Medicare Part D

[spicyone18]

So tonight I finially enrolled into a PDP. I enrolled w/AdvantraRx Premier. So just out of curosity I was wondering who everyone else signed up with or if they decided not to enroll. This PDP is supposedly covers 8 of my 13 prescriptions. $33.72 monthly premium, $5 co pay for preferredgenerics, $25 co pay preferred brands, $60 copay other price categories.

Anway just curious.

 

[Faust]

LOL While sitting here going through this maddening process I was about to post the same exact thread about Medicare part D. I decided not to. I am sitting here looking at the PDF file of my county and still a tad clueless. I guess I will write down the cheapest ones that cover the most from a well known company (large) and call up the place with 5 or 6 possibilities, and a list of my medications. I saw several in my area that were PPO's like united healthcare (best healthcare out there IMO in general) with almost no premiums and no deductibles and generic and brand names and 100 out of 100 popular drugs covered. Of course the CF drugs won't be on that list, so I will have to call and find out. What's funny is, I have been paying into medicare since 95/96, and have never used it. 10 bucks says I can't use any of it retro wise.


Last check on the phone, the aetna one (forget which one) came out to be the overall best for me, with only two of my CF related drugs costing a stinging 40 bucks each, and the rest (oddly enough the most expensive drugs) being as cheap as two bucks each copay, and that was zero deductible. It's all terribly confusing, but thankfully it says if you commit to one plan, you can swap plans next year, so I guess it's not too bad. But i'm still extremely nervous about making the jump.

 

[spicyone18]

I still confused with all this mumble jumble medicare crap, but as what I understand you can switch plans at least once a year if the first one doesn't work as well as you thought. But you have to have signed up for somthing by the 15th. I went to walgreens and they listed all my meds and then printed out what plans covered what. Then from that list I picked which one seemed the cheapest and covered the most. I also have CSHCN supposedly they will cover whatever the PDP wont cover.

 

[Faust]

STILL looking through it all...I have medicare part A and part B, but have never used it. So every month I pay the 80ish bucks or whatever and never used it since 95. I'm trying to find out if I can get a drug plan that is cheap, and covers the meds that I need with a very low - no deductible/low out of pocket expenses to be my prescription D plan through them, then have a regular health care plan also to just take care of whatever medicare won't take care of. I will call them tomorrow to find out for sure. While all the info is there for me to read, i'm not 100% clear on 50% of it. I can only imagine how bad some real old people are about this who aren't all clear in the head.

 

[anonymous]

I have been a pharmacy tech for about ten years now. We deliver meds to the elderly etc..., and I have been trying to explain this to them. It is so very confusing. There is a website that you can go to that list all of the plans. Then you type in the drugs you take now, and those you may one day take and see who pays for what. I am sorry but I can't for the life of me remember part of the address. It's early yet <img src="i/expressions/face-icon-small-smile.gif" border="0"> Anyway, I won't be heading to that job for a day or two, but I will get you the info. You may want to try just googling 'list all medicare plans' etc...

I'm sorry this post was of no use. But, I will try to get that info to you soon!
<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[anonymous]

First sorry for my ignorance... I currently have not signed up for Medicare as I have always had really good insurance through my job. That said, I am thinking about going to disability in the next 6 months to focus on my health and will probably need Medicare in the future, possibly during a Tx I guess. I saw something on the news with our president telling people to sign up for the drug plan now. Is this something I should do now, or by waiting another few months am I risking the premiums going up or not having access to a perscription drug program in the future when I may need Medicare?

 

[marianne]

I am a little confused. Do you have to be on dissability or Medicaid to enroll in one of these? I currently have insurance, but it does not cover any prescriptions. Would I qualify for Medicare part D if I don't currently have Medicare, Medicaid or Dissability?
Thanks

 

[JazzysMom]

You must be disabled or retired to be eligilbe for Medicare. After being disabiled 2 years your Medicare Part A becomes active & you have the option of SIgning up for Part B & now Part D. To answer the original ???....I did not sign up for a Medicare Part D plan. I have excellent insurance thrumy husband for meds. Even with my copays its less then the premiums &/or copays I would have with Medicare. That might change by next year, but for this year I am set.

 

[anonymous]

I helped my parents sign up for Medicare part D at the beg of the year. Honestly, if this is what socialized medicine would look like in our country, I think they may as well kill us all now! It was extremely confusing. Plus, there's very little portability because practically every county in every state has different plans...

My word of caution is to make sure you calculate the cost of the "gap" because most plans have a gap where they don't cover any of the meds. Make sure you add in the gap to the cost of your meds when comparing plans. In our county, there was only ONE carrier that had ONE plan that does NOT have the gap. It is of course, the most expensive plan - $67/month. When I originally calculated the costs for my parents, the pricey plan w/no gap cost the least overall for my mom when you considered the costs of the meds. A cheaper plan with a gap originally worked best for my dad but then he was diagnosed with COPD (not a smoker, did smoke for a few years over 25 years ago but his COPD seems to be from airway remodeling from his asthma and scar tissue from the TB he had as a child plus the damage from the smoking. If he didn't have asthma and TB he wouldn't have COPD now regardless of the smoking). Anyway, once he was diagnosed and we recalculated the costs with his new meds added in, the pricey plan also ended up being cheapest overall for him, too.

