Or perhaps one fine day we'll have Universal Health Care and it won't be such a burden on the vast majority of us!

Well, that's crappy news. I also heard that Medicare is changing its policy on chiropractic. They don't want people going for preventive treatment, only to fix an "event." Nice, huh?

We opted not to take Medicare part D...just isn't worth it.

Instead, we are with a private insurer..it's way cheaper.

If you have a very expensive medicine, you can contact the company for help also.

Have you checked into your state's help? For qualifying seniors in our state, the STATE pays the entire medicare part D premium, AND picks up most of the co-pay for prescriptions--my mom and aunt paid only $5 per prescription for each 90 day supply of each drug they took. There was an income limit, of course, to qualify, but if you did qualify and applied for the program, you also got a grant towards your electric bill--in my mom's case, utilities were included in her rent, so she recieved a check. For aunt, the grant went to the electric company as a credit on her bill and usually covered 6-8 months of her electric each year.

I don't know if all states offer that kind of help, but doesn't hurt to ask.

Marie -- We aren't poor enough to qualify for 'help'...yet!

Monica -- Are you refering to a comprehensive policy that is *instead* of Medicare A + B + D? We have A + B + D and an Aetna supplemental. Your plan might be better for my DH at this point, but I think mine is OK. Could you expand on your coverage, please?

My plan for 2012 is $410/yr. + Advair @ $1020/yr. = $1430/yr. Retail for my Advair has been $3330/yr., so I'm paying about 45% of what my med would cost retail. (The Advair retail increased from around $500/90 day supply in January 2011 to the currrent $832/90 days.)

EEK! I've also discovered that Medicare has raised each of our three (combined) drugs by a tier from what they were this year. That means DH's Tier 4 must now be paid at 33% of retail.

Medicare D is a bad thing, if you ask me. (And I used to work for Social Security). I have better (creditable) drug coverage thru my husband.

I dont agree with how they handle medicare,not that it matters at all,When I started dialysis they told me 75.00 a quarter,we all get same thing in there.all of a sudden it went up to 800 I said wow whats this financial lady said its based on income,you are paying for the ones that cant..Were getting same treatment???

Monica -- Are you refering to a comprehensive policy that is *instead* of Medicare A + B + D?

No and never. They are more like HMOs.

I have standard Medicare with a Medigap policy from Banker's Fidelity and a prescription drug policy from AARP.

Total cost for Medicare and Medigap policies is $260 a month. I pay NOTHING,NADA else. All my bills, for Dr visits, testing and hospital stays - all paid.
I do NOT have to go through a "family doctor" to get a referral to see any of my specialists. I am free to see any doctor.

With a policy like this, no co-pays, I know Jan 1 what my medical costs for the year will be.
For prescriptions, the monthly premium is $32. Frankly, I use all generics, and all the policy does for me is a discounted price on higher tier non-generics.

Is the $260 what you are currently paying or what you will be paying with the increases? I'm about to go on Medicare the 1st of Dec and am gathering all the info I can get to choose the right Medigap and Rx plan etc. Right now that $260 sounds like music to my ears, as I am paying $658/ mo for medical insurance as an individual.

Monica, I have the AARP prescription drug coverage, too, and I think that is Medicare Part D. Here's how the Medicare website defines Medicare Part D:

To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

When I enrolled in Medicare I was told it was essential that I enroll in one of the Part D programs; otherwise, I'd be heavily penalized if I wanted to enroll later on. I started out with the Blue Cross/Blue Shield prescription drug coverage, but switched to the AARP policy when the BC/BS rates took a big jump.

I have been all over the entire system regarding Medicare Part D...with some successes...but the end result is an AARP/United Healthcare meds plan that has a penalty [albeit reduced because I challenged it] that as some of you have recently discovered, is going to go up upon renewal. That fact added fuel to my already inflamed opinion about forced insurance coverage which had previously been heightened by the fact that I don't even use the required policy. I have no need for this forced coverage yet it's been costing me $44.50/mo. for the past year. So...when I learned of the hike in the premium I got back on my little telephone and started making calls to all the applicable parties. Medicare accepts/approves of Humana [Walmart] Plan D coverage and to my delight...I can replace my existing coverage for about half of what it's costing me now. Perhaps it will be the same for many of you. It's worth a phone call.

