Question about Medicare Part D selection for my Mother in Law

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ramsfan
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Question about Medicare Part D selection for my Mother in Law

Post by ramsfan » Tue Dec 05, 2017 9:24 pm

Hello, I am helping my Mother in Law with her Medicare elections. She is 83 years old. Previously, she was on a Medicare Advantage plan which included prescription drug coverage. We feel good that she has been accepted to a Medigap Plan G. So, she now retains her Medicare coverage, and has a Plan G MediGap plan which will go into effect January 1 2018.

We now need to select a Medicare Plan D prescription Drug Plan (PDP). I am working from the Medicare.gov site, and have entered all of her medications. She is on five maintenance medications, all of which are generics. One specific plan shows lowest cost by far. It is called Express Scripts Medicare Saver PDP. Her projected annual drug cost is $570, and the other plans estimated her cost to be over $1,200 per year.

Here is what I would like to validate. Is the recommendation to pick a plan based on current medication usage? If a new medication is required, it may cost her more, but that is difficult to predict, and the plan can be changed next year.

All of the information on Medicare.gov seems to focus on comparing cost of current drug, deductibles, and coverages in the "donut hole".

My question is this, am I missing anything if we have her select this plan? We know it does not have "donut hole" coverage, but she does not currently hit that mark. I just want to avoid some major thing we don't get if we select this plan, and am struggling to find anything major.

Thanks in advance for any help!

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Tue Dec 05, 2017 11:30 pm

Select several different pharmacies. This is could be a little tedious because you can only compare two pharmacies at a time. You won’t know which pharmacies might be “preferred retail pharmacies” unless you try each of them. For example in our county, the CVS which is housed in Target is not an Express Scripts preferred retail pharmacy, but the stand-alone CVS has the "preferred cost-sharing" status. I even called CVS to ask if this was intentionl. It was. If she won’t be doing mail order, then the cheaper retail pharmacies will be the ones with preferred cost-sharing. We too are looking carefully at Express Scripts. We don’t want mail order because of delays due to lost prescriptions. Thus we will be enrolling in Express Scripts and use the stand-alone CVS pharmacy.

If the dose of her medications could change, compare the price of a higher or lower dose. If she visited her doctor recently, did the doctor mention other medications which she might need in the future? Sometimes problems aren’t advanced enough to benefit from medication, but that could change suddenly. Do her lab results suggest areas to watch, like LDL? Then price the statin drugs.

If your mother were to enter long-term care, there might be a chance that she could switch pharmacies before the next open enrollment period. Often this is to one mail-order pharmacy which the facility uses for all of their residents though.

ramsfan
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Re: Question about Medicare Part D selection for my Mother in Law

Post by ramsfan » Tue Dec 05, 2017 11:41 pm

Thank you Harmony! I selected two retail pharmacies that are right near her home. one is a CVS and the other is a Walgreens. The estimated cost for her currents drugs for the Express Scripts plan was cheapest for mail order, but not much more for Walgreens. It was a fair amount higher for her CVS, so that might be an example of what you are talking about. Her preferred pharmacy is the Walgreens, which she uses now, so we are going to stick with that. She likes going to the Pharmacy and feels better asking any questions face to face, so that is a good fit for her.

The total estimated cost for her, on this plan, with a $405 deductible, no donut coverage, and a $22.07 monthly premium comes to only $582 per year. This is based on her current medications.

I am leaning towards advising her of this plan, but I think in the back of my mind I am concerned as to why it is so much less in terms of estimated cost. As long as there isn't some big "gotcha" of reduced coverage elsewhere, this seems to be the one to go with.

I remain open to other things to consider.

Thanks!

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Tue Dec 05, 2017 11:53 pm

In our past experience with Medicare.gov and in planning for this coming year, just one drug accounted for a $100 difference in annual cost. It was a non-preferred generic in one plan and a preferred generic in the other plan. We have both been wanting to get back with Express Scripts since we quit our employer health plan. It is the only prescription drug insurance company which has not merged with another health insurance company and yet has maintained a 4-star rating on Medicare.gov despite not merging.

