Re: medicare coverage for drugs?

[Guest guest]

Hi, I know nothing about insurance either.  When I turned 65, a friend of mine

in the medical business researched it for us and decided AARP was the best.  I

selected plan

" J " , which is no longer available now, but they grandfathered it in so I can

keep  it.

I never pay a bill.  No co pay, no hospital ER, no dr. office visits.  All of

my medical expenses are covered, 100%, except for drugs.  My AARP bill is

218.55 a month, in Jan going up to $224.  I have plan " D " for drugs, with

Medicare.  But as I have been in trials for 10 years, I have never had to pay

for drugs like Gleevec, or Sprycel.  When I did have to pay for Gleevec, for a

short period between trials, Novartis picked up the bill.

I have a daughter in FL that sells insurance and she keeps telling me DO NOT

CHANGE INSURANCE, KEEP AARP, IT IS THE BEST.

I pay about 375/month for health care, without drugs, and I have to say, if I

did not have an income , other than Social Security, I would be in the

proverbial " out house " , as my SS is minimal due to not working most of my

life. 

I am sure health care is once again going to be changed, but don't understand

the ones against it, they had 8 yrs. to put a plan into effect and did not,  Do

they not like it because they did not think of it?  or is it genuinely bad for

all of us?  I surely don't know, but it was a start, and instead of repealing

it, maybe they should just work on changing what needs to be changed??  that's

another can of worms!  Bobby

a ( Bobby ) Doyle, dob 12/17/29

DX 5/1995

Interferon 9 weeks/Hydroxyurea 5 years

02/2000 to 06/2002 Gleevec trial, OHSU

06/2002 Gleevec/Trisenox Trial, OHSU

06/2003 Gleevec/Zarnestra Trial, OHSU

04/2004 Sprycel Trial, MDACC, CCR in 10 months

04/2008 XL228 Trial, U of Mich.

01/2009 PCR 5.69

04/2009 Ariad Trial AP24534

09/2009 PCR 0.01

11/2009 PCR 0.034

02/2010 PCRU

#840 Zavie's Zero Club

From: nchando@... <nchando@...>

Subject: [ ] medicare coverage for drugs?

Date: Monday, November 8, 2010, 7:47 AM

 

I have also wondered about this topic. I am 60 yrs. old, so I hope I

live

long enough to receive Medicare. BUT, when I do, what happens?? I take

Tasigna 800 mg. per day. It is extremely expensive. I am a retired teacher

and have my health insurance which covers the cost right now. I thought

it was automatic that Medicare becomes your primary ins. and your employee

coverage becomes secondary when you turn 65. Is that true or not? Can I

opt to keep my currrent insurance or prescription coverage as primary? I

don't know anything about this.

Thanks,

in NY

[Guest guest]

>

> I have also wondered about this topic. I am 60 yrs. old, so I hope I live

> long enough to receive Medicare. BUT, when I do, what happens?? I take

> Tasigna 800 mg. per day. It is extremely expensive. I am a retired teacher

> and have my health insurance which covers the cost right now. I thought

> it was automatic that Medicare becomes your primary ins. and your employee

> coverage becomes secondary when you turn 65. Is that true or not? Can I

> opt to keep my currrent insurance or prescription coverage as primary? I

> don't know anything about this.

>

> Thanks,

> in NY

_____________________________________

Hi ,

You are already a retired teacher...but still working?

Many teachers get health insurance for life when they retire? is that your case.

What your insurance does when you become 65 is that they (usually) take

advantage of the Medicare coverage that you have and create a health insurance

around this. To find out what your retirement insurance actually does, you need

to talk to them (as it can vary). In the example that I mentioned, you would

keep your health insurance and they would bill Medicare, etc....and if you have

drug coverage you also keep that, but sometimes the coverage for retirees

changes (but usually is has an annual maxiumum out of pocket). Generally, if you

have the option of keeping health insurance related to work, that is better

coverage and costs less, especially for drugs.

I learned about this from the school of hard knocks! When I took an early

retirement at age 57, I kept my health insurance by paying Cobra, which only

lasts so long. I did not want to go on Medicare then because they did not have

drug coverage. I should have gone onto retirement health insurance with my

employee (state of Oregon) and would have had drug coverage but I did not

realize this....and I screwed up! You can only stay with your employee

retirement health insurance if you sign up within a certain period of time, but

it sounds like you might already be using retirement insurance? Bottom

line....find out early if you can just stay with your present health insurance

even when you reach Medicare age...which is actually what most vested employees

do.

Also, plan to be around to reach Medicare age and beyond!

This mess of all these different insurance options and companies is one reason

that many people are in favor of a single payer system...to get rid of all these

money-making middlemen.

C. (from Oregon)

[Guest guest]

Hi :  I am so confused on what to do also.  I am under my husbands

insurance from his job, but when he retires we will both be on Medicare. 

Somehow I think we will have to pick-up the AARP, as everyone says its the

best.  I am on SS Disability, and if I go on Medicare now it would mean taking

out money from my check toward my Medicare.  We cannot afford to do that.

We have used up all my retirement money that I had from my previous job before I

went on Disability, and my husbands is based on investments.  We have seen it

climb and bottom out some months.  We will not depend on that for later years.

    IT seems the only answer is to work till you die.  I just turned 63 last

week, and my husband says he will have to work till he is 70 to be able to

afford all these expenses. I am on Gleevec 400mg OD, and I am paying through a

mail order plan from my husbands job.  I still find it hard at times to come up

with that co-pay along with all the other meds that we both take.  Then at tax

time, you have to hit a certain amount before you can even deduct.