HTH........Anne

Good to know, Anne--I'll check it out. I was angry about being forced to have prescription insurance because I don't take any meds regularly. However, when I got shingles and needed an expensive anti-viral, I was glad I didn't have to pay for all of it. And I felt the same when I was prescribed ridiculously pricey eye drops before my cataract surgery.

That said, I'm certain I've taken a significant loss on three years of insurance premiums.

Susan...I've had to take a few drugs this past year, too...but nothing that wasn't covered by my regular medicare coverage. That's the thing that Medicare doesn't regularly share with us poor servants. Medicare...all unto itself...covers the price of a long list of meds that they don't broadcast to the public. As a matter of fact...many of the heavy chemo drugs that my hubby took during his unsuccessful battle with pancreatic cancer were covered by regular Medicare. My diabetic test strips are covered by regular Medicare. If you can find a copy of the regular Medicare formulary [try Googling for it.] you'll be shocked at how many of your occasional meds are covered. I was. sigh And...that's one of the reasons I'm still seething about this forced coverage "bit".

Susan....Found this info on a search but didn't find the complete formulary list. If you have the 2011 Medicare book, it may be part of your booklet. Everything differs from State to State so my info won't do you much good. Sorry.

What are Medicare Part B Covered Drugs? Medicare Part B covered drugs include a limited number of prescription drugs such as those you get in a hospital outpatient department under certain circumstances, injected drugs you get in a doctor's office, certain oral cancer drugs, and drugs used with some types of durable medical equipment (like a nebulizer or infusion pump). Medicare Part B drugs include, but are not limited to, the following types of drugs.

Durable Medical Equipment (DME) Supply Drugs such as: nebulizers, external or implantable pumps.
Hemophilia clotting factors: Self-administered clotting factors if you have hemophilia.
Immunosuppressive Drugs: Immunosuppressive drug therapy a beneficiary has received from a Medicare-covered organ transplant.
Oral Anti-Cancer and Anti-Nausea Drugs.
Pneumococcal and Hepatitis B vaccines and administration.
For additional information on Medicare Part B covered drugs, refer to your Summary of Benefits or Evidence of Coverage

Te financial woman at dialysis told me to stay with bluesheild instead of medicares,its better so I did.

Thanks, Anne. My Medicare supplement (BC/BS) has recently informed me that they are looking into claims I made in March of 2010. I don't know what the claims involved, but I can find out. In any case, this is not encouraging!

As I understand it, AARP has lent its' name/endorsement to United Health Care -- for a healthy fee, I would hope! There may be other AARP tie in's with other insurers.

DH and I have had the same "AARP" United Health Care Medicare Part D plans for 2011. I paid $30.40/mo. for this in 2011. The same plan will cost me $34.20/mo. in 2012.

Monica -- It seems that you DO have Medicare Part D. It's the $32/mo. plan you mentioned. If your meds are all generic, that's why your costs are less than mine. My plan costs about the same as yours, but my Advair is an expensive non-generic. My total annual costs for my plan plus my Advair will run $1490 in 2012 -- about 45% of the retail cost of the Advair, $3330.

DH and I also have Medigap insurance with Aetna through his former employer. That's was $95/mo. for both of us in 2011. It pays 100% of any medical costs after Medicare Part B has paid its' portion.

For 2011 the insurance portion for us both added to $4272:

Medicare Part B for two = $2314

Medigap for two = $1140

Medicare Part D for two = $818

Our daily meds will cost us $4404 in 2012:

My daily med will cost me $1080 in 2012. (Retail $3330)

My DH's daily meds will cost him $3324 in 2012. (Retail $8267) He will be in the Part D 'gap' before May, but will never make it to 'beyond the gap' -- Out of Pocket costs of $4700. He'll pay 50% of the retail cost of his non-generics for eight months of the year, but will never reach the 'catastrophic coverage stage' where you pay only 5%.

