Medicare part D

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tc101
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Medicare part D

Post by tc101 » Wed Dec 29, 2010 11:29 am

How do you make decisions about Medicare part D? A friend asked me to research this for her 85 year old father, who is in pretty good health, but recently had to pay $200 for an antibiotic prescription.

I have two basic questions:

1. Is Medicare part D a good idea for everyone? If not, how do you decide?

2. How do you shop for the best plan? We are in Georgia. When I put my father on it years ago, I asked a friend who was a pharmacist and he told me which one to use. I have since lost touch with that friend, and I think most pharmacists would be forbidden from telling you the best plan.
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Mel Lindauer
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Re: Medicare part D

Post by Mel Lindauer » Wed Dec 29, 2010 11:37 am

tc101 wrote:How do you make decisions about Medicare part D? A friend asked me to research this for her 85 year old father, who is in pretty good health, but recently had to pay $200 for an antibiotic prescription.

I have two basic questions:

1. Is Medicare part D a good idea for everyone? If not, how do you decide?

2. How do you shop for the best plan? We are in Georgia. When I put my father on it years ago, I asked a friend who was a pharmacist and he told me which one to use. I have since lost touch with that friend, and I think most pharmacists would be forbidden from telling you the best plan.
Go on the link below and then click on "Compare plans" at the bottom. Then plug in your Dad's location, drugs and preferred drug store and let the program do the comparison and show you the results.

http://www.medicare.gov/navigation/medi ... art-d.aspx
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sscritic
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Post by sscritic » Wed Dec 29, 2010 11:44 am

If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.
from Mel's link

I presume he was eligible in the past and chose not to enroll. Did he have other coverage?

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tc101
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Post by tc101 » Wed Dec 29, 2010 3:05 pm

Thanks for your help. It looks like that site does everything, including letting you sign up.
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LarryG
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Post by LarryG » Wed Dec 29, 2010 4:32 pm

I have not enrolled in part D in the past because my diabetic medications were paid in full by my medicare supplemental insurance.

This year because of the possibility of needing expensive medication, I decided to enroll in part D.

I'm sure that my total cost will be higher, but I think of it as insurance. I hope that I don't need the high cost medication (chemotherapy) but if I do, it will be covered by part D.

I carry insurance on my house and I don't wish to have a fire so that I can collect.

LarryG

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tc101
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Post by tc101 » Wed Dec 29, 2010 7:58 pm

We just signed up for my friends father. It was not all that expensive. $35/month I think. After my original post I learned he is taking some memory drugs that cost $200/month, so this should save him a lot unless I misunderstand how it works.
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supersharpie
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Re: Medicare part D

Post by supersharpie » Wed Dec 29, 2010 8:06 pm

tc101 wrote:How do you make decisions about Medicare part D? A friend asked me to research this for her 85 year old father, who is in pretty good health, but recently had to pay $200 for an antibiotic prescription.

I have two basic questions:

1. Is Medicare part D a good idea for everyone? If not, how do you decide?

2. How do you shop for the best plan? We are in Georgia. When I put my father on it years ago, I asked a friend who was a pharmacist and he told me which one to use. I have since lost touch with that friend, and I think most pharmacists would be forbidden from telling you the best plan.
I am a Social Security Claims Representative. I recommend to my interviewees that they contact their state's SHIP (State Health Insurance Assistance Program) for help in making Medicare decisions. Federal employees (including Medicare employees) are barred from providing advice due to the joint private-public nature of the program.

SHIP volunteers, OTOH, are free to offer advice on Medicare enrollment and coordination. They tend to specialize in matters pertaining to Medicare Part D.

You can set up an appointment for your mother to meet with a SHIP rep to discuss her Part D options. She will be asked to bring a list of her medications with her.

Georgia's SHIP is called GeorgiaCares, here is a link to their website:

http://www.mygeorgiacares.org/

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nisiprius
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Post by nisiprius » Wed Dec 29, 2010 8:28 pm

I brooded about this and fussed about it at length. You probably don't want to slog through it but the thread is here. The conclusions I came to with the help of other Bogleheads are that:

a) You absolutely need Medicare Part D for one reason alone: the "catastrophic" coverage that kicks in when your total out-of-pocket cost for the year hits, I think, $5100 or something like that. Just for laughs, I told Medicare's website to suppose I am taking--it gives me shivers just to type these in--Actimmune, Avastin, Humira, and Zyprexa. Sure hope I'll never need any of them in real life. With those answers, it told me without Part D, my estimated annual drug cost would be $76,374. With Part D, 29 drug plans gave me estimated costs ranging from $6,423 to $7,605.

