Medicare D prescription plans

[judd]

Who has the best?

[_______]

Who has the best?

It's going to depend on where you live and what your rx's are. There are over 1000 plans offered though you will only have to sort through the 30-50 offered in your region.

No simple answer to this. You may want to contact an agent for help.

[whodoyoulike]

Isn't there a website you can review which plans are offered in your area? I believe the site offers 1 - 5 stars based on participants or someone has provided an opinion. Check with the Medicare government office.

[gregrph]

"The best" is subjective and different for each individual. The best thing to do is to go to www.medicare.gov and look for the plan comparison tool. It will ask you a series of questions such as: 1) Do you live in one location all year? If you travel around or have multiple homes that you stay at for an exented period of time, some plans to not have out of area pharmacies that they work with. 2) Do you have costly medications? Ask your pharmacist for their current full retail (non-discounted) prices for 30 day supplies. Add them up and multiply by 12. Will that put you into the coverage gap(I don't recall off hand what it is for next year). If so you might want to look for a plan that covers your meds through the coverage gap. 3) Do you have a pharmacy that you love and would not consider switching from? Then enter that as your pharmacy.

Once you are done answering the preliminary questions (including names, strengths and monthly quantities of meds that you take), the tool will list the top 3 plans based on lowest TOTAL cost for YOU. That total cost for the year will include: Monthly Premium + Deductible (if any) + Out of Pocket Costs for med (copays). GENERALLY the plan with the LOWEST TOTAL YEARLY COST will be the best for YOU (if total out of pocket cost is your main concern).

Things to consider (in no particular order):
1. Some plans have preferred pharmacies that if you use one of those pharmacies, your copay will be lowest. That does not mean that you can't use another non-preferred pharmacy but your copay may be higher. There are also non-contracted pharmacies that cannot accept that insurance because they do not have a contract. You would have to pay full retail cost and try to submit a receipt to get reimbursed (probably will not happen though unless you happen to travel to an area where there is no convenient contracted pharmacy).

2. If you have several very expensive drugs and the tool show you that you will hit the coverage gap early to mid-year vs. late in the year (nov/dec) it might be wise to consider a plan that will pay through the coverage gap. Remember, if you pay out of pocket (no gap coverage) in nov/dec then you start a brand new plan year in Jan with brand new deductible. It is not what YOU pay out of pocket that goes towards the deductible and whether you reach the coverage gap or not, it is the retail cost of the medication that the pharmacy submits. Example, you take a brand name medication that retails for $300.00/month and you pay a $25.00 copay, the 300 is what your insurance applies to reaching the gap. If the med has a generic with a $10,.00 copay and a retail price of $50.00, only $50.00 is going toward the gap. Typically what happens is that pts insist on brand thinking that the $25.00 copay is affordable but behind the scenes $300.00 is going toward the gap.

3. Customer satisfaction with the insurance company is also noted in the comparison tool. If you find a dirt cheap plan with a low customer satisfaction rating, I'd think long and hard about going with them.

4. Many insurance companies have different tier levels of plans to choose from with similar sounding names that all have different coverages. Your AARP plan can be different from a friends AARP plan! Just because they are both AARP (or Humana, or United, etc.) does not mean they are the same unless the FULL plan names are the same.

5. When you do a plan comparison, you will be given a code that will save your search so you do not have to re-enter everything in the futre if you want to go back and make changes. You CAN (and should) go back and do different "what if" scenarios. What if I chose gap coverage vs no gap coverage, what would my out of pocket be?

6. Many classes of drugs (oral diabetes meds, ace inhibitors, copd inhalers, etc)have formulates. Some items are preferred meds and are covered right away. Some have qty restricts (x# doses/month), some have pre-requisite restrictions (will only be covered if you have tried and failed at least on formulary medication), some have prior authorization requirements (p.a.) A p.a. means that your pharmacy has to submit a form to your doctors office requesting that they (md office) contact your insurance company for you. I know first hand that these are often ignored! Once the md office contacts the insurance to give them clinical information, then ins co will review it and it usually takes 3-5 business days (sometimes multiple weeks!) and will then contact your doctors office. Your doctors office if then supposed to contact the pharmacy to let them know the outcome. Of course, many times the md will just change the med instead of going through that agonizing process!

7. Many new drugs have a mfg assistance coupon available. More often than not, they REQUIRE you to have primary insurance that covers the drug. These are usually $ off coupons ($25 off, etc.) that can be used one or multiple times. Some coupons are for a free trial (one months worth at no charge) and then $ off for x number of months afterward. IF YOU HAVE A GOVERNMENT SPONSORED PLAN (Medicare D, Tricare, Medicaid, etc.) YOU CANNOT USE THE $ OFF COUPONS! If it's a 1st month free, $x of next y months and the drug is not covered, after the first month, you can't use the coupon!

I know this is long, I hope it helps provide some insight into medicare d. Any questions, just ask.
Greg

[ldiatone]

"well care" through SS. $23.00 a month. now my wife is on SSD. she gets 80% of her meds free. she pays for vesacare(not for men) and one of her blood pressure meds. she takes a drug called "Baclofen" 250mgs a day. over $400 a month but this one is free. we also discovered some of the name brand drug stores have lower co-pays,,eg sams wal mart walgreens, Judd Giant Eagle has won of the higher co-pays. we switched

[whodoyoulike]

I agree with Greg which is what I was trying to summarize in my post. If only I knew the website, I would've provided the details.

Thanks Greg.

