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Wow medicare part D is tricky
Old 05-21-2013, 08:59 PM   #1
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Wow medicare part D is tricky

I take no meds at this time but have to decide real soon on a drug plan,just started to really look into it.
What I see is best to have a good formulary,if you are stuck with a brand name drug not on the formulary,you have to pay for all of it no help.
The AARP preferred for 37.50 a month seems real good. Here are some very expensive drugs that are on the list,so expensive you hit the donut whole by the third month,total OPP 5300 for 57,000 retail cost.
With the 15 a month plan you would pay a lot more,of course if you never need any drugs then the 15 a month plan is great. But at some point,you may need some very expensive ones.
I still have my wits about me,but this is still pain to figure out all the ramifications perhaps better safe then sorry.
I had a nice chart but it did not format correctly.
Old Mike


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Old 05-21-2013, 09:23 PM   #2
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Being able to afford meds in retirement is pretty tough. Their cost when not covered by insurance is completely insane!

Sorry, I know you know that but I just wanted to vent!!! I don't know much about Part D. I have federal retiree health insurance that covers drugs, and they tell me that because of that I don't need Part D. Even so, medications sure add up. I guess I should feel lucky that I am only paying $91/month for my long term prescriptions.

You have to have some sort of drug coverage, though, IMO. If your health declines you will want to have the more expensive option, I'd think.
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Old 05-21-2013, 09:33 PM   #3
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Part D is important to sign on with, even if you only need one drug (like me). If you don't sign on when Medicare allows, signing on later may be a problem.

Its a crap shoot with Part D plans; we initially went with Cigna Level II and paid a lot for my wife's many drugs. This year we switched plans and our costs are much less for the same drugs (go figure!). I ended up with a new plan with no deductible since my drug needs are few. Wife pays $325/yr deductible.

Medicare has a very good plan evaluator on their site. Saved us a bundle.
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Old 05-21-2013, 09:45 PM   #4
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Originally Posted by mf15 View Post
With the 15 a month plan you would pay a lot more,of course if you never need any drugs then the 15 a month plan is great. But at some point,you may need some very expensive ones.
What you need to remember is you can change to another more suitable Part D plan should you end up taking meds not favorably priced in the $15 Part D plan.

I don't take any prescription meds and went with the lowest cost plan available knowing I can change to another plan in the future. You can only choose a new Part D plan during the open enrollment period at the end of each calendar year, but there are no pre-existing condition requirements or other limitations.

Understanding Medicare Part C & D Enrollment
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Old 05-22-2013, 05:53 AM   #5
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This will get better. The "donut hole", or cost share will be phased out over the next 7 years. Over the same period pharmaceutical companies must discount the list prices they were charging. Medicare D is one of the few areas the PPACA reforms directly affect Medicare.
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Old 05-22-2013, 12:22 PM   #6
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This will get better. The "donut hole", or cost share will be phased out over the next 7 years. Over the same period pharmaceutical companies must discount the list prices they were charging. Medicare D is one of the few areas the PPACA reforms directly affect Medicare.
Phasing out the donut hole is irrelevant if the formulary for your Part D plan doesn't cover the drug you need.
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Old 05-22-2013, 12:44 PM   #7
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It is basically too confusing to bother with. IF you use few drugs or only common generics, a reasonable plan is to go with whatever is cheapest in your area, as a placeholder. If you suddenly have to start using some expensive medicine, like REW said it can't last longer than one year since you can change plans annually.

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Old 05-22-2013, 01:30 PM   #8
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When to take Social Security, how much LTCG to take, Roth conversion or none. Reduce tIRA before RMD's, staying under the PPACA income cliff, now in three years what medicare plan to take. I give up.
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Old 05-22-2013, 01:37 PM   #9
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It is basically too confusing to bother with. IF you use few drugs or only common generics, a reasonable plan is to go with whatever is cheapest in your area, as a placeholder. If you suddenly have to start using some expensive medicine, like REW said it can't last longer than one year since you can change plans annually.

Ha
This is the best action plan I have seen and has the added benefit of being relatively easy to implement.

So summarize: During open enrollment, pick the cheapest plan (premiums + co-pays, etc.) given current set of drugs; repeat during each open enrollment period.
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Old 05-22-2013, 01:44 PM   #10
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This is the best action plan I have seen and has the added benefit of being relatively easy to implement.

