Medicare again.............decisions, decisions......

16 years ago

With the help I got here recently, I decided on the Blue Cross/Blue Shield Medigap policy. Now I have to figure out what to do about a prescription drug plan.

I've pretty much decided on one of the ones offered by Blue Cross. It has a monthly payment of $27.70 and no deductible. The thing is, should I sign up now or wait?

I'm not on any medications. This is not an accident . . . I take some credit for it because I put quite a bit of effort into keeping my cholesterol, triglycerides, and blood sugar in line despite a strong family history of heart disease and diabetes. However, I know things can happen, and my situation could change at any time for whatever reason.

It would be nice if Medicare recipients could simply choose to enroll later if need be. But our government punishes good self-care by imposing a penalty on those who do not enroll in a prescription drug plan as soon as they quality to do so. Here's the arithmetic:

The penalty is calculated by multiplying 28Â¢ by the number of months you wait before enrolling. So if I were to wait, say, three years, my penalty would be .28 x 36, or $10.08. This amount would be added to my premium every month. Using that same calculation, I would pay an additional $121 a year for coverage. If I wait longer than three years, the penalty goes up, of course. If I wait five years, the penalty is almost $17 a month. And that's by today's calculations . . . who knows how much the numbers will rise in five years??

I realize I could get hit with the need for a prescription drug on a temporary basisÂlike an antibiotic. Some of these can be quite expensive. But a year's worth of premiums to insure against that comes to $332. I'm dizzy trying to figure out the risk-reward ratio here.

I wonder what the government's rationale is for charging a penalty for those who wait?

Any thoughts on my dilemma? Thanks!

Susan

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Comments (8)

patti43
16 years ago
I'm facing the same problem, Susan. I'll be 65 in October but not taking any prescriptions right now. They sure make it complicated, don't they?
mariend
16 years ago
I think that is what my sister in law is on, and so far the prescriptions are paid in full. Think of it as a preventative pill--you may never need it but if for some reason you do, it is there. Like car insurance, house insurance etc.
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First, Alisande I believe if you look on the back of your Medicare EOB you will find the information about APPEALING their denial of coverage. It should be there .... somewhere. Denials are always appealable, usually there are 2 levels of appeal. So, exercise your RIGHT TO APPEAL. Write a letter & explain your situation. If that fails, enlist your chiro to write an appeal for a second review. Medicare doesn't "think". They have guidelines for coverage. A low level clerk of a computer program screens outs targeted types of claims that have traditionally been abused. That system isn't perfect. But if you don't appeal something that is legitimate, or *possibly* legitimate, they have no way of knowing that they've snagged something in error. The error could even be in how the diagnosis &/or treatment was coded on the bill by the chiro's staff. Chiro has its place & can be a helpful adjunct for treatment. But it does have quite a history of "hocus-pocus" & of duping people &/or insurance/Medicare. I am aware that there are those "lonely sorts" who ... truth be known... use a chiro visit as somewhat of a social outlet. Why should Medicare or insurance pay for clearly unnecessary treatments. Preventive chiro generally isn't in the same league as preventative in traditional medicine. I guess we can look forward to more of same as the government inserts itself even further into our healthcare delivery system. Gibby, I don't understand your statement. At.all. Medicare IS & has ALWAYS been a gov't run healthcare system. I want my tax $ spent as wisely as possible. If there is fraud/abuse, weed it out. And of course, they certainly can't afford to cover absolutely everything on the healthcare menu.
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monica_pa Grieves
16 years ago
Blue Cross Personal Choice 65 is the best plan...and take the perscription benefit.
alisande
Original Author
16 years ago
Is that a Medicare replacement (Medicare Advantage) plan, Monica? Do you have it? I haven't heard of that one, so whichever kind it is I'm guessing it's not available in my county. Not everything is.

The Medicare replacement plans look tempting, but I've heard several complaints about them.

Complicated, Patti? I'll say! It's almost physically dizzying. I've been reading through the materials all day. Oy!
santacltr2
16 years ago
I did this earlier in the year. If you call the number of the one's you are interested in they will send some one to explain them to you. The information they explained and left made more sense than what I read in the Medicare and you book or the website. I will tell you that I never had to take medicine up until one day I was told I had MS, I could no longer work so joining one was not an option for me I had to my medicine is very expensive. In this life you never know from one day to the next what is going to happen to you. I'm glad I got the extra coverage besides the medicare.
okwriter
16 years ago
Susan,

My folks have been on Medicare for years but had to make the dreaded "prescription" choice a few years ago. My dad takes many meds--my mom only takes one.

My niece spent two days making phone calls for them and found that they were eligible for some government program that pays half of their premiums. That was GREAT! (Check to see if you are eligible...I was surprised they were!) Then my niece ended up signing them up with AARPs prescription program.

My dad's meds would run about $4,000/year but cost only about $400. Many times when he is on a short-term antibiotic, his RX is less than a dollar. :-)

My mom's meds would run about $1,000/year but cost only about $100.

I think their premiums are around $15/month each.
bigfoot_liz
16 years ago
if i were you i'd probably get into a program this yr. this linked up report is predicting SS and medicaid/medicare insolvency and future cuts backs. i am shocked this hasn't made much news outside the financial world where it is a big deal. many financial experts are predicting serious problems w/in 7 yrs to these programs so you'd better get what you can now. no doubt the script program will be going away sooner than later...when henry paulson speaks everyone should take note. ~ liz

Here is a link that might be useful: insolvency of SS & medicaid/medicare
alisande
Original Author
16 years ago
Good point, Liz! Also, I just read (either on the Medicare website or the AARP website) that any penalty you earn by waiting will go up every year after you finally enroll.

Okay, enroll I will.

Thanks, all!

Medicare again.............decisions, decisions......

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patti43

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Medicare again.............decisions, decisions......

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