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Is Medicare Part D (RX plan) worth it for PWC?

Messages
32
Location
Florida
I will be eligible for Medicare as of 7/1/11 and I have to make a decision on if I want to add on the Part D plan. None of the expensive meds I take are in the formulary, the ones that are in it are generic so cost isn't much of a concern. I am leaning towards this extra coverage probably being useless because if any drug does come out for treatment of CFS, it will probably be expensive and not on their formulary anyways. In addition, most drug companies offer programs if you are low-income you can get meds for free or cheap.

Anyone have any thoughts about this?
 

Sushi

Moderation Resource Albuquerque
Messages
19,934
Location
Albuquerque
I think it depends on the meds you take. Medicare drug plans don't cover any benzodiazepams, so your clonazepam would not be covered.

I decided to get a drug plan that costs about $30 per month and gives free generics, and partial coverage of name brands. I got the plan partly because I didn't know what meds might lie in my future. I have just seen an ME/CFS specialist and he has, indeed, prescribed some things that will be covered. You can also have your doc to petition to have non-formulary drugs covered--though I don't know how often they approve it.

It is a personal call. I think it does save me money so far though.

Sushi
 
Messages
32
Location
Florida
Thanks for giving me your personal experience...

I think it depends on the meds you take. Medicare drug plans don't cover any benzodiazepams, so your clonazepam would not be covered.

I decided to get a drug plan that costs about $30 per month and gives free generics, and partial coverage of name brands. I got the plan partly because I didn't know what meds might lie in my future. I have just seen an ME/CFS specialist and he has, indeed, prescribed some things that will be covered. You can also have your doc to petition to have non-formulary drugs covered--though I don't know how often they approve it.

It is a personal call. I think it does save me money so far though.

Sushi
 

illsince1977

A shadow of my former self
Messages
356
You probably already understand that there is a penalty in future premiums if you delay in getting Part D coverage.

For me, it has paid off, but don't think it will be easy to figure out which plan benefits you from year to year. They make it difficult on purpose. If you qualify for income dependent benefits/SSI it should be free/no premiums for you, but I'm sure this differs from state to state and I know nothing about your situation or your state.
 
Messages
32
Location
Florida
I didn't realize there would be penalties for adding Part D later. I thought that was only Part A&B. Will have to re-read my stuff.

I'm not eligible for SSI. I get SSDI and for 1 person I am considered over-income for any other type of assistance.

Thank you.

You probably already understand that there is a penalty in future premiums if you delay in getting Part D coverage.

For me, it has paid off, but don't think it will be easy to figure out which plan benefits you from year to year. They make it difficult on purpose. If you qualify for income dependent benefits/SSI it should be free/no premiums for you, but I'm sure this differs from state to state and I know nothing about your situation or your state.
 
Messages
57
Location
Seattle area
Have you looked into one of the Advantage plans with Rx coverage? The montly premium is more but you might save money in the long run. With these plans, the formulary is usually larger and many generics could be covered at $5.00 for the "doughnut hole" period.

If you go go Medicare.gov site, you can enter your Rx's and then check and compare the total cost of each plan. It's worth the time to compare plans. Also, you may find other meds of the same class that are generics.

Since my Medicare starts soon, we've been able to switch two brand meds to similar generics. It will save me a lot of money.
 
Messages
32
Location
Florida
I did go online and look and tried to compare but got overwhelmed. I'm going to have to look again. Thanks for the tips.

Have you looked into one of the Advantage plans with Rx coverage? The montly premium is more but you might save money in the long run. With these plans, the formulary is usually larger and many generics could be covered at $5.00 for the "doughnut hole" period.

If you go go Medicare.gov site, you can enter your Rx's and then check and compare the total cost of each plan. It's worth the time to compare plans. Also, you may find other meds of the same class that are generics.

Since my Medicare starts soon, we've been able to switch two brand meds to similar generics. It will save me a lot of money.
 

Sushi

Moderation Resource Albuquerque
Messages
19,934
Location
Albuquerque
Have you looked into one of the Advantage plans with Rx coverage?

The Advantage plans are the ones scheduled to be "trimmed" by the government. Many of them have hidden expenses also, so investigate them carefully. They sound great in the brochures, but I went to a state Medicare counselor and they advised me to choose the standard Govt' plan.

Just do your research before signing!

Sushi
 

caledonia

Senior Member
I went the free meds from the drug company route. I only had one med to cover, Zoloft. My other med is Armour Thyroid which is also covered but it was so cheap I didn't want to bother with the paperwork.

Pfizer's income limit for a single was $18k. You should look into the income limits for the other programs for your drugs and see if you qualify. It's all or nothing. You can't have any other prescription coverage to get into these programs.

If there was some kind of penalty for not getting coverage, I figured screw it, I didn't want the govt. to be holding that threat over me and controlling my life in that way. They already have enough/too much control in other areas.

After 10 years, I don't have to take Zoloft anymore. Yay!

I work with a naturopath and take a lot of supps for my other issues - all those are out of pocket.
 

anncavan

Senior Member
Messages
107
Location
San Francisco, CA
Supplemental coverage - Prescriptions and care

Hi All,
I transition to Medicare in September. The information re adding part D later will be more expensive... is EXTREMELY HELPFUL!! THANK YOU!! Are part D plans national policies or a state by state thing? Sushi, would you be willing to share with me the plan you got?

In addition to part D for prescriptions, there's also the ability to get supplemental care insurance. However I've been told that being only 33, it will be all but impossible to find an insurance company willing to pick up a disabled 33 year old as then they'd be stuck with me. Any opinions? Sound about right?