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celia
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Re: Question about Medicare Part D selection for my Mother in Law

Post by celia » Wed Dec 06, 2017 12:28 am

ramsfan wrote:
Tue Dec 05, 2017 11:41 pm
The total estimated cost for her, on this plan, with a $405 deductible, no donut coverage, and a $22.07 monthly premium comes to only $582 per year. This is based on her current medications.

I'm in the middle of comparing plans for us too. (I'm a procrastinator.). $405 is the standard deductible for 2018. Of her expected $582 cost for the year, $264.84 is the premiums for the year (which is about what she'd pay even if she didn't take any meds). The remaining 317.16 is her co-pays. It looks like she wouldn't even reach the deductible for the year.

She WILL have donut hole coverage but her meds are not expensive enough to get to that stage.

If she has a WalMart or Sam's Club nearby, you might try these pharmacies in the calculator. WalMart has (or used to have) a lot of the commonest generics for $1 or $4 a month. The lowest plan might then be Humana WalMart.

It all depends on:
The meds needed
The tier of each med (may differ between companies)
The pharmacy you use
The zip code where she lives
The order in which you pick up the meds (if you will be reaching the donut hole)
The insurance plan you use

Changing one or more of these (besides the meds, of course) could make your costs go from the lowest you found to about 3 times as much.

I am leaning towards advising her of this plan, but I think in the back of my mind I am concerned as to why it is so much less in terms of estimated cost.
Each insurance sets it's own prices for the meds. Some have "preferred" pharmacies, put the meds in different tiers, negotiate with the drug makers differently, and have different market share in each region. (The more competition there is, the more they will have to lower their prices in order to compete).

kaneohe
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Re: Question about Medicare Part D selection for my Mother in Law

Post by kaneohe » Wed Dec 06, 2017 12:50 am

harmony wrote:
Tue Dec 05, 2017 11:30 pm
................................... We don’t want mail order because of delays due to lost prescriptions............................
............................................................................
Don't know about Express Scripts but all the mail order places I've used are extremely fast, typically within a week. They typically allow ordering after 2 mos. of a 3 mo prescription so any delays due to being lost would be noticed well before you run out. Plus no waiting in line. Our local Walgreens can get pretty backed up at times.

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Wed Dec 06, 2017 1:37 am

The sequence of delays with mail order that we experienced twice were not the fault of the prescription drug insurance company. Once when my physician was out of the country on vacation, he had to approve a change in my prescription after a lab result had been produced and sent around the world to catch up with him while he was traveling. This lab had to be scheduled within the 4 weeks of when the script could first be reordered. Unfortunately, the nurse was not in this loop, so I had to keep calling the mail order pharmacy to see if it was sent out yet. In another instance, a mail order medication did not arrive, but the post office had a record that it had been delivered, so they sent out a posse to try to figure out what happened. It was delivered to another address where someone was in the habit of selling “lost” deliveries on ebay. (Our temporary letter carrier got into big trouble over this.) In the meantime, we kept waiting because the insurer didn’t want to send out another script when the post office had “proof” that it had been delivered. Finally when the postmaster uncovered the real problem, the mail order pharmacy agreed to send out another one of the scripts. This all took close to 4 weeks. Yes, we had many years of satisfactory service with mail order, but after two events like that in close succession with some very essential drugs that we take daily, we are all done with mail order. Some of our decision is also with attention to our increasing forgetfulness as we are aging. If I have to wait a little longer at the local pharmacy when I pick it up, that is nothing compared to the many days I’d have to wait if I forgot to order a new script at just the right time. I don’t set up prescriptions on repeat-robot because I may need to schedule a lab first to make sure the dose is still right.

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Wed Dec 06, 2017 1:59 am

There is some extra information about deductibles on this site https://q1medicare.com/PartD-Medicare-P ... -State.php
that I could not find at the Medicare.gov site. (If anyone has found this on Medicare.gov, please tell us where you found it.)

When you go to the above site, click on your state. When you get to your state, click on a link which offers to show you all the PDPs for your state. On this list you will find some plans which will note that Tiers 1 and 2 are exempt from the $405 deductible. This note should appear just under the deductible amount. Thus if you are getting all generics, then it is my understanding that you could get them for the generic co-pay with the first script. You would not have to fulfill the deductible before the insurance would kick in.

ramsfan
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Re: Question about Medicare Part D selection for my Mother in Law

Post by ramsfan » Wed Dec 06, 2017 9:25 am

This info is all incredibly helpful.