All this just to say, be really careful when you calculate, don't forget about the "gap", and be sure to calculate the costs of the drugs or copays in when estimating your costs. The gap is usually from $2,250 in drug costs to $3,600. During that period, you pay 100% of the cost of the drug, so you'd pay $1,350 just during the gap if your policy has a gap. It is very hard to pick the best plan because you honestly aren't comparing apples to apples - the plans are soooo different.

Oh, and to the poster who asked if you qualify for medicare part D if you're not on disability or medicare, no you don't.

 

[JustDucky]

Hi all...I signed up for a medicare part D plan in Feb after months of investigating and calling the companies, which by the way, I highly recommend. In my state alone, there were 47 companies to choose from!! Made for some long computer hours and phone calls. Also, to help you out, go to Medicare.gov. As for my choice, I picked the Humana Complete plan, costs about $40 bucks a month but the nice thing about this plan is that it covers through the "gap" as well, even covers both generics and brand names...For those who don't know, the gap is where you have to pay 100% of your med costs (that is if you don't have other help like Medicaid) until you reach an out of pocket amount of something like $3600 until you hit what is called catostrophic coverage and then drug coverage kicks in again. This paragraph is directly from that site:

"...Coverage Gap
If you have high drug costs, you may consider which plans offer additional coverage until you spend $3,600 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This "gap" in coverage is generally above $2,250 in total drug costs until you spend $3,600 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug..." (source: Medicare.gov site, <a target=_blank class=ftalternatingbarlinklarge href="http://www.medicare.gov/pdp-things-to-consider.asp">Things to consider</a>


Anyhow, when was doing my research, I went to Humana's site and plugged in my meds that I take into their formulary, which you all know as Cf'ers are pretty damn expensive, so I wanted to make sure all of my meds were covered (and they are) and how much my copays would be. At this point, even since February, I have reached the "gap" stage, it is nice to know that I have coverage through that. Humana even covered my IV's...the meds, not the supplies though (been writing letters to the powers that be to coordinate Medicare parts B and D so that IV therapy would be completely affordable and covered. Part B deals with the durable medical equipment, which would include the needles, dressing kits and any other materials associated with IVT)
Everyone's choice is personal, just research your options until you are completely satisfied with that company. And yes, I do believe you can change your mind once as far as companies go. To those who are still trying to figure out which one to chose, good luck. For those who have insurance through their spouses, please check with their policy before enrolling...chances are that your spouse has better coverage than part D...(no gaps, better IV coverage etc...) Hope this has helped and not confused anyone....
Hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[NoExcuses]

go to www.medicare.gov and you can search to see which plans cover your meds

 

[anonymous]

Hey, Jenn, the Humana Complete plan is the same one I signed my parents up. Their copays are 10/30/60 with almost all of their drugs at the $30, brand-name formulary price. It, too, has no GAP but costs $67/month (per person). We're in IN. Just out of curiosity, what state are you in? I find it interesting that even when the same basic plans are offered in different areas, the monthly premiums are different. Interesting.

 

[Faust]

Heres what pisses me off. My moms insurance is united health care, and totally rocks. Real cheap and covers everything. The one through my work is also united health care, but sucks.

 

[spicyone18]

Why/how are they different?

 

[Faust]

I let my mom look over my works one (shes a director of human resources through a large company so knows all about this crap) and said it was quite bad for me, and had a relatively low "ceiling" with regards to how much I can go through $$ wise regarding drugs and so forth. She recommended I get the medicare stuff goin, and also get the stuff from work, but I don't make a ton of cash at work (I view it as just a stepping stone to get more experience), so i'm trying to limit what comes out as it is.


I already pay the 88 bucks for medicare and have been paying that for a long time. I want to keep any additional medical/perscription drug coverage totalled to not much more than 100 bucks taken out a month.

 

[NoExcuses]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>SeanDavis</b></i>

Heres what pisses me off. My moms insurance is united health care, and totally rocks. Real cheap and covers everything. The one through my work is also united health care, but sucks.</end quote></div>

If you get insurance through work, your company contracts out with the insurance company for benefits.

It has nothing to do with the "name" of the insurance company. Has everything to do with how much coverage your company pays for.

 

[JustDucky]

Hey anon, I live in NY...it is odd that your poor mom and dad pay so much. Wow! I looked on my deductions on my SSDI, it actually is $47 but still.....I wonder why it is so expensive in other states..good grief!!! Maybe it's the branch that exists there, who knows or some polital reason. That's something I have gotta try and find out out of curiosity more than anything. Either way, it isn't fair at all. In my case, it was definitely the best choice as some of my meds can be generic, of course some can't like my enzymes but paying $500+ a month out of pocket without the insurance would really bite. My doc has been a godsend too, she belongs to a federally funded office which by the way offers prescription help, so she gets my Nexium, Singulair and Flovent for me practically for free. If I run out, she gives me enough samples to last months...I don't kid. Like my Synthroid, she always has tons of that sitting around in her office so she gives a good deal to me. I owe her tremendously, the think is that she does this to just about all of her Medicare patients to help them with costs. If I find a good reason why ins. companies vary so much in price when it is the same exact plan in every respect, I will be sure to post it.
Hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">