Re: EDU: Medicare Prescription Drug Plan (easier)

[Guest guest]

Dear Caroline, I read with interest the info you have provided. I have not had

prescription drug coverage since I became ill 10+ years ago. That was after I

was no longer able to work and had gone through TDI. I have not been able to

find a drug plan that they offer through Medicare D that will help me more than

hinder me. I was so hoping it would be useful, as my meds have always run about

$1,500. to $2,000. monthly. They will not cover the prescriptions that I need at

the dosage that I am taking. And I will not give up the doctors that I have

finally found. I am afraid of getting in tangled in one of the plans that will

try to dictate what I am taking, and how much. I hope others will be able to get

some benefit from Medicare. Also my mother's insurance company advised her to

not take part in the program. Too bad it is all so confusing for people. I have

been on the Internet going through all that they offer here. And I could not

believe it , they called me on the phone. I

actually thought it was a scam as I had read about that on the Internet. But I

received a letter in the mail confirming that it was actually them calling.

Mandy

C J wrote: Ok, maybe not easy... but

easier. I have done hours and hours of research on this topic for myself and my

own Medicare needs. Here is the simplest version of the information I can get

for you.

1 - I ALREADY HAVE DRUG COVERAGE

I have been told by both Medicare and competing drug insurance companies that

you can have BOTH an employer / spouses employer drug plan and Medicare part D

(drug coverage, at least for now. Some employee plans can NOT separate out the

drug coverage so if you get Medicare part D, you will still pay for the private

employer drug coverage or cancel it and loose your major medical. BE CAREFUL.

Enrollment began Nov 15Th and in order to have coverage on Jan 1, 2006, you

must sign up on the Medicare plan by Dec 31, 2005. You don't have to sign up

until May of 2006 but after that, you will have penalties.

If you don't sign up for Medicare by May 2006, you will get a 1 % per month

penalty for every month you were eligible but failed to register for the

insurance. That means after May 2006, if you waited 3 years before you signed on

for the Medicare drug plan (because you had employer benefits that you suddenly

lost), you would have to pay 36% more for your premiums, coinsurance and

co-pays. Your copay could jump from $10.00 to $13.60, your premium from $50.00

could go to $68.00 and then add 36% to your 25% coinsurance, 25% to your

deductable.... and you begin to see why failure to sign up in a timely manner

WILL COST YOU.

HOWEVER - TO AVOID THE PENALTY - you must receive a LETTER OF CREDITABILITY -

from your current drug care provider that states that the insurance you

currently have is at least as good as the Medicare Drug plan part D. YOU MUST

GET AND KEEP A COPY OF THIS LETTER IN CASE YOU NEED IT. Your current employer or

spouses employer had until NOV 15, 2005 to get you a copy of this letter.

IF YOU DID NOT RECEIVE A LETTER AND YOU HAVE DRUG COVERAGE THROUGH AN

EMPLOYER, CALL MEDICARE AND REPORT THEM. Medicare will see to it that you get

what you need through their resource network. Medicare's phone is 1.

TTY is 1..

MEDICARE WILL ONLY COMPARE 3 COMPANIES PROGRAMS FOR YOU so be sure you narrow

it down to the 3 YOU want to compare, LIKE...the ones who cover your drugs for

example. Do the following research FIRST and then call Medicare to compare your

final 3 choices.

IF YOU HAVE A LETTER OF CREDITABILITY - you won't have to pay the penalty if

you don't sign up for Medicare part D by May 2005 and will be given a 61 day

grace period to find new coverage if and when your current Drug Coverage ends.

This is why you need to KEEP IN A SAFE PLACE your letter of Creditability from

the employer who currently carries your drug plan, if you have one.

2 - DOES IT COVER MY DRUGS? HOW DO I CHOOSE A PLAN?

This is the easy part. Folks already on Medicare received a handbook with all

the plans available to them for their state. In the back, there is a list of the

carriers you can choose from. TO NARROW DOWN THE OPTIONS: go to

www.medicare.gov

On the home page, it offers a FORMULARY FINDER. Select that option.

Choose your state and hit the continue button.

Enter in the drugs you take one at a time under the " A. Find the Drugs by

Name. B. Review the drug list will let you add more or delete something.

When you are done, hit, " continue with selected drugs "

Continue with selected drugs will show you part C. Choose how you want to view

the plans. BE SURE YOU DO THE " CHANGE / UPDATE MY DRUG DOSE AND QUANTITY " which

is the " yes " option. You need to be sure they have the correct dose of your

medication, otherwise, the next information you are offered will not be correct

and could create problems for you later.

When you have selected the update / change option you will be shown drop down

menus that allow you to choose the dose and the times per day / week / month

options. Be meticulous and be sure all of it is correct. Print this list and

then choose " continue with selected drugs. "

The Plan Formulary Finder will show you the drug companies that cover your

current drugs. No need to compare all the others. Print a copy of just the

plans that cover your drugs. If you click on the name of the company that covers

the drug, it will show you the requirements of this company for your drugs.

Things like what tier it is, does it require prior authorizations, have quantity

limits and need step therapy. Print each company plan that covers all your drugs

so you can compare them.

From what I can find out, tier 1 is generic, tier 2 is formulary, tier 3 is

non formulary and any tiers higher than that affect the co-insurance (the amount

you pay in addition to the copay). Prior authorizations means your doctor has to

approve it, limits means there may be a " cap " on how much of a certain drug /

dose / frequency a person can have in a month. Step Therapy means you have to

try Tier 1 and 2 drugs first for this to be covered or to have tried and failed

other drugs and that's why you need this one.

