Recently approved disability/medicare question

[girli565]

I frequent these boards so much and find all of the contributors so helpful and knowledgable that I thought I could ask this here.

My mom was just recently approved for disability after a 6 year battle. She got a settlement and her medicare. We started researching the Medicare stuff because her lawyer told her that she will need to understand it all. Her card came in today and it has Medicare part A&B (hospital and Medical). But now we are wondering about Medicare Prescription Drug Coverage.

We've read all the stuff on the Medicare.gov site but I'm so confused and so is she.

There's the HMO or PPO options because then it includes all medical and prescription coverages if you opt for that coverage. Then theres just the Prescription Drug Coverage only plans which we are so confused about. Well everything is so confusing!

My mom has severe back problems and takes several brand narcotics and controlled substances for pain. She also takes hormones that are brand drugs and do not come in generics. I know that the type of drugs she takes are a big part of which plan to choose. I just don't understand what she should choose.

The more I read about the PPO plans which encompass all, like medical and prescription plans, I think that's the way she should go. Am I wrong.

Please help me! She's stressed and is going to call Social Security to see what they recommend but I think that could be a mistake before we resaerch this ourselves.

Thank you so much! I will be so grateful to you all!

 

[taekwondo mom]

call your pharmacy they can tell you what plan will be best based on her meds.
Good luck ..

 

[Cheshire Figment]

I am on Medicare (A and B) but I also have coverage from Blue Cross/Blue Shield. They pick up all of the Medicare Co-Pays and Deductibles, so all I have to pay is either $10.00 or $35.00 CoPay for 90 day supplies of prescription medicines using their mail order pharmacy, or some other co-pay if getting less than a 90 day supply from another pharmacy (which is more for short-term uses).

What you should be looking for is a plan that will pick up the deductibles and copays and look to see what their pharmacy benefits are.

I did a quick look on www.opm.gov which is the web site for Federal Employees. A key reason is they list all the insurers that are acceptable into the Federal Employee Health Plan. Before moving to Central Florida I had belonged to Kaiser; I had to change since I was moving out of their coverage area.

There are three HMO or PPO organizations that cover South Florida that are on the OPM list. These are Av-Med Health Plan, JMH Health Plan, and Vista Healthplan of South Florida. I would suggest that you look at them, as well as the majors like BC/BS, Aetna, or Met Life.

I would avoid any local area health plan that is not on the OPM list, because this means the Federal Government would not be willing to contract with them for coverage of Federal Employees or Retirees.

 

[girli565]

I am on Medicare (A and B) but I also have coverage from Blue Cross/Blue Shield. They pick up all of the Medicare Co-Pays and Deductibles, so all I have to pay is either $10.00 or $35.00 CoPay for 90 day supplies of prescription medicines using their mail order pharmacy, or some other co-pay if getting less than a 90 day supply from another pharmacy (which is more for short-term uses).

What you should be looking for is a plan that will pick up the deductibles and copays and look to see what their pharmacy benefits are.

I did a quick look on www.opm.gov which is the web site for Federal Employees. A key reason is they list all the insurers that are acceptable into the Federal Employee Health Plan. Before moving to Central Florida I had belonged to Kaiser; I had to change since I was moving out of their coverage area.

There are three HMO or PPO organizations that cover South Florida that are on the OPM list. These are Av-Med Health Plan, JMH Health Plan, and Vista Healthplan of South Florida. I would suggest that you look at them, as well as the majors like BC/BS, Aetna, or Met Life.

I would avoid any local area health plan that is not on the OPM list, because this means the Federal Government would not be willing to contract with them for coverage of Federal Employees or Retirees.

Her lawyer also recommended BC/BS saying that many of his clients seem very happy with it. Do you mean their all encompassing health plan?

I went to their site and I plugged in all her med, most are name brands, like Avinza and Estratest. And the Rx plans they showed me all require huge copayments for brand drugs. She's calling social security now to see what they say but I'm still so confused.

I went to the medicare site and used their Rx plan selector and that's even more confusing. It shows me deductible and monthly premium but not copays or anything like that. She currently goes to the Target pharmacy and she's very happy there but she will change if she must. I saw the BC/BS uses Target so that would make her happy.

 

[girli565]

Bumping to see if anyone else has some input!!

 

[Cheshire Figment]

My BC/BS plan requires that I get all my "standing" prescriptions through their mail order pharmacy. Normally my routine prescriptions are given for a 90 day supply with three refills.

If I am getting generics my copay is only $10.00. If it is non-generic the copay is $35.00. If it is something short-term, such as an antibiotic I have a wide choice of pharmacies and my copay is about 25% of the total cost.

You might want to call them and talk to a real person rather than getting lost on the web site.

So I am getting Medicare A, paying for Medicare B and also paying about $125 a month for my BC/BS (with the former employer picking up the rest of the BC/BS cost).

 

[barkley]

just be aware that most of the controlled level pain meds are not available through the mail order meds programs offered by any kind of insurance (2 or the meds i use fall under this category and i can't even get scripts with refills, have to get a brand new script every month).

you might want to see if there is a local branch of aarp in your mom's area. they know those plans inside out, and since offerings differ greatly from state to state it's important to get info. that is specific to where she lives.

 

[girli565]

just be aware that most of the controlled level pain meds are not available through the mail order meds programs offered by any kind of insurance (2 or the meds i use fall under this category and i can't even get scripts with refills, have to get a brand new script every month).

you might want to see if there is a local branch of aarp in your mom's area. they know those plans inside out, and since offerings differ greatly from state to state it's important to get info. that is specific to where she lives.

Yes, the controlled meds are month to month. That's how it is now with her current insurance because doctor's can't write Rx's for the controlled med for more than a month. I know that the only ones she will have to put on the mail-order is her hormones.

Thank you about the tip for the local AARP office! I think I may look into one in Miami. Thanks!!