I just glad all this medicare stuff is not very complicated (sarcasm).

Thank you all!

kaneohe
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Re: Question about Medicare Part D selection for my Mother in Law

Post by kaneohe » Wed Dec 06, 2017 9:38 am

harmony wrote:
Wed Dec 06, 2017 1:59 am
There is some extra information about deductibles on this site https://q1medicare.com/PartD-Medicare-PartD-Overview-by-State.php
that I could not find at the Medicare.gov site. (If anyone has found this on Medicare.gov, please tell us where you found it.)

.....................................................
What is the relation between the .com and .gov sites listed above?

KCRoyals
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Re: Question about Medicare Part D selection for my Mother in Law

Post by KCRoyals » Wed Dec 06, 2017 11:11 am

I am a retail pharmacist, much means, this time of the year all I do is answer questions about Medicare Part D🙂.
All the replys are good. Only think I would add is to keep in mind that the drug prices listed on medicare.gov are ESTIMATES. We have been going through a period of pretty significant inflation for generic drugs. Medicare D plans will often change the “Tier” of a medication if cost increase. The “Star Rating” is a good thing to factor in if a couple plans are close.
I am also obviously biased toward the used of your local pharmacy😉.

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Wed Dec 06, 2017 12:17 pm

If you scout around at the Q1Medicare site you can get more information about them. Here’s a link to their “About Us” screen:
https://q1medicare.com/PartD-About-Us-A ... ign=footer
I am guessing that the .com site is part of the commercial effort to get in on the brokering of Medicare supplemental plans and PDP plans. The Medicare.gov site does show all plans available in your area, but we found it helpful to use a broker for the supplement plans. We didn’t want a broker for the PDP plans. We preferred to use the .gov site so we could take our time and try out different pharmacies, etc. Since we expect to compare PDPs every year, we knew it would save a lot of time to do this part ourselves.

The Medicare supplement plans do screen for pre-existing conditions if you are enrolling into a different plan after age 65. (Sometimes this is advisable if the premiums have risen and you can qualify for a cheaper plan.) Our broker has "institutional knowledge" and has copies of applications which we can peruse, so we can know ahead of time which companies would most likely turn us down for medical conditions. So if during the open change period a broker can guide you as to which supplement is most likely to accept you, and you like the plan’s other features such as premium and reputation of the company, you can save valuable time since you can only apply for one at a time. Like OP's MIL, we still had time to add on the PDP before the December deadline.

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celia
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Re: Question about Medicare Part D selection for my Mother in Law

Post by celia » Wed Dec 06, 2017 12:44 pm

kaneohe wrote:
Wed Dec 06, 2017 9:38 am
harmony wrote:
Wed Dec 06, 2017 1:59 am
There is some extra information about deductibles on this site https://q1medicare.com/PartD-Medicare-PartD-Overview-by-State.php
that I could not find at the Medicare.gov site. (If anyone has found this on Medicare.gov, please tell us where you found it.)
What is the relation between the .com and .gov sites listed above?
The ".gov" extension is reserved for US (and state) official government websites. The ".com" extension is for all kinds of companies (or want-to-be companies). More importantly, look at the part of the url before .gov and .com . Q1Medicare is different than Medicare. Q1Medicare is not the government. It uses the term "Medicare" as part of its name probably to be included in google/search results involving "Medicare".

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celia
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Re: Question about Medicare Part D selection for my Mother in Law

Post by celia » Wed Dec 06, 2017 1:05 pm

harmony wrote:
Wed Dec 06, 2017 1:37 am
Once when my physician was out of the country on vacation, he had to approve a change in my prescription after a lab result had been produced and sent around the world to catch up with him while he was traveling.
All the records at our primary care doctors are now electronic. They have told us if any of our specialists are not available to confirm refills, that they would do it on a case by case basis (not permanently as we still need to see the specialists regularly). To show that we really do take the meds that others prescribe, we once had to bring all the bottles in. The primary care doctor looked at each bottle, the dose, and prescribing doctor and it matched what we have been reporting to her from when we see specialists outside of the group.

