Medicare Prescription Plans

[lindajo]

Have any of you had experience with prescription coverage for Medicare patients. All medicare patients will have to sign up for a prescription plan by November 25th 2005, but I know some have been eligible for the temporary plans this year.

Before I sign up I would like to know if any of you have researched the plans and know which drugs, Vidaza, Revlimid, Nuepogen, etc are covered and what is the cost.

I am going to a meeting tomorrow so I will see what I can find out.

[lindajo]

I went to the meeting today and found out too much to put in a post.

If you can attend a meeting in your area go. Things that will help confusion from abounding on this forum is as follows.

EACH STATE WILL HAVE DIFFERENT POLICIES AVAILABLE. YOU NEED TO LOOK AT WHAT PLANS YOUR STATE WILL BE OFFERING. FOR EXAMPLE; Kansas is probably going to approve 15 to 17 plans. To know the best policy for me I will have to look at the drugs I am taking (or might take) and look to see which plans cover them and what is the cost, in order to see which plan is best.

For my mother who has Alzheimers, what she takes is different so I will have to also research 15-17 plans for her.

Supplement D is going to be difficult to evaluate. Area agencies on aging might be able to help you with what is looking like a difficult decision.

It will be the middle of October here in Kansas before we know what plans will be offered.

The first date that you can enroll nationwide is November 15,2005 ( if you qualify for assistance in paying the Part D premium you can fill out that form now.) The first date for coverage is January 1, 2006. In order to have coverage you have to apply by May15,2006 or pay a penalty. After May 15,2006 you can’t apply again until Nov 15,2006.

For assistance in paying part D premium single people have to have income less than $14,455 and for couples <$19,355 with assests of no more than $10,000 plus a burial benefit of $1500. That is just the basics. Use every available free service out there to help you understand what is best for you.

[Suzanne]

Good Lord! Could they make it more complicated!!I have already found the rules for disability benefits and social sec for the disabled almost impossible to understand and when I made calls and asked questions so I could plan for what might be ahead, I got different answers from different people and resources-often incorrect ones. In the end it caused so much stress I decided to just let the government do whatever they decided to do– so I fill out the forms they send me and wait and see whatcomes next. I never thought I would want to be a year older but even the benefits when you are 65 are convoluted to say the least. I read my very bright children a paragraph or two from the medicare booklet I finally got within weeks of qualifying and none of us had any idea what it said. My guess is that some bright person will study up on these drug plans and sell the service to the rest of us of figuring out what plan we should take. I even read somewhere that the companies can change their minds about whether they will cover a drug and/or the cost so you can’t be sure the plan you pick will stay the best. And how about those of us that don’t take anything on a regular basis. sorry to “yell” but I think the whole thing is crazy. People who are dealing weith age and/or illness have the right to have things made more simple not too complicated to deal with even in normal times!!

[Fran]

Hi Linda:
I tried to e-mail you but it didn’t work. this is Fran, the wife of Jim that has MDS. I told you that Medicare will pay for Vidaza as long as you have a supplement. Call or wirte to Medicare and see what they say.

Good luck.
Fran…Jim is starting Vidaza on the 10th of November. I hope it works, since he has a bad heart and is also Diabedic.

[Jimbob]

CAUTION ON SIGNING UP FOR MEDICARE PRESCRIPTION DRUG COVERAGE
On page 45 “Medicare & You 2006” there is an important caution that they give us but is almost hidden in the gobbledygook:
“If you drop your employer or union coverage, you may not be able to get it back. Yoy also may not be able to drop your union drug coveraqge without also dropping your employer or union health coverage.”

The reason for this is that the group coverage plan gets well enough paid to provide you with drug coverage that it makes it worthwhile for the plan to provide health coverage. If you take away that payment, they are likely to lose money on the health coverage and the government gives the plans the option of dropping you.

The book does tell you that you should keep your group plan drug coverage if it is part of your health coverage and it is at least as good as or better than medicare drug coverage. BUT you might want to keep it even if it is not as good as Medicare drug coverage and see if you can get needed drugs direct from phramacutical company or other sources.

Tucked among the fine print of the new Medicare privatization drug bill is this fish hook that will snare millions of beneficiaries: The law prohibits the sale of new Medigap policies to cover the deductible and the 25 percent co-payments on drugs. For many beneficiaries, that means they’ll be spending the maximum $3,600 out of pocket each year. Why? Congress decided that if you had Medigap insurance to help pay for your prescriptions, you would overuse your benefit and ask your doctor for drugs you really didn’t need. This is the “donut hole” that is described on page 53 of the book. Switching from existing drug coverage within an existing plan could be extremely costly.

I was alerted to this likelihood of health coverrage loss because my wife works for a company that oversees benefits for many other companies and unions. If you have drug coverage that is at least as good as what the Medicare coverage would be, you will not be penalized for not signing up right away while you check this out for yourself.

Jim

[patti]

Well, once again, NOTHING the government does is better then private industry. This is crazy. My husband and I refuse to take part in any government entitlement partly out of protest and partly because the governent doesn’t do anything right. Especially when it comes to spending our (my husbands and mine) hard earned dollars.