When I start thinking about this stuff my mind just goes blank. Any suggestions on where/how to begin?

Thank you!!!!!!!
 

ahimsa

ahimsa_pdx on twitter
Messages
1,921
supplemental medicare plans

anncavan, is there a group in your state you can call to get advice? When I went on Medicare (in my 40s, so I was not a senior either) I called an Oregon volunteer group called SHIBA (Senior Health Insurance Benefits Assistance). They were extremely helpful for me to sort through all the issues with transitioning to Medicare. For example, I thought I could just stay on as a dependent on my husband's insurance plan after he retired and was on COBRA coverage. But I would have had to pay a penalty if they had not explained to me that I had a shorter deadline for signing up for Medicare.

The point is that if you can find a California group that gives advice to seniors they also help those who go on Medicare due to disability. There's probably a completely different acronym for each state but check out whatever resources exist for seniors and they might be able to help you.

Supplemental Medicare plans vary quite a bit from state to state (and even among different counties). I happen to be on one of the Medicare Advantage plans (these might go away, but it's working for now). I believe the other supplemental plans are called Medigap plans.

Of course, there are web sites with information (http://ssa.gov/pgm/medicare.htm and http://www.medicare.gov/) but it can be complicated to navigate these web sites without having someone who can answer questions.

Best of luck!

PS. General comment on this thread -- Don't forget that having ME/CFS does not mean you'll never get another illness, be in an accident, have to go to the hospital, etc. Trying to guess whether it is worth it to sign up for Part D may not be possible because you can't predict what drugs you may need in the future for some non-ME/CFS illness.
 

Sushi

Moderation Resource Albuquerque
Messages
19,934
Location
Albuquerque
Hi All,
I transition to Medicare in September. The information re adding part D later will be more expensive... is EXTREMELY HELPFUL!! THANK YOU!! Are part D plans national policies or a state by state thing? @Sushi, would you be willing to share with me the plan you got?

Any suggestions on where/how to begin?

Thank you!!!!!!!

I got Wellcare Signature. The same plans are available in most states, though if you move you have to let them know and "move" your plan. Each company offering Part D has a confusing array of plans. If you go to the government Medicare site and select "part D," you can "plug in" the drugs you usually take (or think you might take) and see which plan covers them for what price.

I got Wellcare as it was about $32 per month and offered a no co-pay, no deductible plan for generics. You do pay a lot more for brand names, but I try to stick with generics and thus get them "free." As I take a few, the part D is less than paying the normal cost for the meds without insurance.

I think it just depends on how many meds you take, whether they are brand names, whether you can qualify for "low income assistance" from drug companies.

I recently was prescribed some meds that my plan doesn't cover, and I had to order them from a Canadian pharmacy. There will probably always be some things that are not covered and since each plan has a different formulary, it is kind of Russian roulette choosing a plan.

But you do have a couple months each year when you can switch plans without a penalty. It is a hard decision though and they don't make it easy to "pick a plan."

Good luck,
Sushi
 
Messages
32
Location
Florida
I still have to decide too! I have one month left, argh. The company that represented me for my disability claim, Allsup, will advise me for a fee of $200. I don't know if it's worth that or not. I really need to get on this ASAP....
 

Sushi

Moderation Resource Albuquerque
Messages
19,934
Location
Albuquerque
I still have to decide too! I have one month left, argh. The company that represented me for my disability claim, Allsup, will advise me for a fee of $200. I don't know if it's worth that or not. I really need to get on this ASAP....

Don't pay their fee! There are government agencies in Florida that will advise you for free! I used one, but don't ask me which one cause I don't remember! But they were knowledgeable.

Sushi
 

anncavan

Senior Member
Messages
107
Location
San Francisco, CA
WOW, thanks everyone! This is really helpful. I might be moving states in a month. So sounds like I can't really make any decisions until then anyway. I'm sure I can fill my time with other paperwork until July :) But knowing there are these sorts of plans out there ($30/mo = free generics) is really helpful. Those would definately pay for themselves for me. Will just need to figure out where I'm living first!
 

Sushi

Moderation Resource Albuquerque
Messages
19,934
Location
Albuquerque
WOW, thanks everyone! This is really helpful. I might be moving states in a month. So sounds like I can't really make any decisions until then anyway.

Just don't miss your sign-up deadline and get into penalty fees! Remember, most plans are transferable from state to state.

Sushi
 

Rooney

Senior Member
Messages
185
Location
SE USA
It was easiest for me to select a formulary by calling Medicare and speak to a human versus working with my computer to enter my meds. It's less taxing on this pitiful brain and they record your list just like you would on your computer.

I'd join now as it's the best protection for the future. The penalty for the delay really bites. Also, I found no medigap insurance for someone under 65 of any value. It hardly exists.

Good luck.
 

Sherlock

Boswellia for lungs and MC stabllizing
Messages
1,287
Location
k8518704 USA
When I did this for my father about 6 years ago, I thought it was an arduous thing to get through - partly since I didn't know terms like formulary to begin with, but mainly because the instructions were not so great. But once I did learn it on my own, it seemed such an easy thing to do again and again.

The end results that the website gives to you are really helpful.

If you had someone to go through it with you in person, it'd possibly be a breeze. Back then, some pharmacies eventually had people to do just that. Maybe some still do.


For me, the only tricky part was trying to gauge how your prescription needs might change over the following year.
 

hensue

Senior Member
Messages
269
Glad I saw this thread by August I also am a part of medicare ssdi. I have A and B but need to decide on the drug part. Live in GA I do not understand the drug plan and the people in my town are of no help.