Then, there is the case of what happens when your primary care doctor is sick for a while. That happened to us recently. Although a roving doctor filled in for our doctor for the day (week?) after the original appointment had already been postponed, you should ask your primary care doctor what their procedure is if their doctors are out for more than 2 or 3 days.

harmony
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Re: Question about Medicare Part D selection for my Mother in Law

Post by harmony » Wed Dec 06, 2017 1:46 pm

Good points, Celia. Yes everything with health information sharing is improving, except our own memories. One of us is now in the mid-seventies. We recently buried an uncle who lived "sharp as a tack" half a year past his 84th birthday. We can see evidence now of how many things (financial and his own health care) that he forgot about or was just too tired out to do anything more about. I think local pharmacies and insurers who want to compete with mail order will find many customers who want what they can offer.

Good Listener
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Re: Question about Medicare Part D selection for my Mother in Law

Post by Good Listener » Wed Dec 06, 2017 2:56 pm

You are doing fine and the good thing is that one can change drig plans every year during open enrollment. Basing it on current drugs and the local pharmacies being preferred is the way to go. I just enrolled for January for the 1st time.

I want to applaud you for getting her out of Medicare Advantage and getting the supplement instead. As you pointed out, she was ACCEPTED. I have been in Medicare Advantage for now the second month and hate that I dont have complete freedom like regular Medicare. And one is guaranteed being able to enroll in a MA plan annually but not a supplement. Medicare Advantage can be like Hotel California if anything is wrong or goes wrong.

3feetpete
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Re: Question about Medicare Part D selection for my Mother in Law

Post by 3feetpete » Wed Dec 06, 2017 7:14 pm

I would go with the lowest yearly priced insurance that Medicare.gov finds for her. If a new medicine is required, most likely that insurance will be fairly competitive. If it isn't you will only be locked into that insurance company until this time next year at which point you can use Medicare.gov to find the lowest insurance for the updated list of medications. You should revisit medicare.gov every year anyway and check for the lowest cost and switch insurance companies as you see fit. It's really pretty easy.

ramsfan
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Re: Question about Medicare Part D selection for my Mother in Law

Post by ramsfan » Wed Dec 06, 2017 8:20 pm

Good Listener wrote:
Wed Dec 06, 2017 2:56 pm
You are doing fine and the good thing is that one can change drig plans every year during open enrollment. Basing it on current drugs and the local pharmacies being preferred is the way to go. I just enrolled for January for the 1st time.

I want to applaud you for getting her out of Medicare Advantage and getting the supplement instead. As you pointed out, she was ACCEPTED. I have been in Medicare Advantage for now the second month and hate that I dont have complete freedom like regular Medicare. And one is guaranteed being able to enroll in a MA plan annually but not a supplement. Medicare Advantage can be like Hotel California if anything is wrong or goes wrong.
tHanks for the feedback. We learned a valuable lesson with my own Mom. She had a Medicare plus a Plan F supplement. My Dad has a Medicare Advantage plan. My mom broke her back and required extensive treatment, surgery, and therapy to recover. She was able to get into very high end services like in patient therapy (which her Doctor felt gave her the best treatment path), and on top of that she got to choose the facility she wanted to use. All without any billing or cost (other than her monthly charge).

Every step we took in her care, someone would point out to my Dad - "under your plan, you would not be covered to have this treatment, or you would not be allowed to use this provider or facility". Everyone we spoke with said to stick with Medicare.

One note, we learned Plan F is being phased out, so we enrolled my Mother in Law in a Plan G supplement.

Good Listener
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Re: Question about Medicare Part D selection for my Mother in Law

Post by Good Listener » Thu Dec 07, 2017 10:59 am

ramsfan wrote:
Wed Dec 06, 2017 8:20 pm
Good Listener wrote:
Wed Dec 06, 2017 2:56 pm
You are doing fine and the good thing is that one can change drig plans every year during open enrollment. Basing it on current drugs and the local pharmacies being preferred is the way to go. I just enrolled for January for the 1st time.