If you need the prescription coverage make sure you add the additional cost of premiums with how much you might actually use in prescriptions. So often it’s cheaper just to pay cash outright. Also, if you need the coverage, I’m going to hedge my bets that buying from a third party will be better then directly letting the government supply the funds. ie. My MIL has a medicare plan through the local hospital district that makes her overall out of pocket costs less. Sometimes the limitations are frustrating but there are even ways around those.

Oh, Suzanne, shout woman all you like! I think I’m screaming louder. Can you hear me? Why must it be so complicated? It’s as bad as the tax code (and I’m just betting it’s as big too!).

Thanks for letting me rant.

Patti

[Suzanne]

I have some of the material for the state of Md.There are something like 47 plans with about 20 medicare approved companies. Many of the approved companies have more then one plan -and of course more then one cost. The base seems to be the required plan for medicare but for an increased monthly cost you can have lower or zero deductable,lower co pays or % of cost you pay, and two or three “levels”(like generic, preferred and specialty drugs) of drugs covered at different %of the cost A few of the higher cost plans get rid of at least part of the cost during the “donut hole”.(so that must not be illegal-at least in Maryland) The main thing I see that is really stupid is that a company that covers a drug when you sign up can stop covering it with 30 days notice to you. Guess what will happen if a drug is hurting their profit margin! They could at least have made it that they notify you 30 days before the open period when you can change plans so that you could move to a plan that does cover something you need to take regularly.
Delaware has 15 approved companies and 47 plans!

People here who have drug coverage through their previous employers or the government have gotten letters saying that they will get a second letter about whether the coverage they now have will change at their renewal date and whether whatever they can get from their old company is better then the medicare coverage or not. I don’t know anybody who thinks thay have any idea what program they should take and I know one very experience and successful credentialed financial planner-and he is struggling and going crazy trying to figure the program out. (so it is not just that the chemo has muddied my mind)
Some of the material makes it sound like there is a base list of drugs somewhere that are “medicare approved”. Haven’t figured out yet where to get lists of drugs that are on any required cover list for medicare approval or what the individual companies are listing as covering – haven’t had time to begin that research. I am still on narrowing down to which companies are dealing with the nearby pharmacies-ie the major drug store here is only dealing with about 5 of the 20 companies medicare has approved for Md.
I do believe “cancer drugs” are treated separately-as someone on the forum said they had coverage for vidaza now and these plans for prescription drugs don’t start covering anything until the 1st of the year.
If any of us come across any “great truths” I am sure we can share-but just like our disease differs in different people, this thing is different in different states(However I do believe it is a total confusing Mess in every state!!And may not help anybody much except maybe those of us who have no drug coverage )

[gemloyear]

Hi jimbob, Thanks for posting the info on drug plan coverage under medicare. I received the gov. medicare handbook a few days ago and have been afraid to open it, because I knew I would need to study it for hours to make sense of it. You answered a question that I had in my mind regarding coverage that we already have. We do have coverage under our supplemental policy that seems so much better than anything that the medicare plans offer. If the drug plans require that we pay a maximum out of pocket before they kick in that would be far more than we are already paying. Your right, be cautious about sighing up for anything until you research it throughly.For now we are satisfied with what we have.
Many thanks Ellie

[diner]

I’m with all of you guys. What a confused mess this new drug coverage is going to be. Right now I get the more spendy drugs for my mom free from different pharmcutal companies, but one company won’t give her anymore because they said she can sign up for the drug coverage under Medicare. Luckily my husband has good coverage on us from the place where he worked but that might be dropped at any time because of the government mess. Dee

[Jimbob]

My primary health coverage for the past 4 years had been thru United HealthCare thru my employer, even though I have been on disability for 2 1/2 years. I still have to pay the premiums but they have covered almost everything. My secondary insurance was thru my wife’s employer. THey don’t have anywhere near the coverage but they paid most of what was not covered by my insurance. All this changed on 8/1/2005 when I went on Medicare.
Because I do not work and my wife does, her insurance became primary. Again, it is not as good as mine WAS. Now Medicare is secondary. It pays what was not covered by the by the primary up to the Medicare schedule. That does NOT cover everything even though I am paying additional premiums for it. My insurance company is third. It now pays WITHIN the limits of what is allowed by Medicare. It may or may not actually cover something, we havent’t gotten back any bills or EOBs yet. But whether we took the Medicare coverage or not, they will pay only as if we had it. I cannot drop this insurance because it is the only way I can get coverage for my diaabled adult dependent daughter.
What a mess!
Jim

[Suzanne]

I ran into similiar complications. Medicare on disability started for me in July. I ended up taking a gap policy because they said if I didn’t take it in the beginning they could turn me down on pre-existing conditions later. Could not afford that and the private insurance I had with limited drug coverage and no gaps were sold in Md with drug coverage because of the new drug programs coming. So I have been waiting for the new programs to at least get some drug coverage. In the meantime I have a medical review by medicare in March and all the income restrictions to deal with and may end up being taken off disability & medicare as much as a year before I qualify for it on age. They could not answer how I was going to get insurance if this happens with a pre-existing condition of a blood cancer.Talking about making me a little nervous!

[Author]

Posts