   Its a scary thing the way this medical care is going.  We need some

answers and changes to benefit the elderly.

A.

From: nchando@... <nchando@...>

Subject: [ ] medicare coverage for drugs?

Date: Monday, November 8, 2010, 7:47 AM

 

I have also wondered about this topic. I am 60 yrs. old, so I hope I live

long enough to receive Medicare. BUT, when I do, what happens?? I take

Tasigna 800 mg. per day. It is extremely expensive. I am a retired teacher

and have my health insurance which covers the cost right now. I thought

it was automatic that Medicare becomes your primary ins. and your employee

coverage becomes secondary when you turn 65. Is that true or not? Can I

opt to keep my currrent insurance or prescription coverage as primary? I

don't know anything about this.

Thanks,

in NY

[Guest guest]

> I pay about 375/month for health care, without drugs, and I have to say, if I

did not have an income , other than Social Security, I would be in the

proverbial " out house " , as my SS is minimal due to not working most of my

life. 

> I am sure health care is once again going to be changed, but don't understand

the ones against it, they had 8 yrs. to put a plan into effect and did not,  Do

they not like it because they did not think of it?  or is it genuinely bad for

all of us?  I surely don't know, but it was a start, and instead of repealing

it, maybe they should just work on changing what needs to be changed??  that's

another can of worms!  Bobby

______________________________

Hi Bobby,

I have a Medicare Supplement Plan F which is basically as you described.....it

covers all deductibles and co-pays, so the only time I would pay anything is if

the doctor did not accept Medicare assignment, which is not usual for the types

of doctors we see. I do see a chiropractor who does not accept Medicare

assignment (what Medicare pays) so I do have to pay him some extra.

Then I have a Medicare Plan D for drug coverage and for the first time I am not

in a trial for my drug, Tasigna. Medicare Plan D is not inexpensive.....because

even at best, when you reach catastrophic drug coverage after the donut hole,

you are paying a 5% co-pay....and on an $8000 monthly prescription, that comes

to $400 per month!

This is why if you have any option of staying with an employee plan when you

retire, your drug expense is usually much less and may even be capped at a

certain annual max amount (like $1200 out of pocket, etc).

_____________

I usually watch the Sun AM political talk shows and most think that the health

care reform will not be scraped, they do not have the vote for that....but that

they will break it down by cutting off the funding for portions of the plan. The

government has been 'talking' about health care reform for 3 decades....not just

8 years. There is BIG money who does not want anything to change....the health

insurance lobbies, drug companies, etc. Drug companies spent more on their

lobbying than they did on drug research.

Individual states, like Mass. has done, might come up with their own single

payer health care systems. Oregon could be one of them in the future. We have

just re-elected a former governor to lead the state again, he is a retired

emergency room MD and was the author of the Oregon Health Plan, which does give

health coverage to uninsured people of low income in this state.

Like you say, it is a big can of worms.

C.

[Guest guest]

I am 52 and have Medicare through getting disability. THANK GOD for that, or I

would have no way to get health insurance since my husband lost his job 2 years

ago.

There is a lot of information on the Medicare website, and that is the first

place to look. Most states also have an organization to help you with the

differences from state to state.

In my case, I am on Traditional Medicare -this costs $90 a month and is deducted

from my disability. My husband (68) is paying $110, because he is getting

unemployment so is being penalized for " already getting help " (!) We do have a

Part D coverage as well.

I do not get a supplemental plan. For most people, this is the most cost

effective way to go. There is a $175 a year deductible (i.e. you pay the first

$175). After that, you pay 20% of the MEDICARE NEGOTIATED PRICE. this means that

a doctor visit costs anywhere from $6.29 (my chiropractor) to $25 (my gyn) a

visit. My visit to Dr Druker at OHSU costs $14.

I would have to see an awful lot of doctors a year to justify the additional

$200 (and up) a month that a supplemental plan would cost. With AARP (in

Colorado) we would be paying a

flat $35 per visit co-pay for any doctor.

The place where it IS better to get a supplemental plan is if you have concerns

about being hospitalized. I don't remember the exact details, but a

hospitalization of longer than a week becomes less viable on traditional

medicare (because Part A covers the hospital, but your Part B covers the DOCTORS

in the hospital).

For people who are basically healthy, a supplement does not usually make sense

(according to AARP magazine, about 75% of people on Medicare do not get a

supplemental plan).

As to Part D (drug coverage). Most plans have a calculator on their website that

will help you figure out your out of pocket costs. I buy the cheapest possible

plan ($14.50 per month. Includes a $150 deductible). I do not pay for Sprycel (I

am on study) but if I did, according to the calculator, it would cost about

$5000 for the year (not cheap, but not $5000 a month!). I have not checked

whether it would cost less on a much more expensive plan.

One more thing -if you do not take any type of Medicare coverage as soon as you

are eligible, there will be a penalty if you join later, UNLESS you have a valid

reason. having other coverage is a valid reason, but you will have to document

this when you apply for a Medicare plan. So be sure to save the " proof of

coverage " letter you wil get if/when you terminate other coverage.

Leah

>

> I have also wondered about this topic. I am 60 yrs. old, so I hope I live

> long enough to receive Medicare. BUT, when I do, what happens?? I take

> Tasigna 800 mg. per day. It is extremely expensive. I am a retired teacher

> and have my health insurance which covers the cost right now. I thought

> it was automatic that Medicare becomes your primary ins. and your employee

> coverage becomes secondary when you turn 65. Is that true or not? Can I

> opt to keep my currrent insurance or prescription coverage as primary? I

> don't know anything about this.

>

> Thanks,

> in NY

>

>