to cover the 20% copays for the covered inhaled drugs that fall under PartB (which covers 80% of covered inhaled drugs)

Your other question is whether Medicare covers enough stuff. Except for the horrible Part D, it actually covers a lot. And with a Medigap policy, most things are covered 100%. These days, most private insurers do whatever Medicare does. If Medicare doesn't cover it, neither do they. And with private insurers paying so little on claims, most doctors will take Medicare because they know exactly what they will be getting paid.

If your husband's policy is reasonably priced, and covers what you need -- I would stick with that. You can use their drug coverage (and everything else) plus use Medicare as a secondary policy. Then you wouldn't need a Medigap policy.

 

[Nightwriter]

I guess first you have to figure out how much you pay for your husband's premiums, your drug copays and deductables. Then go to the Medicare website, click on Search Tools then go to Compare Part D policies. Then you plug in your meds and see what the costs come to...
<br />
<br />The problem is the companies change the copays all the time. And if your drug isn't on the list, then they can charge a really high copay. I think you can get your doctor to say that it is a medical necessity and then you might be able to get it without the higher charges. The larger companies seem to have bigger covered drug lists.
<br />
<br />No one likes Part D. It is expensive and confusing. And with this donut hole, a lot of people are forced to skip medications because it gets expensive. Let me explain how the donut hole works:
<br />
<br />The donut hole or gap begins when a patient's total drug cost reaches $2510. But with CF drugs you will reach that quickly. Here's why -- they add together what Medicare pays for the drugs, what the patients pays, plus deductables.
<br />
<br />Then you pay 100% of drugs for the next $3616 until it reaches $5726. You are allowed to pay for generics to keep costs down -- but a lot of CF drugs are not generics. After reaching $5726 then catastrophic coverage kicks in and you pay 5% of all drugs from then on for that year.
<br />
<br />So in other words, during the gap you will pay more than $3000 plus whatever you paid before the you fell into the donut hole.
<br />
<br />You also have to pay Part D premiums which are higher than what senior citizens pay.
<br />
<br />Also, you have to factor in the premiums for a Medigap (supplemental) policy if you have one (which you should) to cover the 20% copays for the covered inhaled drugs that fall under PartB (which covers 80% of covered inhaled drugs)
<br />
<br />Your other question is whether Medicare covers enough stuff. Except for the horrible Part D, it actually covers a lot. And with a Medigap policy, most things are covered 100%. These days, most private insurers do whatever Medicare does. If Medicare doesn't cover it, neither do they. And with private insurers paying so little on claims, most doctors will take Medicare because they know exactly what they will be getting paid.
<br />
<br />If your husband's policy is reasonably priced, and covers what you need -- I would stick with that. You can use their drug coverage (and everything else) plus use Medicare as a secondary policy. Then you wouldn't need a Medigap policy.