Medicare Part D

18 years ago

For the past few weeks, I've been helping a couple of neighbors and an aunt try to pick which prescription drug program they want/need. This is the most confusing thing I've dealt with in a long while. I worked for the federal government for 25 years and can read bureaucratese pretty well, but this one is a real stinker. We figured out the best one for my aunt, going by the Medicare website and the booklets we had gotten, comparing costs of meds, donut hole coverage, etc. One down, two to go! This certainly isn't one size fits all or even close. We have it narrowed down some for the other two. I'm sending one to her doctor to see if she can use generic prescriptions instead of the brand names he gives her samples of, when he has them. Both were in a medical management project that really helped them with expenses and was very good. That's going by the wayside on 12/31/05, so they need to get one picked real quick. I hope that there's someone around to help me when I have to select one. I just wish that the representatives who passed this thing had to figure it out for themselves. I'm sure if that were the case, it would be much less bum-fuzzling, would not have a donut hole, and Medicare could get contracts for the drugs, like the VA does. Good luck to anyone who's trying to do this.

Sort by:Oldest

Comments (15)

grittymitts
18 years ago
Pathetic, ain't it? According to Medicare's own staff, when plan is chosen it can be changed only once a year, however, the drug provider can change their prices every 30 days!

What is one supposed to do if Dr. prescribes a totally new Rx which is NOT on your drug provider's list???

Expect premiums to go up every year too.

