Medicare Supplements and Prescription Plans
Posted 28 May 2009 - 10:45 AM
I become eligible for Medicare on August 1 via SSDI (what a relief!). I am attempting to navigate the world of supplemental insurance and prescription plans. I spoke with AARP this morning and they were very helpful ... any other resources that other folks have that might be helpful to check into for the best insurance and cost?
Posted 29 May 2009 - 10:16 AM
I also have just become eligible Medicare and the prescriptions plans and here is what I have found.
1 - Contact your state insurance department to find out what medicare supplement programs are eligible to you. This is especially important if you are under 65 as not all medicare plans are available to you. For example, in Florida there are no medicare supplemental plans available as I am under 65 and disabled. In Connecticut, I can purchase Plan A, B and C. These are the only plans that can be sold to me. I believe each state is different.
Also, keep in mind that Medicare covers stem cell transplant -- so when you go to a medicare advantage program, I think that it is the advantage program that now pays for your coverage and you are not using the medicare program. For me, I want to make sure I am in Medicare and don't want to muddy the situation with the advantage program.
2 - As I see doctors in many different states, it is best if I get the medicare supplement and NOT a medicare advantage plan. With a medicare supplement, if the doctor accepts medicare, then they have to accept the supplement as it works in all states. Under the medicare advantage plan, it is only good for doctors in their network as then you have out of network requirements which from what I can see, means limited coverage for those of us under 65 and disabled.
3 - For the prescription plans, I am going to the cheapest plan as most of my drugs are generic and I will get from a local pharmacy, etc.. I set up my drug list, and for me the only drug that has been problematic is the Nexium -- so I am looking for an plan that rates it as a Tier 1 drug; does not need prior authorization; does not need step therapy and and does not limit the quantity. Any of the immunosuppresent drugs will need prior authorization from what I can tell, but for me getting Nexium has been my battle with the insurance company.
Also, if you are under 65 and disabled, keep in mind your deadline to pick something. You only have a 3 month window and not the 6 month window that you would have if you are 65. For the prescription coverage amounts the $2700 and the no gap up to $4300, these amounts reset every calendar year (Jan1). Also, I think you can switch in and out of the Plan D program each fall if you do not like your current provider.
Posted 01 June 2009 - 06:42 PM
I just started Medicare in February. It was a nightmare to figure it out, but now I feel like I know the ins and outs of it. If you want to talk on the phone I'd be happy to do that with you. Send me a private message with your phone number and I'd be happy to call you.
Posted 02 June 2009 - 04:37 AM
I have three drug plans to chose from. I too take Nexium which is not generic. I have one other medication that is not generic so I will talk with my doctor (this morning) about alternatives for that one. Otherwise I'm generic with the rest. And thank goodness Cellcept is now generic. I have mild pulmonary fibrosis.
Thanks again for the great information!
Have a great day,
Posted 02 June 2009 - 06:47 AM
Also remember that if your plan changes during the year or your medications do that every year from November 15 to December 31 you can switch to a different Medicare Part D plan.
There is no Medicare Part C the only reason they didn't name the drug plan Med plan C to stay in alphabetical order is that they thought it would be easier for Senior Citizens to remember "D" for "drugs". Only the government would think of that.
With regard to a supplement in our state there are many to choose from and some are very, very affordable but necessary. Remember this is what pays for the 20% that Medicare doesn't pay so you do need it. You also need to now be asking your doctor before they do a test or procedure "is Medicare going to cover this?". If it doesn't then you are on the hook for the entire 100% of the med procedure, test, or whatever.
I will be doing this in January and then will be able to be dropped off at my husband's plan at work. However before I do that I plan on checking with the University that I deal with that Medicare is taken and eligible for all of the testing and workups that I go through almost on a quarterly basis.
ALSO ANOTHER IMPORTANT THING TO KNOW:
Depending on your income your Medicare Part D plan may be free to you. This will be determined when you submit your application for the plan you pick. The government automatically goes by your Social Security Number to see if your income falls in that range. If so, then this Part D is free.
Also, if your qualify for this then you maybe also qualify for the government to be picking up the cost for Medicare Part B that they will begin taking out of your check once you go on Medicare. This right now I believe is $98.00. To find out if you qualify for that go to your local Social Services Department or Social Security office and fill out the paperwork to see if you qualify. This would be a huge savings for some people also.
Wow, I got to discuss stuff that I used to do a year and-a-half ago before I quit selling insurance because of this disease. That felt kind of good.
Posted 04 June 2009 - 05:16 AM
Jefa and Peggy gave you great information that should really help.
Another thing... some of the pharmaceuticals even offer medication to those who fall under the proper guidelines. Again, I'm sure the social security office will be of great help to you. I've had the good fortune of talking to really wonderful folks any time I've needed their help.
Posted 09 July 2010 - 05:30 PM
Open enrollment is the time when you are allowed to enroll in Medicare for the first time and you have many options to assess. Your Medicare open enrollment will happen the day you turn 65 AND are enrolled in Medicare Part B. Insurance companies must adhere to some specific rules at this time in reference to Medical underwriting, here are a few of the rules they must adhere to:
• They cannot refuse to sell you any Medigap policy they sell. If a policy was available to be sold to anybody else it has to be available to you too, regardless of your situation.
• They cannot make you wait for coverage to start, it must start the day that you are eligible under Medicare rules. There is no default time in which you must wait for your coverage in order to qualify.
• They cannot charge you more for a Medigap policy because of your health problems. This is significant because many insurance companies will do this on standard plans in order to avoid paying for something that was pre-existing.
You have the right to have all of these things done for you, if you feel an insurance company is not adhering to these rules you need to call your local department of insurance.
Posted 10 July 2010 - 07:32 AM
Posted 11 July 2010 - 06:40 AM
Welcome to the forum and thank you for the informative post. I'm in the UK but I know that medical insurance can be a complicated issue in the US.
Take care and keep posting.
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