Kinda off topic

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debrajo
debrajo Member Posts: 1,095 Member
in Uterine/Endometrial Cancer #1

Question about Medicare Part D.  I wont be able to be on SS or Medicare til this Dec.  My husban, who is older, is on both now.  He takes ONE medication(the rat fink!) which is part of the deduction of the Part D.  How does that work?  I take several medications daily.  Do they deduct some for each med, it is after a certain amount of perscriptions, do they take out more of the SS if the med is expensive?  I know some of you are on Medicare, but I just can't seem to find out how many medications I can take that Part D will pay for and how many I will still have to pay out of pocket.  Thanks all, Debra

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  • Lou Ann M
    Lou Ann M Member Posts: 996 Member
    #2
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    Medicare

    I have Medicare Blue Cross Blue Shield that includes part D.  Still confuses me. It seems though that it works like most insurance perscription plans.  They have 4 tiers of Of drugs going from generic which are the cheapest up to more specialized drug that have a less deduction. My plan does not have a deductible.  Some have to be pre approved.  I don't have any that are free but I have several prescriptions that cost just a couple of Dollars for a months supply.  I had one perscription turned down because it was not their preferred medication, but I could get a similar drug in its place.  There doesn't seem to be a limit as I have numerous prescriptions.  They do send out a book at the beginning of the year with a list of all meds and what tier they decided to put them in. Once a month they send out a list of changes.  They have something called a donut hole where they don't pay until you get o a certain amount, but I have never gotten even close that amount and don't understand it at all.  Now this is all,as clear as mud isn't it.  I wish I could give you a better discription.  Lou Ann

    Differnent state and even different counties have different plans.  I have only one plan available in the counties where I live and it has a premium . My mother lived in a different state and she had a plan ith no premium and quite a bit of free services like free rides for dr. Appointments.  My mother in law in yet another state has deductibles with her plan.

  • Sandy3185
    Sandy3185 Member Posts: 229 Member
    edited May 2016 #3
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    Medicare

    I have been on Medicare for 5 years now. I have always had a Medicare HMO that included the part D prescription coverage. As LouAnn said they all have different tiers of medication- preferred generic, generic, preferred name brand and non preferred name brand. I have been pretty lucky as almost all of my medications fall into the tier 1, which are free. There is no limit to the amount of medication that is covered, but there is a $$ limit. Once you pass that amount( which is figured using the $ amount the insurance allows for the medication, NOT what the pharmacy charges) you fall into the "donut hole" where there is no coverage although the pharmacy is limited to charging you what your insurance company would pay, not the full cost. I forget what happens after you pass the $$ max in the donut hole but I know you still pay a lot!

    I am not familiar with plans that just cover medication or Medicare supplement policies as I have always belonged to an HMO. Here in Florida we have a pretty wide selection of HMOs although they vary from county to county. I used to live in Miami and they definitely have some of the best plans I've seen and a very wide choice of carriers. I would recommend doing a lot of research before you decide on a definite course of action. Make sure your doctors and hospitals are on the plan, see how and what medications they cover etc.  There can be a wide variance and the plans all change from year to year.  If you Google Medicare you'll see a govt website that lists all the plans in your area, gives info about the plans as well as rating by the plan users and links to get more detailed info about each of the plans. You can look now, but you will only see info about 2016. In the fall they will update with info about next year.  Good Luck! Sandy

  • debrajo
    debrajo Member Posts: 1,095 Member
    edited May 2016 #4
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    Oh Lawd!

    Thank you both!  This is harder than I expected!  I take Eliquis which is 545.00 a month without insurance, Invokana which is 349.00 a month, Lantus which is 295.00 a month and several I just THOUGHT were high...Pravastatin, and several others I can pay out of pocket.  I have checked the supplement insurance  with M.D. Anderson and the only one they could say they don't have problems with is AARP.  Looks like I can't afford to die!  I'll keep looking and go plant myself down at the SS office closer to Dec.!  Thanks again, Best, Debra

  • CindylovesMike
    CindylovesMike Member Posts: 50
    #5
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    Did you ever figure out your meds

    I have the same problems I am on medicare and I had to quit lantis and go on human insulin walmart brand 25 bucks a vile alittle harder not a pen. still costs me 100 a month for insulin. My doc would like to start me on victoza, it is just to darn expensive. I had just started chemo the same time my medicare started I bought a good supplemetal ins. I had no trouble it covered the chemo and nuelasta shots. It is the meds that are the problem.

  • debrajo
    debrajo Member Posts: 1,095 Member
    #6
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    @ Cindy

    I haven't quite got it figured out yet.  The drugs keep changing tiers, by brand, generics( like Eliqest 545.00, changed to warfin which is old, and works about the same, @ 8.00 month.  Stopped the pravastin(160.00 a month) taking my chances.  Seems like the ones to ask for sure are the pharmacy tecs and the drugest.  They run the SS payment and you get to pay the rest...or not.  I'm still paying out of pocket, still not sure how much more money ss takes out for how many scripts, ect.  I am going to go see the tecs and get them to work their voodoo, and deal with the husbands wrath when the SS check is cut!  Good luck!  I will let you know if I ever figure it out!  Best, Debrajo

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