Suzi
linda_tx8
18 years ago
Those lists don't have very many drugs on them, do they? In the real world there's hundreds of thousands of drugs, even going by the generic names. What are you going to do, tell the doctor "no, that's not on my list" and have him prescribe something for arthritis when you need something for acid reflux? Something's rotten in Denmark (or the USA), I think.
Related Discussions
Medicare Part D Plan -- Big Increases
Q
Comments (12)
>>Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? >> I've read several articles (must have been either AARP, NYTimes or WSJournal) that say that 80% of Medicare's budget is spent on 20% of insureds - the very frail and dying. But we should remember, this is true the world over. It's merely a question of who pays for it and for how long. Nobody anywhere wants to be the one who says to the family, "the plug has to be pulled because we're not going to pay for it any longer." Now, the ridiculous claim of "Medicare Death Panels" has been thoroughly debunked already, so no need to go over that ground again. Factually, ALL insurance companies globally have a Chief Medical Examiner whose job it is to approve or disallow payment for expensive treatments. That's what they do - balancing medical guidelines, doctor preferences, patient coverage, and company profit (no, company profit is not always paramount; but is an important factor in overall portfolio risk management). In the absence of clear, specific legal forms by the patient as to how end-of-life treatment is handled, the medical profession by its nature will do everything to save you from dying. Palliative care and pain management is only beginning to make an impact on their thinking, but again - without clear legal guidelines as to what the patient wants, ESPECIALLY if those instructions are contrary to what the family expresses - the doctors will do everything possible. And these days, "everything possible" is usually expensive with little regards to the quality of life. That's why it's absolutely critical to talk about what you want with not only your spouse, but your doctor and your family. Then put it in writing! BTW, I should amend my posting about the 'wellness' exam of the Healthcare Reform Bill. The NYTimes did an absolutely wonderful, comprehensive piece on this subject - what is covered, what is not, and why some consumers are surprised when they receive a bill they didn't expect. We have to remember, a physical exam for a 16-yr-old is going to be different than that of a 50-yr-old, which is again different than the exam for a 70-yr-old with severe medical issues. As it stands now, with the government gradually clarifying what is paid for and what is not, the two key things to note are: most of these don't begin until next year, and in areas where it's still 'gray' without legal definition, the insurers are allowed to make their own decisions about what is covered and what is not. (Access to the NYTimes is limited to 20 free articles/mo.) Preventing Sickness, With Plenty of Red Tape NY TImes September 19, 2011 (Excerpt) "Prevention has never been the cornerstone of American medicine. In this country, we tend to go to the doctor only when something is wrong, a habit long bemoaned by researchers and medical groups. The federal government aims to change that, and soon. Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms. Just last month, the Department of Health and Human Services released additional guidelines specifying fully covered preventive services for women. Mammograms, cervical cancer screening and other services already had been mandated; the new recommendations expand that list to include screenings for human papillomavirus (which causes cervical cancer) and domestic abuse, and reimbursement and counseling for contraceptives. These services are to be fully covered by most insurance plans beginning in August 2012. Despite these new regulations, there's still a lot of ambiguity - and not just among consumers - about what qualifies as preventive care and what insurers are obligated to pay for. "I've seen so much confusion among patients and doctors alike trying to figure out what's paid for and what isn't," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and a primary care doctor. " Here is a link that might be useful: Full Article: Preventing Sickness
...See More
Medicare Part D Question
Q
Comments (6)
This is why I am so appreciative of my Medigap policy. It pays any and all deductibles. Medicare Advantage plans are the ones that include medical (so you don't have Original Medicare) and prescription drugs. My Medigap policy is through the California Public Employee Retirement System (CalPERS) for State Retirees, so I have Original Medicare for hospitalization and medical, and the Medigap policy picks up the deductibles and is a second, supplemental, insurance for both. With this coverage I pay zero (the State even reimburses me for the monthly Medicare premium and also pays the monthly Medigap policy premium). The Medigap policy also includes prescription drug coverage (PSP). The PSP has no deductible, just co-pays (e.g., no more than $5 for a 34-day supply for a generic; no more than $10 for a 90-day supply of a generic). The great thing is that the PSP still pays for medications through what would otherwise be the Coverage Gap Stage (a/k/a the "donut hole"). All I would have to pay is the same co-pay as during the Initial Coverage Stage. When I last filled my high blood pressure medications, my co-pay on one of them was LOWER through my Part D coverage (it was $8) than it was when I was on the "basic" insurance as an active state employee (when I paid $10). ChiSue, didn't you say before that you have a Medicare Advantage Plan? Are you thinking of changing to Original Medicare with a separate Plan D?
...See More
Misunderstanding Medicare Part D "Annual Costs"
Q
Comments (2)
I figured it out. The answer may help someone else. The annual cost is less than the premium plus the deductible because DH won't use up the whole $400 deductible paying for his two daily meds under this plan. (Of course he will have some additional prescriptions, but it's not possible to know what those meds will be.) With this plan his meds total $316/year. Meds @ $316 + Premiums @ $270 = $586/year. It still seems 'too good to be true' because other plans figure his meds costing much more than this plan, even using those plans' preferred pharmacies. (This plan uses Walgreens.) *I* am still stuck with the Never-To-Be-Generic Advair. I will pay an insurance company $350/year for the privilege of paying $850/year for the Advair. (Retail $4000/year.) Minimum medication costs for us will total $1786. We have another $2500 for Medicare Part B. Then there are our ($2100 deductible) Medicare supplement policies...another $2000. We're over $6000 before other Out Of Pocket medical and medication expenses. The total will be more than I budget for food.
...See More
Medicare Part D: Which drug plan are you happy with?
Q
Comments (13)
We have access to licensed health insurance advisers (brokers) through my DH's former employer. After I ran the numbers on the Medicare Part D site, I called these people to verify my understanding of the two different plans I had selected for us. They could tell me nothing about the one I selected for myself because...it's not one that they 'broker'. So -- I wouldn't rely on just what one broker offers. Mutual of Omaha is new in our area in 2020. I enrolled in their Value Part D plan because it was among the cheapest when combining the cost of the premium and the cost of my meds. (Advair is my big expense at $450 retail per month.) I'm OK with their preferred pharmacy being CVS. I'll pay $22.80/month premium, and a total of $1232/month average out of pocket including known meds. (My 2019 Part D plan with United was completely overpriced for 2020 when I ran the numbers on the Medicare guide.) My 2020 Part D card arrived in the mail within two weeks of our October enrollment sign-ups; impressive. DH has so few meds that he rarely exceeds the deductible, so a low premium is a goal for him. (Nearly all Part D plans in our area have a $435 deductible in 2020.) He'll have WellCare Select Part D for 2020. Premium is $15.50/month; total with meds averages $249/month. (He also has to pay an $8 penalty in addition to this, dating from when he did not take a Part D plan the first year it was required.) We're OK with this CVS plan. His Part D card has yet to arrive -- despite two letters confirming enrollment; not impressive. We choose to have premiums paid by deduction from our Soc. Sec. benefits. No coupons. No direct withdrawal from bank account.
...See More
mikeandbarb
18 years ago
It is real scary to think that they have to make it so hard on the elderly just to be taken care of. Just another way to stick it to them. There is no need to make it hard. I'm only 50 and have problems with concentrating on paper work from the insurance companies they don't put it in layman terms. They have to put words in there that I myself don't even think existed why who ever heard of the word's blank blank de blank ya know what I mean.
I feel sorry for the elderly and not looking forward to getting there myself.

