Medicare Prescription Drug Plan. Have any of you seniors

[clydefrand]

figured out how in the world to make a decision on this important matter for us?

I went to a meeting on Tuesday where a speaker from our LOA was giving us the facts on this confusing mess. I not only have to decide which plan for myself, but also for my older sister for whom I'm power of attorney. And my husband must decide as well.

It seems unless one is on Medicaid or are otherwise very low income, one is penalized 2% per month for not choosing a plan between Nov. 1 and next May 15. Also if one already has a medigap policy with a prescription drug card, it will not be valid after May 15. Medigap policies will no longer be allowed to have RX plans.

If any of you have chosen a plan, please advise how you went about doing so. I have looked at the Medicare.gov site, but only a little bit. It too is not clear. Our speaker said the bill passed is 653 pages long. I asked who was it to benefit besides low income people because surely it isn't for the middle class. His answer: Pharmaceutical companies and insurance companies. There you have it---big business wins out and we suffer once more.

Thanks for your replies.
Fran

[movonne]

1. If you are on medicare, do you have to take one if you don't want it.??.

as far as I can see it doesn't do anything for me..

[clydefrand]

4. You don't have to take it if you're on Medicare. BUT here's the

clincher: Let's say you don't have many meds to take now and can afford paying them without the Medicare RX plan which is gotten through companies like Anthem, Banker's Life, AARP, etc. If you ever need to have a plan, you will be penalized for not taking during the window that I stated in my OP. Two per cent a month up to 24%, I think I'm remembering those numbers correctly. That means your premiums will increase that much because you didn't subscribe to a plan when you had the opportunity. That is the way SS will make some money to pay for the lower income recipients. He advised to choose the lowest possible premium of about $21 per month to be deducted from your SS check or you could have it taken from your bank account or send a check each month to the insurance company. He advised against the latter two and advised to have that amount deducted from SS and SS would pay the insurance company the premium.

You have to pick a plan that has your medications, or at least most of them or most expensive ones, on it. And you can't change policies until a year is up. However, those on Medicaid can change any time they want to.

It's a total mess and makes decision making grueling. Ones meds change. One must take what the plan offers. I hate the entire concept. It isn't allowing people to take the meds their doctors prescribe for them and/or what is best for the patient.

[movonne]

7. thank you...

[WePurrsevere]

2. I hadn't heard anything about the 2% penalty thing. Unless it's FREE...

I don't want it, can't afford it and quite frankly there's something about it that just doesn't feel right to me.

My husband and I are disabled and on SSD & Medicare. We use alt health/ non-conventional methods mostly and for well over a decade I've rarely take prescription drugs and he gave up on finding something to help him. If the government wants to give us something for free that's peachy but I'll be darned if I'll be coerced into paying even more for something I don't want, don't need and can't afford right now. Thanks to this "wonderful" economy :sarcasm: I'm a bit more concerned with getting basic necessities taken care of like putting food on our table, heating our home (we live in Northern NY), etc.

[clydefrand]

5. I'm glad you don't have to spend money on meds, but there are

many, many people who do and their meds are extremely expensive. This LOA person was telling us of a woman whose medications are running over 10K a year. If you have a catastrophic illness like cancer and you don't have a medigap policy to help pay your doctor's bills and the RX plan to help with drugs, you're just out of luck. So if you can afford to even take the lowest possible priced plan, you might find it will pay off in the long run.

My older sister has dementia (taking Aricept) and several other ailments that require medication. Her medicine is costing over $600 a month and she has no insurance to pay for it. So I will have to get her one of these policies.

I have SSD and Medicare as well. But I will be 65 in March and my secondary insurance will run out. This insurance is offered through a group from where I worked and I was allowed to keep it until age 65. So I will need a Medigap policy and RX plan because I take several meds also.

[schmuls]

8. still confused

I still don't know if I understand this correctly. My boyfriend gets SSDI and Medicaid. He only pays about $1.00 per prescription. Is he required to send in his application to get his Medicaid options, or would he be safe just ignoring it and continuing to get his current coverage? What do you mean your secondary insurance? Does this apply to him as well? Does it differ by state (our state is Wisconsin). They sure aren't making all this easy to understand! Thanks!