All insurance plans + cost of our drugs = $8631. (More than I budget for food!)

One problem is the uncontroled cost of the drugs. Why should Advair, on the market since 2002, cost $500 for a 90-day supply in January 2011 and $800 as of March 2011. It doesn't help that the US permits advertising for prescription drugs. Only the US and New Zealand permit this.

I know our total will rise further. We haven't received the 2012 health insurance package from DH's former employer yet.

WAIT! I forgot the *dental* expenses...$4200 so far this year.

This is so timely for me. I'll go on Medicare in Dec, if the government isn't bankrupt by then. I plan to get an AARP Medigap plan, friends have it for yrs and are very pleased. I have been paying a substantial amt for BC/BS for yrs as an individual, and I'm not happy. Every yr the premiums go way up and so do the deductibles, their customer service leaves a lot to be desired too. Can't wait to dump them. I'm hoping that the Walmart/Humana Part D will work for me, unless I would need to be on Humana Medigap to get their part D coverage. At least I know enough to ask the question now.

Mare...$260 is what I am paying now. I have very big medical bills, and a year ago, I was paying Blue Cross over $900/mo - with co-pays for Dr's visits, etc.
So, it would have to be a real big jump to make me feel cheated.

I just got the package for the AARP Part D for next year.
The increase is $2.40/mo.
Hardly a catastrophe.

Before you sign up for any plan, check for a free HICAP program in your area. It's a federal program that will help evaluate your Rxs and available plans that are best for you.

Here is a link that might be useful: HICAP services

mare -- Most of the Humana plans in my area are HMO plans. Is that what yours are and/or what you want?

Do you have a Senior Center nearby? Ours has a staffer who helped explain the finer points of the Medigap and Part D plans licensed in our state when I became eligible for Medicare. I've yet to receive the Medicare booklet listing Part D services licensed in Illinois for 2012, so I haven't compared our current Part D plan with others.

Look at the cost of the premiums for a plan, and at what you will pay for your meds under that plan. Add the deductible to the total if there is one. Inexpensive-sounding co-pays often come with expensive premiums, or the reverse.

I like to figure total costs of a plan on an annual basis, rather than the monthly fees usually quoted. That $35/mo doesn't seem like much, but $420 has more impact. If there's a deductible, that adds to the total.

Currently my meds are all generic and the cost is low. I don't plan to enroll in an HMO type medigap. I would enroll in a Pard D plan now, in the event that I am prescribed a costly Rx in the future. Things can change so quickly. From what I know, if I don't enroll in a Part D now and do so in the future the monthly premium will be higher. In my earlier post I was referring to Anne Ct's post that said "Medicare accepts/approves of Humana [Walmart] Plan D coverage and to my delight...I can replace my existing coverage for about half of what it's costing me now. Perhaps it will be the same for many of you. It's worth a phone call." I'm hoping that I don't have to be enrolled in a Humana medigap to take advantage of the Humana/Walmart Part D plan at a lower cost than others I've seen.

Good thing I stopped by. ;-) No, Mare. It's my understanding from Medicare that Humana Plan D is a stand alone policy. You need do nothing but apply when the time comes. My supplemental coverage is with United Healthcare through AARP and provided it doesn't escalate beyond my pocketbook...I don't plan on ditching it for any other coverage. It's been extremely satisfactory in all respects.

HTH

Anne

Thanks Anne, The AARP/United Health route is what I planning also. My MIL had it, she liked it and I have a couple of very close friends who have it for several yrs, and are very pleased. They went with the AARP Part D and are paying somewhere around $34/mo for it. I'm glad to have a cheaper option. Right now I really don't need it, but you never know what the future holds. I have heard horror stories about the price of some meds. $14.40/mo is a small price to pay for peace of mind.