Now that you have the companies listed, look at the possible problems, like

all your drugs are tiers 3 - 6. Many need to have step therapy or prior

authorizations, etc. Look for ones that have the least obstacles to overcome.

GO TO THE MEDICARE AND YOU - DRUG COMPANY OPTIONS IN THE BACK OF THE BOOK.

Look at the plans that cover your drugs and find them in the book. On each page,

look at the deductable, the coinsurance and the copays plue the premiums. I want

NO DEDUCTABLE, Zero co-insurance and LOW copays. I don't care if I have to pay

$60.00 a month premium if I don't have to pay up to 25% of the cost of my mostly

Tier 3 drugs. Kineret = $1400.00 a month. IF the copay is $50 and the

coinsurance is $350.00 that's $400.00 out of pocket for just ONE of my 15

drugs... PER MONTH, after I met the deductable. Won't work for me. No co-

insurance, no deductable, and I pay $40 per month on one plan or $80.00 for 3

months on a plan in my area. When I did the comparison, it was blatantly obvious

which one worked best for me.

HOW MEDICARE PART D WORKS: This is the really tricky part. Basically, it

depends on the plan you choose but here are some of the pitfalls.

Deductables vary per company and must be met BEFORE you get Part D assitance

with your drugs.

You may have to pay a copay AND a co insurance fee for each drug as part of

YOUR costs.

After your deductable is met, when Medicare's drug costs reach $2250.00 for

your medicine, YOU PAY 100% of ALL DRUG costs until your expenses reach $3600.00

our of YOUR pocket. Once you reach this number, your copays and coinsurance

done't go away, they just get reduced a bit.

IF POSSIBLE, GET A COMPANY WITH GAP COVERAGE. This means they help pay the

part you have to pay between $2250.00 and the $3600.00. I am working on finding

out more about the gap coverage between the two companies I am comparing.

WHEN ALL ELSE FAILS OR YOU GET CONFUSED after you have done the " compare the

benefits " you can CALL MEDICARE to compare the 3 companies you have narrowed it

down to. Listed in Medicares Local Plan and Rate Information pages (Chapter 13

in my book) are phone numbers for each company. CALL EACH company that looks

good to you.

CALL THE COMPANIES WHO COVER YOUR MEDICATIONS. Ask the the cost of each tier

listed and jot it down on your list you printed for them. (I found copays for

generics to be $2.00 to 5.00, Formulary from $4.00 - $25.00 and non formulary

from $35 - 40.00 with and without co insurance on top of it. Ask the agent if

they have GAP coverage. Ask them to tell you the answers to the questions you

SHOULD be asking if you knew to ask them. What are the possible drawbacks to the

plan. (you know, the ones they would be concerned with or ask about if they were

getting this for their mom/ grandma) Jot down the answers.

DO NOT just sign up with the person you call. Ask for details about the

plan. You MAY LOSE valuable current coverage if you make the wrong decision.

What I did was exactly what I have described here. I am currently checking on

the gap coverage between 2 plans and waiting for my creditable coverage letter.

There is a plan that covers all of my meds, no deductable and no co insurance.

It's the only plan that has no co insurance but the other plan offers the gap

coverage.

Check with a local insurance BROKER who deals with many plans for help if

needed. I spoke to one this week. I had to make an appointment but it was free.

He said I knew more about the program than he did and he took notes on my

information and resources. The one tidbit he did warn me of that was invaluable

was the GAP coverage. He is currently checking on that with the company I am

looking at.

When you have all the information, call MEDICARE and have them do a comparison

for you. They can get it down to the penny how much it will cost you for each

plan. BE SURE TO CHECK the cost for local scripts versus the cost of a 3 month

mail order. Most of the time, the cost of a local script for a month is doubled

for mail order 3 months but check to be sure.

My current plan is better for the tier 3 non formulary drugs as I only pay

$50.00 for a 3 month mail order, but I pay $30.00 for a 3 month supply of

formulary and generic drugs. The plan I am looking at has $2.00 local / $4.00

for 3 month generics, $20.00 for local month of formulary and $40.00 for 3

months by mail and then the non formulary, which most of mine are - run $40.00

for one month, $80.00 for 3 months. I have quite a few generics too so that

would save me a bundle, despite the premium of about $60.00.I have not decide

yet what I am doing because I am waiting on that LETTER of CREDITABLE coverage.

So... since I have spoken to so many companies and to Medicare at least a

dozen times, I am now confident that I can share with all of you the tips I have

used to make this decision process easier. If you do what I have suggested here,

you should be able to have the task completed in about an hour or two.

Decide what plan works best for you and go for it. I think I will get double

coverage, but Medicare is concerned about people double dipping so to speak so I

have to check that out too. Hoping this helps someone unravel this huge task of

choosing a provider but not knowing where in the blazes to start.

IMPROTANT NOTE: Once you choose a plan, you MAY NOT opt out of that plan

for 1 year. Choose wisely.

Smiles, Caroline the First

Empress of CUS

PS: ALWAYS check with MEDICARE BEFORE joining a plan. If you don't choose one,

Medicare has the option of choosing one FOR YOU and they most likely will choose

the highest bidder and NOT the one who COVERS THE DRUGS YOU TAKE. Your best

option is to choose FOR YOURSELF and not be DESIGNATED a drug company.

LOL NOTE: I did NOT spell check this so just enjoy the typo's. LOL My spell

checker is manual (ME) and I'm too tired AGAIN! LOL LOL LOL You gotta

love it.

(Beautiful Southern Oregon, USA)

We may not be able to change the direction of the wind, but we can adjust our

sails.

May you have enough happiness to make you kind, enough trials to make you

strong, enough sorrow to keep you human, enough hope to make you happy.

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