[Robert Goren]

Most cities have people who can help you decide. Contact your local area on aging to find who they are. Most are volunteers and there is no charge for the help. My advice is to find someone on Medicaid and see which company it using in your state for its clients. It probably best or second best plan out there. In Nebraska it is currently Silverscript.

[judd]

What about a Medicare advantage plan? Is it smart to choose?

[gregrph]

Judd, To be honest, I don't know that much about Medicare Advantage plans but I think there are about 7 didn't levels of services offered along with different levels of pricing. What I DO know is that many of the Medicare Advantage plans that do cover prescriptions have no deductible to meet. It looks like for 2015 the deductible will be $310.00 You will pay a preferred price (less than full retail) until you our of pocket hits $310. Once that has been met, then the price for each med would be either the generic copay, preferred band copay, non-preferred brand copay, etc. The covereage gap will begin at $2960.00 out of pocket. Once you spend $4700 oop in 2015 you will enter the "catastrophic coverage" and you will only pay a mininmal copayment the rest of the year.

If you have a part D plan, some of the plans will pay for flu/pneumonia/shingles shots at the pharmacy and some will not. Those that do not will be covered by medicare B. We have noticed that those patients with the Medicare Advantage plans, immunizations work a little differently. If the immunization is not covered by your pharmacy benefits, the pharmacy will get a claim reject that says pt covered by med. B. If we try that, we get rejects that say pt covered by med D. It's a back and forth thing. What actually happens is in many cases (not all!!!) we have to bill your MEDICAL plan for the immunization! Some plans just plain do not cover pharmacist administered immunizations and you have to go to your doctors office of clinic. to get it at no charge.

I really can't give you much more information than that, please go to http://www.medicare.gov/ and look around. If you're not happy with what you chose, you can always choose something else next year! It's all kind of complicated and inter-related, just like handicapping! Good luck!

[gregrph]

I agree with Greg which is what I was trying to summarize in my post. If only I knew the website, I would've provided the details.

Thanks Greg.

your welcome! his might clear things up better http://www.medicare.gov/

[whodoyoulike]

Isn't part of the consideration for Advantage plans is to make certain the offices of the plans are conveniently located near you? Because, you normally have to go to the plan's doctors and facilities. You're allowed out of plan doctors (if you're out of town) etc., but you may not be covered. I think you can review the plan's websites for more info before deciding if they're appropriate for you.

[nijinski]

Judd, To be honest, I don't know that much about Medicare Advantage plans but I think there are about 7 didn't levels of services offered along with different levels of pricing. What I DO know is that many of the Medicare Advantage plans that do cover prescriptions have no deductible to meet. It looks like for 2015 the deductible will be $310.00 You will pay a preferred price (less than full retail) until you our of pocket hits $310. Once that has been met, then the price for each med would be either the generic copay, preferred band copay, non-preferred brand copay, etc. The covereage gap will begin at $2960.00 out of pocket. Once you spend $4700 oop in 2015 you will enter the "catastrophic coverage" and you will only pay a mininmal copayment the rest of the year.

If you have a part D plan, some of the plans will pay for flu/pneumonia/shingles shots at the pharmacy and some will not. Those that do not will be covered by medicare B. We have noticed that those patients with the Medicare Advantage plans, immunizations work a little differently. If the immunization is not covered by your pharmacy benefits, the pharmacy will get a claim reject that says pt covered by med. B. If we try that, we get rejects that say pt covered by med D. It's a back and forth thing. What actually happens is in many cases (not all!!!) we have to bill your MEDICAL plan for the immunization! Some plans just plain do not cover pharmacist administered immunizations and you have to go to your doctors office of clinic. to get it at no charge.

I really can't give you much more information than that, please go to http://www.medicare.gov/ and look around. If you're not happy with what you chose, you can always choose something else next year! It's all kind of complicated and inter-related, just like handicapping! Good luck!

Some very good information Greg .
The problems that I see with the advantage plans that replace medicare ,
are too large to ignore .
You have larger selection of doctors on medicare and there are no
authorizations to wait on for radiology tests and procedures . Some of
the newer procedures get denied by the advantage plans .
That's huge when testing and treating major illness and disease .

I personally talked my Mom out of the Advantage plans . When she
became very ill , she was able to see any specialist she was referred to .

The pros and cons need to be measured on an individual basis IMO .

[Robert Goren]

These things are needlessly more complicated than the average senior wants to or is able to deal with. Drug coverage was a good idea, but the way it is set up is just plain awful. The donut hole is perhaps the worst idea ever. It put all your costs into a small time frame instead of spreading them out over the year.

[gregrph]

These things are needlessly more complicated than the average senior wants to or is able to deal with. Drug coverage was a good idea, but the way it is set up is just plain awful. The donut hole is perhaps the worst idea ever. It put all your costs into a small time frame instead of spreading them out over the year.

The donut hole is one of the most bone-headed things I've seen!In the 4-5 years that partD has been in place,I've seen a few patients reach the donut hole usually no earlier than october, some as late as december. Most in novemeber. I've seen no one spend their way through the donut hole to reach the catastrophic care level! Then again, my customers are generally families with young kids. The seniors that I do have are not critically ill for the most part. I can't honestly comment about the medical side of advantage plans (doctor's, pre-certs, what's covered, md networks, etc.) But yes, everyone's situation is unique and it would be a disservice to recommend an advantage plan versus regular medicare and a part d plan. One tactic that I do see my customers making is making a list of their doctor's and checking to see if their doctor's are providers in the plan(s) that they are considering. Also asking the doctor's office if they participate in a plan is a good idea. While at it also ask the office what other plans they accept and if they have any problems getting something covred for their patients.