Advice Needed On What Prefcription Drug Plan I should Get

Self ^ | 12/30/23 | OveVike

[OneVike]

I need some advice.

I am 67 years old and in a little over a Month I will be having my right shoulder replaced. I am actively enrolled in Medical-Care for health care, but not in any prescription policies. However, I need to figure out which prescription policy would be best for me before I have the surgery.

As of right now I have no current prescriptions for anything. Until I began having shoulder problems I have not even seen a general practitioner for over 10 years. Other than my shoulder problem I am healthy as an ox, or at least as healthy as an aging ox. The last time I got sick was with COVID in early 2020, and that lasted maybe two weeks and I have not been sick since.

NO, I have not been vaccinated since I was in the army almost 50 years ago., and I would rather die than allow any doctor inject any modern vaccination into my system.

Anyone have any suggestions as to what prescription plan would be best for me? Because after my surgery I know I will have to have at least pain medication if not antibiotics or anti rejection drugs.

I am guessing on what I will be told to take after the surgery, since I am clueless.

[moovova]

Move to California and shoplift for free upto $999.

[OneVike]

Interesting, because I went to AMAC’s website and filled in the information they asked for. Come Monday I expect a call from them to discuss the particulars of what prescription policy I may need, if I even need one.

[steve86]

“If he’s ‘healthy as an ox’”

It always bothers me when I hear things like that since so many conditions are non-symptomatic in their early stages and unknown to the patient. Without a lab panel to diagnose, the condition or conditions may progress to the point where permanent damage is done. Cardiovascular disease, diabetes, liver, kidney, some cancers and other conditions can advance insidiously for years. Many of these can be treated and their progression slowed or even stopped with early diagnosis and drug treatment.

[joe fonebone]

Yes...
Medicare part G...

[millerph]

How quick will Amazon pharmacy get the post surgery pain med to you? Probably about the time you don’t need it anymore

[gitmo]

If you are not already on Medicare Advantage, please consider going with a Medicare Supplements. Far better. I am happy with CIGNA prescriptions on Medicare Supplements. And they ship it to me, so I don’t have to go to a drug store.

My wife was on a different plan this year, but she has switched to CIGNA for 2024.

[bobbo666]

Pain killers, obviously. For weeks and be damned careful unless you want to be addicted to the “good stuff” for what remains of you life (e.g., percodan, oxycontin, etc.).. Make sure that if they give you something like vicodin you also get a few more powerful ones to take you over a weekend if vicodin doesn’t work. It does not for me, and that was just for a kidney stone and an impacted molar after some botched surgery.
You will also be on some antibiotic for the rest of life. Two surgeons told me that I’d have to take something like acetaymiacin (sp?) every time I got my teeth cleaned to prevent an infection of a knee replacement.

[steve86]

Someone else mentioned the Part D Late Enrollment penalties.

You probably don’t need Part D for your coming procedure but odds are high you will later on

It gets worse the longer you delay enrolling...

https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-enrollment/part-d-late-enrollment-penalties

https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-enrollment/when-to-enroll-in-part-d

[steve86]

Opiates always have to be picked up in person with ID AFAIK.

[Oorang]

When you reach the required age for going on medicare you should also sign up for medicare part B and part D (prescription coverage) or a medicare approved prescription plan.

If you don't sign up at that time but choose to do so at a latter date whether it's one year or one decade later medicare will charge you a penalty for the rest of your life. Seriously, it's right there in the fine print. Your premiums will be higher because you didn't sign up at the original required date.

Neither my husband nor myself take prescription medications. We get the lowest cost medicare approved prescription plan (Aetna SilverScript SmartSaver). Our annual premium is $40.00. At that price I figured we're better off having that now rather than a lifetime penalty at a later date.

I know someone that didn't sign up when they initially went on medicare, they got prescription coverage about 5 years later and their premium was double.

[CFW]

“So far I am clueless as to what I will be given. I see my surgeon on the 11th, and the day for the procedure will be within 30 days I understand.

But so far I have no prescriptions.”

---

It’s hard to recommend anything until you know which medications will be prescribed. Search in your area for Medicare insurance advisors and make an appointment with one of them. Maybe call the doctor’s office and ask to speak to his nurse and explain your situation and ask if she can give you the names of the prescriptions usually given after such a surgery.

I was wary until we visited one of the insurance advisors in our area for my husband’s insurance/prescription plan a few years ago. He found the best plan for hubby based upon his current medical issues and prescriptions. There was no charge for his services.

