Medicare Prescription Drug Plan

[msmouse]

You guys have alot of knowledge about a lot of things, so I was hoping to get some views about this. I am trying to help my father in law chose a plan by May 15. It is all so confusing to me. Has anyone gone thru this? If so, what did you choose and why. What criteria should I be looking at before making a decision. Thanks so much for any help you can give me. I am going to go to the site given on the material, but I don't know if that will be of any more help than the written material given to us by the pharmasist.

 

[minniecarousel]

Well, I chose a plan for my DM in December - she just stayed with the Rx plan offered through her supplemental insurance. Come to find out, she will be in the "donut" (no coverage at all) with her next order of maintenance meds. She gets 90-day supplies through mail-order. A couple of her meds are very expensive. It turns out that this is probably not the best plan for her. I don't know if this is the best plan for her - if it is, it sucks! I'm also not sure if she can change her plan this year, considering that she has already received over $1900 in meds this year.
My word of advice (if you want to take the advice of someone who blew it!) make sure you have the names and dosages of each of his medications. There are several websites that will let you plug that info in and should give you an idea of the type of coverage he will get. I'm sure the links to these sites are on the Medicare website.

 

[HERSEY]

Here's what I tell people who call me at work. Get all her rx's together drug names and dosages. Then go to http://www.medicare.gov/MPDPF/Publi...ear=2006&MAPDYear=2006&MPDPF_MPPF_Integrate=N. It filters all the plans down, I personally would use a plan that offers mail order and stay with a large well known company so that if any questions or problems arise they may have a good customer service dept. I hope this helps. Alot of the confusion will ease once everyone gets comfortable with the options and the unknown is relived.

 

[CarolA]

Well, I chose a plan for my DM in December - she just stayed with the Rx plan offered through her supplemental insurance. Come to find out, she will be in the "donut" (no coverage at all) with her next order of maintenance meds. She gets 90-day supplies through mail-order. A couple of her meds are very expensive. It turns out that this is probably not the best plan for her. I don't know if this is the best plan for her - if it is, it sucks! I'm also not sure if she can change her plan this year, considering that she has already received over $1900 in meds this year.
My word of advice (if you want to take the advice of someone who blew it!) make sure you have the names and dosages of each of his medications. There are several websites that will let you plug that info in and should give you an idea of the type of coverage he will get. I'm sure the links to these sites are on the Medicare website.

The "donut" was a little known part of this lovely bill. Almost ALL of the plans have it so I am not sure you could have avoided this. Bascially the way the plans are written after the first $2000 in meds then the patient has to pay the next $2,000 or so and then the coverage kicks BACK in. (Notice Bush never mentioned this little loophole did he?)

You can only change plans annually.

Also, the CMS website referenced above has LOTS of flaws. Use it to narrow down you drug plans and then CALL the companies. Here's one example. My Boyfriends mother takes a very expensive arthritis med. Both Humana and Blue Cross showed it was covered. HOWEVER, what they didn't show was that Blue Cross only covered one pill a day. Mom takes two..... The websites also don't mention the above "donut"......

If you FIL is like my mother and currently takes NOTHING then pick the plan with the lowest monthly cost. It's a risk, but you can change next year. If you don't sign up for anything the penalities will be very high!

 

[Dan Murphy]

The website mentioned above will work you through it just fine. Just make sure you have the names of the meds taken, the strengths, the frequency (usage). Also, if a brand med is taken, find out if a generic can be prescribed by the doctor (the site will tell you if one is available). It is a fairly easy site to work through, just make sure you have those items on hand before you try to work through it. And take your time.

Also, as mentioned, when you think you have narrowed it down to a few plans/companies, call them to verify. Also I would recommend applying though the company website rather than the Medicare site, JMO.

Just as an example, with my MIL back late last year, her meds were running her about $1,800 per year, one brand, two generics. Using that site, the site said a generic was available for the one brand. If she could not get the generic, total costs, meds and plan premium, would have been about $900. If all were able to be generic, about $230 per year, all premium, no med costs at all. I told her to check with her doc, he said generic is fine. So her annual costs went from $1,800 to $230. Four months into the plan, she loves it. Premium is deducted from her SS check, meds are zero cost.

Everybody is different, various areas in the country are different. Using that site is almost mandatory to get the correct plan.

(not to be considered insurance advice)

 

[CarolA]

Dan,
I really wish I could say the websites were good, but....
I work in healthcare and every day I read articles, emails etc. about "problems" with the websites so PLEASE confirm. (And here is another great tidbit... the insurance companies can CHANGE thier formulary during the year, but you can't change plans!)
Your MIL is one of the lucky ones. Her drug costs are low enough that she won't hit the donut. It's the folks with HIGH drug costs that are in a pinch. My boyfriends mother paid LESS last year using the drug discount plans then she will this year using Part D (And it took someone who works with Medicare all the time DAYS to help them pick a plan LOL!)

 

[Lisa loves Pooh]

I would consider shopping around--find out which plan covers the most of your dad's scripts--and who will be the most economically advantageous.

also--if he is low income--you can apply with Medicare to get a low income subsidy that will pay a portion or all of the premium and deductible and a reduced co=pay schedule.

Also--I know the company I do stuff for does this, perhaps others are teh same--you can request exceptions to their policies for doctor prescribed as necessary meds. They are reviewed on a case by case basis. Unfortunately--you will not be able to do this until once he is enrolled.

gaps may differ. From deductible until $2000 or so up to $3500 or so.....that gap is 100% responsibility of the insured.

(ETA: This is not insurance advice either--just speaking from my knowledge from my work dealing with this type of thing).

 

[Lisa loves Pooh]

Dan,
I really wish I could say the websites were good, but....
I work in healthcare and every day I read articles, emails etc. about "problems" with the websites so PLEASE confirm.

I second this.

Also--good follow up is very important. Since the deadline is close--if at all possible--enroll on the telephone. Less likely for snail mail to be lost. Less likely for internet glitches for on-line enrollment.

 

[msmouse]

Thanks everyone. I will start now researching. Gotta gather the information. This is exactly what I was looking for.

 

[C.Ann]

I second this.

Also--good follow up is very important. Since the deadline is close--if at all possible--enroll on the telephone. Less likely for snail mail to be lost. Less likely for internet glitches for on-line enrollment.

---------------------------------
And to be extra safe, you might want to follow up by applying via snail mail with a certified letter, return receipt requested.. That way you will have something with a "date" on it - oppsoed to, "Well I spoke with Marion on Monday, May 1st" etc..

I recently had a situation involving something else with a deadline and if I hadn't followed up with the certified letter, I would have been sunk..

 

[marlasmom]

I found that all the plans we looked at (3 or 4) had the same formulary for drugs. They all have the identical $2,250 cap. The catch is that the $2,250 is comprised on what you pay for the drugs and what the insurance company pays on your behalf. For example, one of my drugs costs me $26.00 - but the actual cost is $86.00 - the insurance company picking up the $60.00 difference. However, when they calculate the $2,250 they charge the full $86.00.

 

[CJMickeyMouse]

Check with the pharmacy he wants to do business with to make sure which plans they are accepting.

You really need to shop around, but you are really in a time crunch right now - you can't sign up on May 14th and expect benefits to start on May 15.... that is just not how this works.

We are a provider who accepts only two plans... and we have had numerous things lost in the mail, numerous computer glitches, and hours of time spent on hold. It's definitely not perfect but it is benefiting a lot of people when they find the correct plan for them and actually get it up and running.

Good luck!!!