Anne & Mare -- I'm looking at 2011 programs because I don't have the 2012 Medicare handbook yet.

IF you don't require help with ANY prescriptions, nor any expensive ones, the Humana-Walmart Part D @ $14.80/mo. may be a good deal. It isn't for us, because our three non-generics would cost us 50% of retail under that plan, and there's a $310 deductible.

The plan would cost me $177.60/yr. plus the deductible of $310 = $487.60. I'd also be paying 50% of the retail cost of my Advair ($3330), $1665. The Humana-Walmart Plan D would cost me $2152.60/yr. It would cost my DH much more, in part because it offers NO discount during the gap, which he is in by May 1.

The AARP-United Health Care Part D @$34/mo. with no deductible and lower co-pays is better for us. I have a lower co-pay for meds all year. DH's co-pay is lower for 4 mos. and goes to 50% for the last 8 mos. of the year, while he is in the gap.

Anne -- Do I understand that you have NO penalty with with the Humana-Walmart plan? You'll pay $14.80/mo.?

Sorry if I'm boring others, going on about this...

Nope, Sue. I wish I could say that I'm free of that albatross...but the governmental arm would only reduce the penalty after my impassioned plea. Not erase it. But I'm still hopeful that the Federal court system will see the error of the government's ways and rule it to be an illegal act. Two courts have ruled thus and I have a feeling that the third...and highest court...may do the same. But, currently, alas...I must still add a penalty to that $14.80/mo. And...considering that I have no need for the plan to begin with...I find this whole experience extremely distasteful...as well as costly at a time in my life when I can least afford it.

Anne

I'm totally confused. Penalties, gaps, tiers, deductibles, co-pays. I know what all these terms mean and I think I understand that if you don't enroll in Part D coverage when you're first eligible, there's a penalty for each month without coverage if and when you do enroll. Seems as if each plan has it's own formulary. I guess I have a lot of reading to do. I may look for someone who can explain it all to me. That's not easy w/o being pressured to enroll in their plan.

It is confusing, Mare...and that's what got me into trouble in the first place. Let me see if I can explain my particular issue to further clarify why I'm being charged a penalty.

When my husband died a few years ago, all my benefits died with him due to an agreement he had made with the PBA long before he even knew me. His decision, unfortunately, was irreversible. Throughout our married life...all contact involving his benefits package had to be made by him even though I was covered under all his plans, therefor I was often left in the dark about what the plan included and who the carriers were.

I was already enrolled in Medicare when he passed and knew that I would have to replace the supplemental policy he'd had for me with BC/BS. I did so immediately. What I didn't know was that I had to replace the Medicare D policy. I had never needed it and had no idea what it was let alone the fact that it existed as part of his benefits package. To make matters worse, the PBA didn't notify me that I had to replace this coverage with a policy of my own choosing.

I went for almost 4 years without realizing that I was in default with Medicare. Fortunately, it was brought to my attention and I applied for a policy but in so doing, I learned that I was going to be penalized for the time that had lapsed between the loss of my husband's coverage for me and my "awakening".

The penalty is based on a formula...1% of the policy monthly premium...times the number of months that one goes without coverage. It was a substantial amount to me and I had limited recourse. I contacted Medicare and filed a challenge. They agreed that I had a basis for my challenge. They reduced the penalty by 12 months...but said ignorance of the law was no excuse and I was left responsible for the remaining month's penalty.

The penalty is NEVER removed. From now until the day I die...I will have that penalty added to whatever Medicare Part D plan I carry. My only hope to be relieved of this burden is that two US high courts agree with me...that the penalty, along with the Federal edict to force people to carry health insurance above and beyond Medicare...is illegal. If the Supreme Court agrees with the two lower courts, the entire forced insurance system will be reversed and my penalty will be dropped. Needless to say, I'm anxiously awaiting their decision.