[clydefrand]

9. Correction: I apologize. It is only 1% per month increase in cost

of premium if you don't sign up by May 15. '06.

[applegrove]

3. A complete "buyed silence" plan. Big pharma was afraid that

state health plans would get together and start a "buying group". Just like the UN did with some medications in the 1990s. UN population group went to the drug companies and said "look - we are buy birth control for a BILLION PEOPLE - so what sorta deal you gonna give us".

Big Pharma hated that.

Monopoly power is only supposed to work in their favor.

One set of rules for them - one set for everyone else.

Remember - this is what the plan is all about. Staving off people getting together to buy meds (just like WalMart does with its buying capacity).

Good ideas are only for the corporations - remember that. :sarcasm:

[clydefrand]

6. I agree with your assessment of the situation. The speaker was

asked if we could get our drugs from Canada like our government does for Veterans. The answer: NO! This man was not liking this program at all. There was a big article in our paper recently criticizing this bill and its consequences. He said he was visited by someone from Medicare and was told to be more positive about the plans. He told him that he wasn't going to look into the eyes of senior citizens and lie to them.

[cosmicdot]

10. what to do?

under 65, but on SSDI and Medicare A & B

I'm living in my 3rd state in 5 years since SSDI/Medicare began. Accepted into SSDI/Medicare (the latter had a 30-month waiting period) in VA. Now, in CA.

My CA MDs have helped with samples, and I've only been buying 1 Rx in recent months. I did a short Canadian thing, but companies like Pfizer made things difficult for these pharmacies. This current 'help' with meds, of course, can end tomorrow. Who knows what tomorrow might bring, right?

Out of pocket Rx can run @$300 a month.
New Rxs can be added.
Some could go away.
Rumsfeld's unknown unknowns.

The one I buy (one of the few not too expensive) is about $25. Note that my pharmacy tells me the Medicare price for this Rx is actually higher than the list price here in CA; ergo, I pay list. The pharmacy has in the past given me some price break just for having a Medicare card.

The Medicare 2006 booklet says the avg. monthly Rx Plan premium is @$37.

It seems that under the Bu$h scheme, the monthly cost of that Rx now could double in price because of having to join an Rx Plan. The monthly premium + buying the drug. @$37 + $25 per month. With a $250 Rx Plan initial deductible, the plan won't be of much help. Not maybe the 10th or 11th month.

This whole cut-corporate medical-in to Pimp my Drugs seems like a bad joke. It can be so much simpler. All could be done by the Dept. of Health & Human Services, under the Medicare program, with us just using our Medicare card when dealing with the pharmacy.


Looking at the Medicare book, there are about 47 different Rx plan options in Southern California. Most corporations have 2-3 levels or choices; ergo the number of options. Some high monthly premium options have no deductible, but the copay conditions of amount one pays per Rx vary.

Is it worth paying higher premiums?

Plus, I suspect (without delving deeper) that each company likely has different prices for each Rx one takes. What meds are part of their formulary differ. Not all plans cover all the same drugs. So, is it possible that by just choosing the lowest premium might not equal the cheapest cost for Rx?


If one doesn't join a Plan now, a "penalty" may apply later. Fear factor.


The Medicare 2006 Book example given is that, each year ...

-there's a deductible for the first $250 of Rx costs.
-Then, one pays 25% of the Rx costs up to $2250.
-After that level is reached, one pays 100% for the next $2850 in Rx bills;
-then, out of pocket reverts to 5% (or some co-payment) to year end.
-Begin again next year. Rinse and repeat.


Then, the Medicare 2006 booklet talks of Medicare Advantage Plans (MAPs) which likely include an Rx Plan. There are as many options for MAPs as there are Rx Plans.

Does one stick with the original Medicare, and close one's eyes and choose an Rx Plan? or consider a MAP?

The grid comparison charts only give superficial information for both the Rx Plans and MAPs.

I find it all overwhelming ... a likely hidden goal.