I want to applaud you for getting her out of Medicare Advantage and getting the supplement instead. As you pointed out, she was ACCEPTED. I have been in Medicare Advantage for now the second month and hate that I dont have complete freedom like regular Medicare. And one is guaranteed being able to enroll in a MA plan annually but not a supplement. Medicare Advantage can be like Hotel California if anything is wrong or goes wrong.
tHanks for the feedback. We learned a valuable lesson with my own Mom. She had a Medicare plus a Plan F supplement. My Dad has a Medicare Advantage plan. My mom broke her back and required extensive treatment, surgery, and therapy to recover. She was able to get into very high end services like in patient therapy (which her Doctor felt gave her the best treatment path), and on top of that she got to choose the facility she wanted to use. All without any billing or cost (other than her monthly charge).

Every step we took in her care, someone would point out to my Dad - "under your plan, you would not be covered to have this treatment, or you would not be allowed to use this provider or facility". Everyone we spoke with said to stick with Medicare.

One note, we learned Plan F is being phased out, so we enrolled my Mother in Law in a Plan G supplement.
Yes, G and F are nearly identical except G doesn't cover the deductible. I just started with F which costs more than G by more than the deductible but I wanted the pleasure of no bills. We will see what happens when it phases out. I read pros and cons. Doesn't matter now as I'm committed.

ramsfan
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Re: Question about Medicare Part D selection for my Mother in Law

Post by ramsfan » Thu Dec 07, 2017 1:51 pm

Good Listener wrote:
Thu Dec 07, 2017 10:59 am
ramsfan wrote:
Wed Dec 06, 2017 8:20 pm
Good Listener wrote:
Wed Dec 06, 2017 2:56 pm
You are doing fine and the good thing is that one can change drig plans every year during open enrollment. Basing it on current drugs and the local pharmacies being preferred is the way to go. I just enrolled for January for the 1st time.

I want to applaud you for getting her out of Medicare Advantage and getting the supplement instead. As you pointed out, she was ACCEPTED. I have been in Medicare Advantage for now the second month and hate that I dont have complete freedom like regular Medicare. And one is guaranteed being able to enroll in a MA plan annually but not a supplement. Medicare Advantage can be like Hotel California if anything is wrong or goes wrong.
tHanks for the feedback. We learned a valuable lesson with my own Mom. She had a Medicare plus a Plan F supplement. My Dad has a Medicare Advantage plan. My mom broke her back and required extensive treatment, surgery, and therapy to recover. She was able to get into very high end services like in patient therapy (which her Doctor felt gave her the best treatment path), and on top of that she got to choose the facility she wanted to use. All without any billing or cost (other than her monthly charge).

Every step we took in her care, someone would point out to my Dad - "under your plan, you would not be covered to have this treatment, or you would not be allowed to use this provider or facility". Everyone we spoke with said to stick with Medicare.

One note, we learned Plan F is being phased out, so we enrolled my Mother in Law in a Plan G supplement.
Yes, G and F are nearly identical except G doesn't cover the deductible. I just started with F which costs more than G by more than the deductible but I wanted the pleasure of no bills. We will see what happens when it phases out. I read pros and cons. Doesn't matter now as I'm committed.
Yes, G and F are nearly identical except G doesn't cover the deductible. I just started with F which costs more than G by more than the deductible but I wanted the pleasure of no bills. We will see what happens when it phases out. I read pros and cons. Doesn't matter now as I'm committed.
[/quote]

Agree, would have preferred plan F, never even receive a bill, etc.. super sweet. However, the quotes for my Mother in Law were $285 per month for Plan F, and $218 per month for Plan G, from the same insurer, so the savings of ~$850 made it a no brainer.

I am curious about those people on Plan F today, like my Mom. What if a worst case scenario happens and her premium skyrockets. Would she be able to simply slide over to an alternate supplement Plan, such as Plan G, or would she have to apply and be accepted as if she was new to applying to supplements, and could be accepted or denied.

Good Listener
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Re: Question about Medicare Part D selection for my Mother in Law

Post by Good Listener » Thu Dec 07, 2017 6:05 pm

ramsfan wrote:
Thu Dec 07, 2017 1:51 pm
Good Listener wrote:
Thu Dec 07, 2017 10:59 am
ramsfan wrote:
Wed Dec 06, 2017 8:20 pm
Good Listener wrote:
Wed Dec 06, 2017 2:56 pm
You are doing fine and the good thing is that one can change drig plans every year during open enrollment. Basing it on current drugs and the local pharmacies being preferred is the way to go. I just enrolled for January for the 1st time.