I hope this gives you a little more info. If you are already enrolled in Medicare, the booklet that they send out every year will give you more information. Or, you can call their office. I've found them to be very helpful...even thought I don't always agree with them. As long as you get Medicare Part D coverage as soon as you're eligible, you shouldn't have to worry about a penalty...unless somewhere along the line you decide to drop the coverage...and then pick it up again at some later date. You'd be penalized for the lapsed coverage time.

HTH

Anne

Anne, you don't have to have Medicare Part D, you can get private drug coverage, or choose not to get any, and hope you will never need a drug that is not generic.
So - you are nor forced.

But, think of any insurance. Waiting until you need any type of insurance before buying it...if everyone did that, you'd have people on their death beds buying million$$ life insurance policies.

Would you wait until you had a car accident to insure your car?, and expect some company to write it? Or wait until you have a house fire to buy property insurance?

In none of the above situations, would any company write you an after the "damage" policy.

Medicare Part D, however will write you a policy, but with a penalty.

The rules for Part D are, and have always been, spelled out right in front.

I also had to take over all the insurance/financial matters when my DH died - he did it all before then. I know how there is so much to do. We all miss some things at that time, and just have to take the responsibility and make it right - if you want to.

Thank God my dh is retired military.We have part A&B and get most of our meds on base,or thru express scripts,where we pay as little as 3.00 up to 9.00 at the most.We use tri care for life,have no co-pays for dr's or surgery,and we use civilian dr's for everything.
Kathi

Mare -- Medicare can walk you through all this. If you are near a Senior Center, they probably have a staffer who is familiar with your area's licensed options. You'll be paying for Medicare Part B, a supplementary medical plan if you WANT one, and a Part D prescription drug plan that you must take or face a penalty later.

If you have few or no expensive prescriptions, a cheap-premium Part D plan should be fine -- like the Humana-Walmart offered @ $14.80/mo. in 2011. If you're not filling prescriptions, you won't pay the plan's deductible ($310 in 2011). Yet, you will still have help if/when you do have an expensive prescription to fill. You'll fund the first $310 of that cost, and the plan will pick up some of the retail cost of your meds -- how much depends on what 'Tier' your med is in. (Generics are usually quite cheap to begin with, and co-pays are small too. Brand name meds are high retail and co-pays are larger.)

If you now take higher-cost prescription meds, look past the cheap-premium plans. Read the formularies of any plan you are interested in to see what portion you will pay for those meds. (Remember to add any deductible to the plan cost.) I find I can figure this better by estimating my total *annual* costs, due the variables.

This is an annual chore for us. Once a company enrolls you, you stay with them unless you initiate a change. There are limited calendar periods when you can change, so choose carefully -- and never assume that the policy you had one year will be best for you the following year! As they say, "Things change," and a person's medical and drug needs do too.

I said earlier that you don't have to take supplemental medical insurance, but we have it. Ours pays *everything* Medicare does not -- not just the 20% that Medicare does not fund...everything! Example: One of my DH's doctors charges more than the Medicare-approved amount for an office visit. Medicare pays about $70 of his bill; our supplemental pays $85. We pay nothing except our premiums for the policy.

Anne, I'm sorry for what you have been thru and the penalty which will continue to be a financial burden. I can understand how that happened to you. A death of one's spouse is so stressful, I've been there. It seems that even my primary MD isn't completely conversant with the nuances of the Part D penalty situation. He is a very caring guy and frequently reviews my meds to be sure I'm not on anything expensive without Rx insurance. On my last visit in June, we were talking about me reaching Medicare age in Dec and he said that since all my meds had generic equivalents, I wouldn't need a Part D plan. He obviously didn't get it. The parts I really need to find out about are the tiers, gaps and deductibles.

Chisue, I plan to get one of the AARP Medigap plands and a Part D plan also. Which Rx plan is yet to be determined. My current meds are generic, so it would probably be cheaper to not get an Rx plan but at this age especially, you just never know when that might change. I'm very careful about things like that.

Here's the Medicare official website with all the Part D info any of us needs. This should eliminate any confusion.

Anne

Here is a link that might be useful: Medicare Part D