Politicians tend to neglect that not all Medicare patients are 65 and over. I'm guessing these MAPs are for any age, not only for those over 65 (like MediGap Plans)... but, they all seem to be HMOs. I prefer the ability to choose my MD. Once again, the Bu$h corporations get the money (Plan B - money deducted from one's Social Security Disability Income goes directly to the MAP plan one might join) ... to do what Medicare already does. Some plans require extra monthly premiums for some additional benefit, i.e, smaller out of pocket co-payments for Rx. They promise some additional benefits which could take a long time to figure out if one goes in depth comparison plan by plan.

Do MAPs offer dental coverage?

After moving to CA, I, also, enrolled in the state's Medi-Cal program. It's essentially the state's Medicaid program. It doesn't help me (yet) because my disability benefits count as the monthly out of pocket which must kick-in first before benefits do. My reason for joining was to help with some dental procedures. Some dentists in CA accept Medi-Cal (Denti-Cal is the dental name). It's not insurance per se, but can help with certain procedural fees charged, i.e., cavities/fillings. Not having dental is something, also, overlooked by our Washington politicians. Being enrolled in Medi-Cal, the state pays the Part B premium which is a big help. With the Gropinator running wild, that could end any day, too.

Meanwhile, the Orange Co. Medi-cal program has issued a new Medicare-Medi-cal combo plan, which includes an Rx plan, but has network doctors to choose from: an HMO. Neither of my MDs are party to it which means I have to opt-out. If I don't respond by November 1, I'm automatically enrolled. Just another 'issue' local people are having to face.

I see the suggestion for opting for the lowest premium Rx Plan.

In SoCal, here are some of the low-end choices (per month):

Blue Cross $20.04
Health Net Orange $17.65
United HealthCare $20.70
Humana $5.41 and another for $11.25
Sierra Rx $18.98
PacificCare Saver $20.40
Unicare $20.04
WellCare $18.04

Now what do I do?

[cosmicdot]

11. btw

Guess who is selling/spinning the Medicare plans on the gov't website?

Scott McClelland's brother ... Mark ... he works for the Department of Health & Human Services' Centers for Medicare & Medicaid Services (CMS)

isn't that special?

http://www.cms.hhs.gov/medicarereform/pdbma/maplan.asp

http://www.cms.hhs.gov/about/leadership/more_mcclellan.asp

wonder if Condi and Mark worked at Stanford University during the same period?

[cosmicdot]

12. what are tier levels; and, what are quantity limits?

OK, so I've put it off for a number of reasons ... anti-Bu$h sentiment I suppose ...

I got a letter from Medicare on Monday saying sign up or they'll sign me with SierraRx ... why Sierra? on Wednesday, I get a letter from Sierra welcoming to their program/here's your card ... nice going there ... some collusion going on?

anyway, Sierra only covers 3 of 5 meds

looking at alternatives, I'm seeing limitations/restrictions like "prior authorization" (isn't my doctor's Rx enough?); "quantity limits"; and, "step therapy" (hello, been there, done that) ...

using the online formulary finder, I see that some plans have certain meds at various "Tier" levels, i.e., Tier 1, 2,3 and 4. The meds' tier levels vary from plan to plan. Lipitor is Tier 4, for example, with Blue Shield; and, Tier 2 with others.

To think that 11 Democrats voted FOR this in the Senate (2 didn't show up) ... with 9 GOP voting AGAINST it ... it was one of the few bills since 2001 handed to the people's party on a silver platter. Makes me lose hope.

I'll appreciate any help. Feel free to PM me, too.

I, also, see that PacifiCare and UnitedHealth are merging. Wonder how that affects the apple cart?
I found it interesting to see that Donna Shalala and Tom '911' Kean sit on UnitedHealth's Board of Directors. Is it a wonder why we're not making progress on universal healthcare?

[trof]

13. I have AARP at about $35/mo. A doctor friend said this:

"You're buying the plan NOW, on the very good chance that you'll be taking some very expensive medications in the future."
Right now I take one for cholesterol and 2 for hypertension.
They're not all that expensive, but I still come out paying less in premiums and co-pay than if I had to purchase them outright.
Good luck.
It's complicated.