Medicare Questions

July 7, 2020

[metmom]

This past May I turned 65 and HAD to go on Medicare.

I'm curious about other people's experiences with it.

I hate it, myself. Our primary insurance that was mr. mm's from work is now allegedly the secondary insurance, and our rates for that insurance went down, but I am getting nailed to the wall with prescription expenses. Some of the meds I am on for my Mast Cell Disorder are ridiculously expensive and even with the so-called co-pays, would bankrupt us because of the coverage gap.

I have medicare Part B and D but I have no way of knowing how the different providers do with coverage. IOW, would a different provider cover more of the cost or is it set by Medicare?

Also, one thing I would do different, if I knew, is that I would have refilled every prescription I had in April, while still under our regular insurance. I had to get some Epi-Pens because mine had expired, and paid a ridiculous price for two, WITH the co-pay. Over $200.

So does anyone have any Medicare provider they are happy with?

Thoughts? Opinions?

Thanks in advance.

[BunnySlippers]

I’m 72. Retired equities trader.

I just fell and hurt my hip. Medicare paid 100% for x-rays at emergency room. And now 100% for CT Scan at Cedars Sinai.

It pays for most of my meds. occasionally I get an oddball prescription that they do not pay much on. But overall, they pay for most things.

[smokingfrog]

https://www.mymedicarematters.org/costs/part-d/

[McGavin999]

Get Medicare advantage and make sure it has prescription coverage. Talk to a broker who you trust to find the plan best for you. If you don’t like it you can change between Oct and Dec.

[MrChips]

I am in the same boat. In addition, because of some pass-through income driving up my total, I wast forced to pay three times as much for Medicare. This is separate from my secondary insurance. Together, I am showing out nearly $500 a month. My doctor also put me on Procepa, which is VERY expensive, hundreds of dollars. There is a coupon one can get that reduces the cost to nine dollars, but not if you are on Medicare. I am still working of course, and my cost will go down when I stop, but I plan to keep working for several years.

[Pining_4_TX]

They like to make things confusing, but basically there are 2 kinds of supplemental Medicare plans. One is called medigap and is offered through various companies such as USAA. What my husband and I have is called Part C, a supplemental Medicare insurance plan and ours is run by Aetna. It is an HMO with prescription drug coverage. We never have to deal with Medicare directly. We can go to any doctor who is on our plan and we have zero copay for primary care visits, $40 to see a specialist.

Many Medigap plans have premiums but no copays. Our plan has no premiums other than our basic Medicare premiums, but we do have copays for specialists and other things. We also have copays for some prescriptions. Some of the simple, basic ones are free.

What really helped me figure all this out was going to a presentation by our supplemental plan explaining all their plans and benefits.

Supplemental plans tend to be local, so if you move out of the area, you will need to find a new one. Medigap plans follow you no matter where you live, but you do have to find doctors who take Medicare when you get there.

The Medicare website has ratings for supplemental plans in your area based on user reviews.

Hope this helps a little. There are so many details and different plans, that it’s difficult to explain it all here.

[FatherofFive]

I had coverage with my own plan. Was paying about $700mo. Medicare is about $240. I got a Medicare advantage plan. Doesn’t cost anything. I have one med for HBP. Cost $60/mo on old plan. Now costs $0 when I get it delivered. Went to the dermatologist today. Just a checkup. No co-pay. Was $40.

I can see why they are going broke

[Real Cynic No More]

I don’t understand. With my medicare supplemental prescription plan, my medication costs are way lower - when you combine my monthly premium costs and the drug costs. You should contact a medicare consultant this upcoming renewal period to help you pick the provider that’s best for your situation. They have vastly different pricing structures. What’s best for you won’t necessarily be best for your spouse. My wife and I have different prescription plans, but the same supplemental health insurance plans. It all depends on your personal health situation and where you’re located that determines the pricing structure. Good luck, and stay safe!

[metmom]

The two meds I need that are so expensive are Tier 5, which means they are barely covered.

[Robert DeLong]

I’m with Humana and I have no complaints whatsoever. You might look into them as your gap coverage and drop yourself off of your husband’s plan. Whatever you decide on I wish the best of luck for you.

