Medicare Choices

[Another Reader]

Dovetailing on this, which drug plans are best? Who will be most generous in picking up those costly cancer drugs and less difficult about making you try all the cheap drugs before paying for the one that works?

 

[REWahoo]

No way to know which Part D (drug) plan is best for you until you go through Medicare.gov and plug in your zip code and the actual drugs you take (if any). That will let you know what plans are available in your area and what each plan costs.

The good thing about Part D is you can change to whatever plan you want during open enrollment each year. This allows you to move to another plan should it offer lower premium/prescription costs for your specific drug requirements.

Even if you take no prescription meds you need to enroll in the lowest cost plan available as a "place holder". This will prevent you paying a penalty on future Part D premiums for failure to enroll in a plan during your initial eligibility period.

 

[Another Reader]

No way to know which Part D (drug) plan is best for you until you go through Medicare.gov and plug in your zip code and the actual drugs you take (if any). That will let you know what plans are available in your area and what each plan costs.

The good thing about Part D is you can change to whatever plan you want during open enrollment each year. This allows you to move to another plan should it offer lower premium/prescription costs for your specific drug requirements.

Even if you take no prescription meds you need to enroll in the lowest cost plan available as a "place holder". This will prevent you paying a penalty on future Part D premiums for failure to enroll in a plan during your initial eligibility period.

I don't care about the cost, I care about how the insurance company behaves. If they are going to drag their heels on expensive drugs and expect me to try drugs that are not as effective or have side effects before allowing me to get the more expensive but better drug, I want to avoid that company. I will pay a higher premium to minimize these problems.

 

[kaneohe]

Through DH's former employer I will get a HRA account of a little over $2k when I turn 65. I can use that to apply to my Medicap or Part D plan. The catch is that I must use the OE exchange to buy the plan to get the HRA reimbursement. If I buy non-OE I get nothing. If not for the HRA I would probably get an AARP Medigap supplement. I guess I can get a part D plan through OE but it is unlikely to have high enough premiums to cost over $2k since I take no regular medications at all and would normally just buy a really inexpensive prescription plan. If I use it for my Medigap plan then I will have to get something other than AARP which I guess is what I will likely end up doing...

Have you talked to OE about the AARP supplement? I don't think it's advertised on their site but many yrs ago when we got the HRA, I called OE
and they were able to get it for me for the same price as I could it directly with UHC and I get reimbursed for that and Pt B Medicare.

 

[Katsmeow]

Have you talked to OE about the AARP supplement? I don't think it's advertised on their site but many yrs ago when we got the HRA, I called OE
and they were able to get it for me for the same price as I could it directly with UHC and I get reimbursed for that and Pt B Medicare.

I haven't talked to them yet. I know I just have to buy through them to get HRA benefit. I don't turn 65 until next year so will look at it more closely then.

 

[MBSC]

I don't care about the cost, I care about how the insurance company behaves. If they are going to drag their heels on expensive drugs and expect me to try drugs that are not as effective or have side effects before allowing me to get the more expensive but better drug, I want to avoid that company. I will pay a higher premium to minimize these problems.

Who will be most generous in picking up those costly cancer drugs and less difficult about making you try all the cheap drugs before paying for the one that works?

This is called 'step therapy'. Once you have a list of plans that cover your current needs, you can go to their website and view their step therapy drugs and criteria. For example, the Express Scripts step therapy drug list and criteria are half-way down this page. https://www.express-scriptsmedicare.com/medicare-part-d-covered-drugs.shtml

Alternatively, if you know of self-administered drugs that are routinely subject to step therapy you can enter them into the Medicare Plan Finder. The results page has a Yes/No field for Drug Restrictions. Click on the blue 'yes' link to see if the restrictions for that particular drug/plan combo include step therapy.

Part D coverage is generally limited to self-administered drugs. Some cancer drugs must be administered intravenously in a clinic setting. These are generally covered under Part B/Medigap and will not appear on the Part D plan's formulary.

 

[jimandthom]

Anyone else with FEHB (federal govt retiree) and Medicare? I took Part A only, and not Part B. I feel comfortable with this decision.

Haven't decided what to do yet. Each hit 65 next spring. We may take both, but go with Aetna Direct versus our present Rural Letter Carriers. Aetna gives a $900 reimbursement account per person yearly and you can bank it up or send in for B reimbursements.

Someday, I expect that all FEHB will be required to take B. My dads company did that in the 90s and then provided a partial reimbursement for B costs instead.

 

[John Galt III]

I went to the medicare.gov website and got to the 'view all medigap policies' page. It shows policies A through N. Each policy has an $8,XXX 'annual estimated cost', which is more than the annual cost of the premiums for part B and the medigap policy. Looks like a typical premium cost for one year would be $4,000 (combined part B plus medigap) which leaves $4,XXX in non-premium costs. Even in policies which cover part a and part b deductibles, and the 20% coinsurance. Wonder what costs they are thinking about here.

 

[REWahoo]

Wonder what costs they are thinking about here.

From the Medicare.gov website Glossary.

 

[kaneohe]

I went to the medicare.gov website and got to the 'view all medigap policies' page. It shows policies A through N. Each policy has an $8,XXX 'annual estimated cost', which is more than the annual cost of the premiums for part B and the medigap policy. Looks like a typical premium cost for one year would be $4,000 (combined part B plus medigap) which leaves $4,XXX in non-premium costs. Even in policies which cover part a and part b deductibles, and the 20% coinsurance. Wonder what costs they are thinking about here.