So summarize: During open enrollment, pick the cheapest plan (premiums + co-pays, etc.) given current set of drugs; repeat during each open enrollment period.
Yes. That's exactly what I am doing.
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Old 05-22-2013, 02:13 PM   #11
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I've mentioned in other threads on the subject of prescription drug cost, how important it is to check out all available sources for cost of your drugs. Some of our drugs are the same price or a little more at WalMart as they are with our prescription drug plan; however, it you buy them at WalMart (or Costco, Sam's or some other place) the plans cost does not come into play, hence no effect on the donut hole. Example, Metformin (for diabetes), diclofenac (for arthritis) cost $16 for a 90 day supply. They are free through our drug plan but the plans cost is added to out running total toward the donut hole. For these low costs I would rather they have no effect on the donut hole.
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Old 05-22-2013, 06:23 PM   #12
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All good tips,thanks. First health looks pretty good.28.20 month zero deductable,reasonable formulary. Since I am on no meds right now,no problem.
But who knows what the future holds. Interesting what might happen,first health is owned by by coventry,coventry was just bought out by Aetna.
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Old 05-23-2013, 07:05 AM   #13
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This is the best action plan I have seen and has the added benefit of being relatively easy to implement.

So summarize: During open enrollment, pick the cheapest plan (premiums + co-pays, etc.) given current set of drugs; repeat during each open enrollment period.
But what will you do if something happens that you need to take expensive medication.

I thought that is what insurance is for: Unforseen events.
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Old 05-23-2013, 07:20 AM   #14
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But what will you do if something happens that you need to take expensive medication.
The other side of that question is how do you know if the plan you choose will cover the cost of your unknown expensive medication?
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Old 05-23-2013, 07:41 AM   #15
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The PPACA did include a new "must carry" mandate for certain categories of drugs. From BCBS
Quote:
Protected Classes. CMS shall designate the classes of medications that should be included in the “protected” classes in Part D, and in the interim, prior to a rule regarding these classes, the current 6 classes will be codified. Beginning 2011, requires all Part D sponsors to cover all drugs in the 6 protected classes (currently they have to cover “all or substantially all”). (PPACA § 3307)
This does not resolve the issue but does make it less likely to have a prescription that is not covered by Medicare D.
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Old 05-23-2013, 09:56 AM   #16
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Here is a case of my own meds.
Had prostatitis,3 years ago,took generic flomax,tried 3 different brands all had side effects I did not like,switched to brand name Flomax much less side effects.
Even with corporate health insurance I had to pay full price out of my own pocket,but it was worth it. Anyhow prostatitis gone.

In my zip for part D,entering brand name Flomax only turns up 2 plans with it in the formulary,and they are expensive plans 113/month and up. You could only get real Flomax on other plans by a formulary exception,how often does that happen,don't know.

As it works out retail drug cost 2152.
For hi cost plan you pay 2198.
Low cost plans not on formulary you pay about 2344 with the cheap
15 a month aarp plan. So you pay retail plus plan cost,the expensive plans the cost per month is so hi it eats up any savings from the fact they cover the drug. Brand Flomax is only 180 a month not real expensive as far a drugs go like biologics,but you can see what a mess this system really is. They are going to push generics of course to save money, I can see that,but all the equivalence testing in the world between brand and generics,at least on Flomax will not convince me that the generic is equivalent. I digress.

The mess in the system is forcing seniors, some perhaps older and not too sharp anymore to go through this maze of commercial drug plans and try and figure out what the hell is going on. Going with the cheapest plan and reduced formulary not great,the most expensive plans not great, somewhere in the middle probably might be best. Also part of the mess is that the plans can change drugs on the formulary,and tiers at will,yes they are required to notify,but this still might add another layer of confusion for older folks.

I can see now that I am close to being in the system,I don't like what is going on.

Anyone know if to get the united healthcare part D plans if you actually
have to join AARP.
Old Mike
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Old 05-23-2013, 10:17 AM   #17
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A help with the donut hole. Try goodrx.com.

This site has arrangements with most pharmacies. It is not insurance. You enter your drug, dosage amount, number of pills and zip code. It displays a map of pharmacies in your area, the cost of the drug, and if a coupon is needed. You print the coupon from the site.

I'll need to deal with this situation next year. Luckily, I am taking 2 drugs that are fairly common and reasonably priced.

-- Rita
PS, I use this site for prescriptions for my dog (yes most pharmacies now carry common drugs prescribed for pets!)
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Old 05-23-2013, 11:46 AM   #18
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But what will you do if something happens that you need to take expensive medication.

I thought that is what insurance is for: Unforseen events.
I plan to self insure for the potential of expensive medication until next open enrollment. As others have mentioned, no grantee that just choosing a more expensive plan's formulary will cover whatever I might need anyway. So, for me, the guaranteed expense increase in premiums is not worth the small decrease in probability of large occasional drug expense.

I do not consider Medicare programs to be strictly insurance in the same since as life and casualty which are closer to real pooled risk vehicles. Medicare programs also have a social welfare aspect in my opinion and cannot be considered exactly the same as other insurance.
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