Now, the agent just emails us a form each year to update and if there is no new and better plans available, he advises us to stick with what we have. It is a lot better than searching through all the volumes of info we receive each year or trying to navigate the government’s website. We will visit him again next year when I turn 65 in order to get whatever supplemental plan I will need since I’m still on my former employer’s plan.

[Chewbarkah]

Ask your doctor what prescriptions you will likely be put on after the surgery, to help you make wise choices on prescription coverage. They will want to hedge, since they can’t foresee possible complications, etc.—tell them up front that you understand and just need a reasonable guess ssuming nothing odd arises.

Most areas have some sort of Senior Center or Bureau on Aging. Figure out who does this where you live and ask if they can recommend a certified agent who helps advise seniors on the best plans for them. This should be free (the people that do this are often volunteers). Contact the recommended peson, give them your drug list, and they will run it through software that indicates the best deals mong the pharmaceutical coverages. The Medicare.gov website likely has software for doing this yourself, but it sounds like conversation with a human would be helpful to you.

Insurers might balk at starting coverage for known pre-existing conditions, especially if high cost meds are anticipated. Being 100% honest about your entire situation going in will avoid unhappy surprises later. Nothing is likely to slip by them.

Good luck with your surgery and the all-important post-surgery rehab.

[Dandy]

My Dad had Medicare and several prescriptions. I used to order his drugs from Canada and they were cheaper than the copay from his supplement. I don’t know if they can ship opioids or not. I am on medicare and havent taken a prescription drug in more than 20 years.

[steve86]

Good comment, however, I checked the premium for Aetna SilverScript SmartSaver for my zip code (it is offered and actually has a lower premium than yours) and entered one of the drugs I take to see what the copay would be. It was NOT COVERED and so the monthly cost for that drug would be $153 instead of the $15 I pay now. And the deductible is way higher. (I am puzzled about the lack of coverage for that drug since it is a common generic drug — not the brand name — doesn’t seem right).

[steve86]

I have ordered Rx drugs for the cost savings from Canada and other countries as well, but no need to do that now.

[RightField]

Use the medicare.gov prescription drug finder. It gives good information on what the total costs are, not just your copayment. Remember that the build-up to the 'donut' hole amount is composed of BOTH your copayment and what the pharmacy charges the gov. There can be huge difference there for the same drug ... affecting when or if you reach that amount. This is useful info if you are taking expensive drugs and both costs are shown on the medicare tool. (full disclosure, the last time I used that site was in 2021, but it probably hasn't changed much.

Also note that you do not have to use your insurance to get a prescription. Several pharmacies have low costs for common drugs Walmart has $4/30 day and $10/90 days. Their list is online. Again, if you anticipate needing an expensive prescription, what you pay outside of insurance does not count toward the donut hole calculation.

When Mr.RightField was living, we successfully avoided the donut hole problem by getting most of his prescriptions through Walmart, Publix and GoodRx. The only Rx that went through his insurance was the expensive one.

Also be aware of the large deductibles this year for upper tier drugs. You might want to calculate the cost effectiveness of higher premiums vs lower deductibles. The medicare tool should be able to give you this info once you know what prescriptions you'll need.

Most of my info here has to do with long-term, maintenance meds. As others have said, most pain prescriptions are relatively low cost, so shop around for those. You may find the free/low cost options at Walmart, some grocery stores, GoodRx, etc are less costly than your copays.

[steve86]

I also looked at the Silverscript Choice ($44 monthly premium) and Silverscript Premium ($89 monthly) and the drug isn’t covered there either. Not sure what the deal is.

[steve86]

I also looked at the Silverscript Choice ($44 monthly premium) and Silverscript Premium ($89 monthly) and the drug isn’t covered there either. Not sure what the deal is.

[Oorang]

Ouch! Thanks for the info. I know you don't have to get meds through the insurance, you can just pay cash.
My husband had to take some prescription meds for dental surgery. I called a local pharmacy and asked the cost of the meds if we ran it through the insurance vs. cash. The cash option was just a few dollars.
Was helping a neighbor who was new to the medicare maze and her prescription coverage was the same as ours (low premium/high deductible). She takes a fairly expensive thyroid medication. Called the same pharmacy and running it through the insurance was high. She would meet the deductible in just a few months but then the insurance would only pay 50% of the cost. She was dollars ahead, by far, just paying cash for the medication.

My theory is get the cheapest medicare approved prescription coverage in order to avoid a penalty but pay cash for the meds.

[jdt1138]

Diet and Exercise is a pretty good plan.