GL, Help us
rick_mcdaniel
16 years ago
That part has been criticized every which way to Sunday, but you have no other options, save choosing to not take medications, and suffering whatever health consequences are involved.

The elderly are simply considered a nuisance, in the US. Most people couldn't care less.
rick_mcdaniel
14 years ago
Well folks, the congress just passed the health care bill.....in spite of the fact they haven't figured out how to pay for it yet.....so you can expect medicare to get much worse, as well as medical care to get much worse.

We will now have to deal with all the problems that the NHS in the UK deals with......one of which is denial of care to the elderly.
carrie751
14 years ago
Yeah, Rick, if you are over 59, you can just hang it up.
rick_mcdaniel
14 years ago
Remember the movie "Logan's Run"? We are headed that way.
little_dani
14 years ago
Well, I was going to say I may not even file for it when I am 65 next year. So much trouble and confusion.

It doesn't matter anyway. If this "Health care" bill gets signed, Mr. O is going to put me in a room and not feed me. No water, no medications, no nothing. NO, "she's old, not worth the trouble".

I really resent the fact that they can't be bothered to even read the bills which will cause me to accept a shortened life before they vote for them. The only way to stop it is to raise holy hell!

Janie
carrie751
14 years ago
Noticed that Mayo Clinic has come out AGAINST the bill ... saying it will do much more harm than good.
clayridden
14 years ago
Here is a statement from Mayo

Here is a link that might be useful: mayo
linda_tx8
13 years ago
Ooh, what a list! I'm SO glad I don't have to do that. In a few years, I'll sign up with A & B. My primary, CHAMPVA, will then become my secondary, paying after Medicare (after the small CHAMPVA deductible is met). Medications I'll get free if I get them through Meds by Mail. I believe I WILL have to pay a percent of the bill if I can't wait and have to go to a pharmacy.
carrie751
13 years ago
Linda, please explain ........what is A and B????
carrie751
13 years ago
I was so amazed by your "free meds" I totally forgot the name of the thread and it's relation to SS...........
linda_tx8
11 years ago
Hmm! I hadn't seen this in a while. A and B, of course, is Medicare, which I do have as of this year. One part is hospital care and the other (the one you pay for) is doctors, tests, etc. DH is a disabled veteran with full VA benefits, that's why I have the ChampVA as secondary coverage and the Meds by Mail program. Very few veterans get full VA benefits and so few dependants of veterans can use ChampVA. Yes, free meds from their mail order program, but when I need a new medication quickly and have to go to a pharmacy I do pay 25% out of pocket. Meds by Mail is VERY slow for a new prescription to be sent out. But I'm very lucky to have that.
honeybunny2 Fox
11 years ago
I went on medicare on 11-01-12. They would not fill my benicar medicine, until they spoke to the doctor to see why I needed it. It was during the holidays, and he was not going to be in the office until Monday. I went for 4 days without medication, until they could speak with him. I told them, I have been taking it since Dec 1996 when I had my bypass surgery, didn't make a diffrence. They told me that if I needed the medication, I could pay $147 and buy it. They will not let me get a 90 day supply, I have to go every 30 days now and get medication. I can no longer get it at HEB ( they are not approved by medicare, and it cost more to get medication there) I have to get it at CVS, Walgreens, or Wal-Mart. Yep I can tell you all about medicare part D. The summary they sent said I paid $81 for the benicar, and they paid $51 for a 30 day supply. I only paid $5 for it. I am not even going to question them about that. Barbra

Medicare Part D

Comments (15)

grittymitts

linda_tx8

Related Discussions

mikeandbarb

rick_mcdaniel

rick_mcdaniel

carrie751

rick_mcdaniel

little_dani

carrie751

clayridden

linda_tx8

carrie751

carrie751

linda_tx8

honeybunny2 Fox

COMPANY

BUSINESS SERVICES

GET HELP

CONNECT WITH US