[Reddy]

Look on drug manufacturer’s website for coupons/discounts. Contact the manufacturer if you are having hardship paying for the drug.

Ask dr for samples.

Try GoodRX, sometimes it pays better than insurance.

[Rembrandt]

Before I retired, I quizzed the plans Dept. at my employer to the point that the guy said why wouldn’t you want to take our el cheapo insurance with prescription coverage plus medicare. I use that and it works fine.

Call your former employer and ask how you can adjust your secondary provider insurance so it covers prescriptions - then it’s all cheap.

[metmom]

Thanks.

I have Humana for the Rx coverage.

Mr. mm and I have discussed whether it might be better to go to Part C and use them as the primary ins.

All in all, aside from these couple prescriptions I’m on for controlling the mast cell activity that are very expensive, I really don’t have much else on my plate.

It’s just so very frustrating that what our insurance covered, for which I am very grateful, is not covered by Medicare. And to be forced off it and onto Medicare and lose all that.....

My coverage gap for my meds would be close to $10,000 in expenses for us between the co-pays and what they don’t cover.

[metmom]

I’ll look into that..

Thanks.

[mplsconservative]

My husband will turn 65 soon and is working full-time at home. Does he have to buy a Medicare supplemental? He gets mail for this every day. I just turned 60. Confused by the rules.

[old-ager]

Believe it or not, GoodRx works sometimes. Can save a lot of money. Free prescription card. There are others, too.

Look up your meds here: https://www.goodrx.com/

[Moonmad27]

I’ve been on Medicare a couple years, with Medicare Advantage via United Healthcare (through AARP, which I’m not a fan of otherwise). Things have gone very well. My two meds are at no additional cost to me. Outpatient surgery a year ago cost me $275. No cost for doctor visits, etc., and once a year (yesterday, in fact) there’s a required clinic visit to check vitals, etc. I hope I’ll always be as pleased.

[metmom]

Someone at the pharmacy is checking into coverage from the manufacturer for people with limited incomes. Apparently there are discounts etc, for people who qualify.

I’m kind of surprised, now that you mention it, that the pharmacy didn’t say anything about a coupon for the Epi-Pens. I know they have them on occasion as I used them before.

Course, if they hadn’t jacked up the price of the Epi-Pens a few years back just to make more money, it wouldn’t be a problem.

Price gouging at its worst for a medication and is life saving when needed. Epi-Pens are not optional when you are in anaphylaxis.

[Ken H]

I think you meant to use the term “Advantage plan” instead of “supplement”.

Supplemental policies are the same thing as Medigap policies.

[hanamizu]

Medicare is complicated and it helps to have someone who know what’s going on to help you navigate through the many options.

There is Medicare which you “join” when you are 65. Then there’s Medicare Part B. You don’t have to take Part B, but be aware that you will be penalized for not joining—the longer you delay, the higher the penalty. It costs $109/month and is deducted from your Social Security payment. If you aren’t drawing SS yet, you’ll have to send them a check.

I would strongly suggest a visit to your local Social Security office to find what you need to do. My office worker was friendly and helpful, your milage may vary!

The next step is either buying a Medigap policy from a private insurer that covers or partially covers expenses not covered by Part B or a “Medicare Advantage” plan. Some Advantage Plans can be free but come with strings attached. They are very like an HMO.

We don’t have HMOs where I live, so we buy a Medicare Supplement Plan. They have different levels of coverage. I am on a Plan F which right now costs me $230/mo. It basically pays for everything that Medicare A & B don’t. Went through cancer radiation treatment that were $5000 a pop, with no out-of-pocket expenses. Obviously I’m quite pleased with that! But Plan F is going away. Plan G is similar but has a deductible.

Drugs are covered by Plan D. I pay $20/mo for my plan, but I haven’t been using lots of drugs.

As I wrote earlier, it helps to have a disinterested someone to help you navigate through this. Aging Matters (used to be Agency on Aging) might be able to help, or google some local resources. A great deal depends upon where you live. Different places do things differently.

HTH