I want to applaud you for getting her out of Medicare Advantage and getting the supplement instead. As you pointed out, she was ACCEPTED. I have been in Medicare Advantage for now the second month and hate that I dont have complete freedom like regular Medicare. And one is guaranteed being able to enroll in a MA plan annually but not a supplement. Medicare Advantage can be like Hotel California if anything is wrong or goes wrong.
tHanks for the feedback. We learned a valuable lesson with my own Mom. She had a Medicare plus a Plan F supplement. My Dad has a Medicare Advantage plan. My mom broke her back and required extensive treatment, surgery, and therapy to recover. She was able to get into very high end services like in patient therapy (which her Doctor felt gave her the best treatment path), and on top of that she got to choose the facility she wanted to use. All without any billing or cost (other than her monthly charge).

Every step we took in her care, someone would point out to my Dad - "under your plan, you would not be covered to have this treatment, or you would not be allowed to use this provider or facility". Everyone we spoke with said to stick with Medicare.

One note, we learned Plan F is being phased out, so we enrolled my Mother in Law in a Plan G supplement.
Yes, G and F are nearly identical except G doesn't cover the deductible. I just started with F which costs more than G by more than the deductible but I wanted the pleasure of no bills. We will see what happens when it phases out. I read pros and cons. Doesn't matter now as I'm committed.
Yes, G and F are nearly identical except G doesn't cover the deductible. I just started with F which costs more than G by more than the deductible but I wanted the pleasure of no bills. We will see what happens when it phases out. I read pros and cons. Doesn't matter now as I'm committed.
Agree, would have preferred plan F, never even receive a bill, etc.. super sweet. However, the quotes for my Mother in Law were $285 per month for Plan F, and $218 per month for Plan G, from the same insurer, so the savings of ~$850 made it a no brainer.

I am curious about those people on Plan F today, like my Mom. What if a worst case scenario happens and her premium skyrockets. Would she be able to simply slide over to an alternate supplement Plan, such as Plan G, or would she have to apply and be accepted as if she was new to applying to supplements, and could be accepted or denied.
[/quote]

At that premium difference, I agree with you. Mine was about 30 per month. If F runs into problems or G for that matter I assume that things would be handled smoothly and things wouldn't skyrocket. Remember that these plans are federally regulated and Congress won't allow a bunch of seniors to get into real trouble.

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dm200
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Re: Question about Medicare Part D selection for my Mother in Law

Post by dm200 » Thu Dec 07, 2017 7:15 pm

Then, there is the case of what happens when your primary care doctor is sick for a while. That happened to us recently. Although a roving doctor filled in for our doctor for the day (week?) after the original appointment had already been postponed, you should ask your primary care doctor what their procedure is if their doctors are out for more than 2 or 3 days.
One (of many) reason for having Primary Care from a Physician in a group - where the different physicians work together...

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dm200
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Re: Question about Medicare Part D selection for my Mother in Law

Post by dm200 » Thu Dec 07, 2017 7:18 pm

Every step we took in her care, someone would point out to my Dad - "under your plan, you would not be covered to have this treatment, or you would not be allowed to use this provider or facility". Everyone we spoke with said to stick with Medicare.
It all depends on the MA plan.. I run into lots and lot of folks who make such criticisms of MA plans that are just not true. While such folks may be correct that a particular provider or facility would not be available, I doubt they know that the appropriate treatment would not be covered.

Johio
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Re: Question about Medicare Part D selection for my Mother in Law

Post by Johio » Thu Dec 07, 2017 7:33 pm

My wife and I have used Silverscript for Part D for the last couple years. So far, great service and no problems with mail order delivery. They use Caremark as their fulfillment company, and I have found Caremark's website to be very easy to use. Neither of us get close to the donut hole, so I cannot comment on Silverscript's cost for those situations. However, for the medications we take our cost is relatively low, and the Silverscript premium was far lower than others I looked at..

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