Click on the link for a plan e.g. Plan F . You will end up with a chart showing
some details. Near the top of that page in the first box is a link "View Details". If you click on that you get https://www.medicare.gov/find-a-plan/staticpages/medigap-out-of-pocket-costs.aspx

a page with more details that supposedly represents some average costs for
the population. Looks like, in this case, almost $400/mo for Rx drugs which
sounds high.

 

[Ian S]

Folks considering an "F" Medigap policy should also look at a "G" policy which is identical to "F" except you have a deductible to pay. Often though, the cost of the deductible plus the annual premiums for the "G" is less than the cost of the "F" premiums alone.

 

[kaneohe]

Folks considering an "F" Medigap policy should also look at a "G" policy which is identical to "F" except you have a deductible to pay. Often though, the cost of the deductible plus the annual premiums for the "G" is less than the cost of the "F" premiums alone.

plus the fact that the F plan will be closed to new applicants in a few yrs and
the the expectation that the closed aging pool in F will have higher expenses and thus higher premiums w/o the incoming youngsters.

 

[meierlde]

plus the fact that the F plan will be closed to new applicants in a few yrs and
the the expectation that the closed aging pool in F will have higher expenses and thus higher premiums w/o the incoming youngsters.

If G is offered in your area. In my area 2 years ago UHC only offered plan F.

 

[NoMoreJob]

UHC does offer Plan G in my area. I purchased it a little over a year ago.

The Part B deductible is about $185. My premiums for G were about $220 less than Plan F. Since the only difference between F and G is that I pay the deductible instead of the supplement I chose G.

I have no idea if the pool for F aging faster than the pool for G will make a difference in premiums but it makes sense that it would - providing the policies are priced based on the claims experience of the policy's own pool.

 

[MBSC]

UHC/AARP allows Plan F members to downgrade to Plans G/N with a simple phone call to customer service. No underwriting. The change becomes effective the following month.

If the annual Part B deductible was already covered by F, you do not have to meet it again when switching mid-year.

 

[Ian S]

UHC/AARP allows Plan F members to downgrade to Plans G/N with a simple phone call to customer service. No underwriting. The change becomes effective the following month.

If the annual Part B deductible was already covered by F, you do not have to meet it again when switching mid-year.

That's exactly what I did last year when the AARP G plan became available.

 

[audreyh1]

UHC/AARP allows Plan F members to downgrade to Plans G/N with a simple phone call to customer service. No underwriting. The change becomes effective the following month.

If the annual Part B deductible was already covered by F, you do not have to meet it again when switching mid-year.

That's useful information! Thanks again.

So UHC administers the AARP Medigap plans?

 

[Another Reader]

Yes, UHC administers the AARP plans.

There must be a reason it's so easy to switch, one that benefits UHC. Once you switch, you probably can't go back.

 

[audreyh1]

Yes, UHC administers the AARP plans.

There must be a reason it's so easy to switch, one that benefits UHC. Once you switch, you probably can't go back.

Well, its essentially the same plan, only Plan G has a small deductible, and Plan F is going to be phased out in 2020 for new Medicare enrollees. So switching back won't be an option anyway in a couple of years.

 

[NoMoreJob]

Well, its essentially the same plan, only Plan G has a small deductible, and Plan F is going to be phased out in 2020 for new Medicare enrollees. So switching back won't be an option anyway in a couple of years.

Actually Plan F pays the Medicare part B deductible, Plan G does not. That deductible typically increases a little bit each year and is currently within a dollar or two of $185 per year.

 

[Another Reader]

In my zip code, per the Medigap policy finder on Medicare.gov, no AARP/UHC Plan G is offered. Only Plan F. On the AARP/UHC site, both F and G are offered in my zip code. More reason to distrust Medicare.gov.

 

[NoMoreJob]

Yes, UHC administers the AARP plans.

There must be a reason it's so easy to switch, one that benefits UHC. Once you switch, you probably can't go back.

I was talking with a broker who does a lot of Medicare supplement business. He mentioned that UHC is much more lenient than many other companies with regard to switching plans. He also mentioned that allowing switching is at the discretion of the carrier (not required by Medicare) and that UHC is free to change its policies in the future.

 

[NoMoreJob]

In my zip code, per the Medigap policy finder on Medicare.gov, no AARP/UHC Plan G is offered. Only Plan F. On the AARP/UHC site, both F and G are offered in my zip code. More reason to distrust Medicare.gov.

I think it's always best to go directly to the primary source. There's always chances of mistakes, omissions, etc. when one site is relaying information from the other.

 

[audreyh1]

Actually Plan F pays the Medicare part B deductible, Plan G does not. That deductible typically increases a little bit each year and is currently within a dollar or two of $185 per year.

I just meant that with Plan G the patient pays a (Medicare part B) deductible.

 

[Ian S]

In my zip code, per the Medigap policy finder on Medicare.gov, no AARP/UHC Plan G is offered. Only Plan F. On the AARP/UHC site, both F and G are offered in my zip code. More reason to distrust Medicare.gov.

AARP/UHC has only recently (within the last year or so) started offering the G plan so it may be that the medicare.gov info has just not been updated. Still you're probably better off sticking with the insurer websites for the most up to date and accurate info.