Obviously that's a wildly pessimistic scenario, but if I try just one drug, Abilify (shudder, another one I hope I don't need), my estimated annual drug cost without a Part D plan is $5885, but with the drug plans the annual cost gets knocked down to around $2600.

There do not seem to be huge differences in the plans when it comes to the superexpensive drugs, they all seem to cover them, and you can't possibly guess which drugs you might need.

Crazy as Part D is, it seems to be very effective for the important purpose of insurance, making sure you don't get bankrupted if you need some of those incredibly expensive drugs.

b) I think Medicare has done a superb job with their plan finder. If you do not want to pay extra for the convenience of lower deductibles and more level monthly payments, it seems as if it's just as simple as entering the list of drugs you actually take and picking one of the plans with the lowest estimated total annual drug cost. They give you a nifty bar chart showing the utterly crazy pattern of monthly costs as various benefit levels kick in and out and you hit the "doughnut hole."
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Tony
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Post by Tony » Thu Dec 30, 2010 2:01 pm

LarryG wrote:I have not enrolled in part D in the past because my diabetic medications were paid in full by my medicare supplemental insurance.

This year because of the possibility of needing expensive medication, I decided to enroll in part D.

I'm sure that my total cost will be higher, but I think of it as insurance. I hope that I don't need the high cost medication (chemotherapy) but if I do, it will be covered by part D.

I carry insurance on my house and I don't wish to have a fire so that I can collect.

LarryG
In California, I called SHIP and discovered that the appointments were booked 3 weeks in advance. Just something to be aware of.

I agree that the Medicare website does a wonderful job of helping out with the Part D decision.
Tony

biasion
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Post by biasion » Fri Dec 31, 2010 12:04 am

I don't envy the elderly having to pay for their meds. Hopefully you have at least a few million minimum... but anyhow.

Part D pays for 80% of your medication costs up to 2,500 dollars. So if you get a prescription for Lipitor that costs 250 dollars a month, you pay 50 dollars, and part D picks up the other 80%.

When you exhaust the first 2,500 dollars, you fall in the dreaded "doughnut hole" and have to pay the next 2,500 dollars all by your lonesome, be it a 4 dollar hydrochlorothiazide prescription, or a 500 dollar Arimidex one. Once you reach total 5,000 dollars, Medicare will the go back to picking up 80% of the cost.

This is an OK plan if you're not on pricey meds and are independently wealthy. It's painful if you have to live on social security and little else.

Prescription plans ARE available, but the cost is so high to insure that you're probably better off with Part D. Hopefully you worked for a town, the state, or GM so you have a generous prescription plan that covers you into your 65+ age. I don't look forward to that time.

Walmart/Target/Stop and Shop have 10 dollar generics for 3 months. However, Rite Aid also has a few surprise generics like Simvastatin, sertraline etc that are usually pricey at the other pharmacies but cost 16 dollars for a 3mo supply. Call around!

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Post by tdhg566 » Fri Dec 31, 2010 12:25 am

biasion wrote:...Walmart/Target/Stop and Shop have 10 dollar generics for 3 months. However, Rite Aid also has a few surprise generics like Simvastatin, sertraline etc that are usually pricey at the other pharmacies but cost 16 dollars for a 3mo supply. Call around!
Even more, when shopping around for the best place to buy you need to know whether your Part D coverage pays a percentage or a flat rate. I've just taken over responsibility for my parent's finances and medical decisions, and also just found out that their Part D (Blue RX PDP) pays on a percentage off cash price. So I moved all their prescriptions to the lowest cash price pharmacy in the area. Unfortunately this has all happened very recently and I didn't get a chance to actually compare plans. That is already my #1 project for next year.
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Post by nonnie » Sun Jan 02, 2011 10:58 pm

biasion wrote:Part D pays for 80% of your medication costs up to 2,500 dollars. So if you get a prescription for Lipitor that costs 250 dollars a month, you pay 50 dollars, and part D picks up the other 80%.

This is NOT correct. Part D is the prescription plan and must be signed up for separately. I believe you are confusing it with Parts A&B of Medicare which does cover some to most medical and hospital costs at 80%. To supplement that and get the other 20% paid one signs up for a Medigap plan.

http://www.medicare.gov/navigation/medi ... art-d.aspx
biasion wrote: Prescription plans ARE available, but the cost is so high to insure that you're probably better off with Part D..
Part D IS the prescription plan.

Nonnie

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