Medicare Plan D

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jonbois
Posts: 87
Joined: Mon Mar 26, 2012 1:19 pm

Medicare Plan D

Post by jonbois »

Need to enroll in a stand alone Medicare Plan D the first of the year. I already have medicare A and B.
Any recommendations or things I should be aware of?

JB
dbr
Posts: 46181
Joined: Sun Mar 04, 2007 8:50 am

Re: Medicare Plan D

Post by dbr »

If you already know that you have significant medication needs you should check the pricing and coverage in specific plans for those particular medications. Most plans have an online capability to enter your medication plan.
Boats day
Posts: 83
Joined: Thu Mar 06, 2014 10:39 am

Re: Medicare Plan D

Post by Boats day »

I used the medicare.gov web site. You plug in your current perscriptions and it will give you some costs.

Then variable that you should consider is "WHAT IF you get really sick and your Doc prescribes a tier 3 4 or tier 5 drug what will the plan cover.
You can plug in some of these expensive drugs and see what your coverage and maximum out of pocket costs would be. For example I am on Enbrel and when I was covered
by C mpany plan I was Only paying a small deductible when I retired and went on a part d plan My out of pocket costs jump to $4800 per year. YIKES

Google tier 3 4 and 5 drugs and just plug them in to figure what your out of pocket costs would be. Of course you could ask your doc what drugs may be used for various chronic
conditions you like cancer etc.

Good luck
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cheese_breath
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Joined: Wed Sep 14, 2011 7:08 pm

Re: Medicare Plan D

Post by cheese_breath »

dbr wrote:If you already know that you have significant medication needs you should check the pricing and coverage in specific plans for those particular medications. Most plans have an online capability to enter your medication plan.
Be sure to price it out with several different pharmacies because some plans have different prices for different pharmacies.
The surest way to know the future is when it becomes the past.
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Grandpaboys
Posts: 878
Joined: Sun Mar 04, 2007 8:16 am
Location: Texas

Re: Medicare Plan D

Post by Grandpaboys »

Plan D is the worst thing to hit seniors get ready to pay thru the nose for the exorbitant prices from the
Drug companies. Problem is there is no way around it.
Good Day | GP
kaneohe
Posts: 6786
Joined: Mon Sep 22, 2008 12:38 pm

Re: Medicare Plan D

Post by kaneohe »

Boats day wrote:
Then variable that you should consider is "WHAT IF you get really sick and your Doc prescribes a tier 3 4 or tier 5 drug what will the plan cover.
You can plug in some of these expensive drugs and see what your coverage and maximum out of pocket costs would be. For example I am on Enbrel and when I was covered
by C mpany plan I was Only paying a small deductible when I retired and went on a part d plan My out of pocket costs jump to $4800 per year. YIKES

Google tier 3 4 and 5 drugs and just plug them in to figure what your out of pocket costs would be. Of course you could ask your doc what drugs may be used for various chronic
conditions you like cancer etc.
This is a good idea. I had done worst case analysis w/ medical plans where it seemed easy. However I had never done it w/ drug plans because I didn't know what drugs to plug in.
Are tier 3 driug costs generally grouped together and lower than tier 4 and similarly for tier 5? Just for fun, I plugged Enbrel in and discovered that mail order can be more expensive than a local pharmacy, a result that surprised me since mail order has usually been much less than the local pharmacy for me.
vested1
Posts: 3497
Joined: Wed Jan 04, 2012 3:20 pm

Re: Medicare Plan D

Post by vested1 »

Boats day wrote: Mon Sep 08, 2014 12:24 pm I used the medicare.gov web site. You plug in your current perscriptions and it will give you some costs.

Then variable that you should consider is "WHAT IF you get really sick and your Doc prescribes a tier 3 4 or tier 5 drug what will the plan cover.
You can plug in some of these expensive drugs and see what your coverage and maximum out of pocket costs would be. For example I am on Enbrel and when I was covered
by C mpany plan I was Only paying a small deductible when I retired and went on a part d plan My out of pocket costs jump to $4800 per year. YIKES

Google tier 3 4 and 5 drugs and just plug them in to figure what your out of pocket costs would be. Of course you could ask your doc what drugs may be used for various chronic
conditions you like cancer etc.

Good luck
I did a search on Enbrel and found this thread from a few years back. I'm reviving it in hopes that what I found with my wife's impending entry into Medicare in July of 2018, will provide an additional option for those in our position who still have company provided health insurance and also need expensive drugs. We are both retired. If my wife went off Enbrel she would likely be in a wheelchair within a year.

I'll preface this to say that I transitioned to Medicare in July of 2017 (my wife and I share the same birthday 1 year apart). I cancelled my company provided insurance because it was getting too expensive and covered only a fraction of what my wife's covers. We currently pay $177 a month for her insurance, which also covers me as Medicare supplemental. I have Medicare parts A and B only. Her insurance is "creditable" as proven by a letter sent to us saying that the prescription coverage in equal to or better than Medicare part D, and that if we signed up for part D it would void our insurance through her previous employer with BCBS (Blue Cross Blue Shield).

We have been using a "debit card" provided by the makers of Enbrel, Amgen, which makes our co-pay for a three month's supply only $10 (1 injection a week of Sureclick). The cost of the medicine is $13,232 every 90 days, or $52,928 a year without insurance. The debit card from Enbrel does not consider income or assets, and is based on your being a citizen and the type of your existing insurance, if any, which in her case is classified as "commercial". If you have any form of governmental provided prescription insurance, such as Medicare Part D or any prescription insurance provided by the State you are not eligible for the card. Enbrel was sued by a competitor and was forced to revoke the cards of those who transitioned to governmental insurance as a compromise to level the playing field. We were facing a possibly large increase in prescription costs when my wife went on Medicare because of this. An insurance salesman who had been pestering me showed up at our door uninvited, so I took the opportunity to ask him what his company could provide us next July due to our circumstances. His quote for supplemental insurance at Medicare was $380 for us with a co-pay for Enbrel of $550 a month, for a total of $930 a month, plus 2x $134 a month for Medicare parts A & B. That would add up to $14,376 a year in addition to other out-of-pocket expenses.

After about 4 hours on the phone with my wife's insurer, the CVS Specialty department, and Enbrel, we were told that my wife can continue to get the free Enbrel discount card with the same $10 co-pay after she goes on Medicare. We don't need Medicare part D because her insurance is "creditable", in fact if we did get part D we couldn't have her insurance or the card. Our total insurance costs after next July will be $5,340 a year, with a likely small increase every year as we age. If my wife were to die, or if her very generous insurance ever changed we could transition to Medicare Part D with no penalty for signing up late because we have the letter of "Credit-ability".

This post isn't for gloating purposes, but once again, is merely a lifeline tossed to anyone who might find themselves in a similar situation when facing the onset of Medicare. We are extremely lucky.

(Sorry for the repeated editing. Proofreading is your friend). :happy
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