Posted on 07/07/2020 7:58:06 PM PDT by 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.
Find a good medicare part c that fits your needs. I too turned 65 in May. Am still looking for a part c plsn
I honestly don’t know.
People tell me that Medicare is easy to sign up for, which I disagree with, and trying to decide which is best is frustratingly confusing.
Everyone is trying to sell you their own plan and what I would like is to find a third party who can give me unbiased advice.
Is your husband self-employed?
One option for some meds that we have found very cost effective, is going through an online Canadian pharmacy. I get Synthroid VERY inexpensively that way, but other stuff is no deal. And you have to be careful to find a reputable company.
“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.”
The pharmacy staff may be overwhelmed/understaffed. It’s good for patients to be their own advocates for their healthcare/medications/payments.
I just recently paid $10 more than I had to for a med, thinking I needed to use a certain pharmacy for an rx. I won’t let that happen again!
I cannot speak to the interaction between the various forms of coverage; but I recently had to change HBP medicine because the old was causing a deep hacking cough. The two old ones (hydrochlorothiazide & Lisinopril) were together under $30/mo. The new Rx, even in generic, was $760. I used the GoodRx card and it was $42. I have no m-care coverage for Rx.
Our medicare, insurance and hospital billing/payout policies are a minefield that can bleed a person drive because of the lack of transparencies and I have yet to find an advocate (not a salesperson) to point out which policy is best for me.
I’ve had Medicare Parts A&B for several years now. As a retiree of NY State, I have the Empire Plan with prescriptions. That became my secondary. Medicare paid everything for 3 abdominal surgeries, and open gall bladder surgery in 2015. I didn’t even have any co-pays for any of the surgeries. Other than the gall bladder where I went home the next day, my other hospital stays were between 5 and 7 days each. All paid for by Medicare. My Empire Plan paid very little toward them. I never got a bill for any of them. I’ve been able to keep all my doctors, and have never had a problem with co-pays, which average $20 or below. About the only thing my secondary insurance pays for are my prescriptions for which I have a co-pay for most of $5.00 or below.
This gal, Bailyn was helpful to me as a “navigator”.
P: 817-697-4657 | F: 888-730-7648
I think she is East Coast time.
The plan books usually come in two parts. A book describing the main plan, hospitalization, copays, Skilled nursing coverage, medical equipment etc. And a list of covered prescription drugs (called their formulary). Comparing is a time consuming chore. So a broker might have software that can compare them for you. Don't know.
Medicare.gov/plan-compare This is a medicare site that shows you the plans in your area and allows you to compare them.
Medicaresolutions.com site claims to be able to compare formularies. They have a 5 star whatever that means. I think they are a broker.
Drugs can be different tiers on different plans. So you might find a plan that covers your drugs better than others. The plans always make changes to the formularies each year. But often the changes won't affect you. There are other things to consider though. Pay attention to skilled nursing care. If something happens and you need to go to rehab for a couple of months for skilled care, that can really be expensive.
You can't have a supplemental plan with Medicare advantage but the medicare advantage plans often cover a lot of what a supplemental plan would anyway.
The other thing you can do is take your drug list to the local pharmacies and get them to print out the prices they charge. I understand that even though the copays are the same, if the pharmacy charges more, that puts you into the donut hole sooner.
OK, so you say that you have Medicare (Primary insurance) and you have another insurance (Secondary Insurance).
This is how it’s SUPPOSED to work: Your providers (all) bill the primary insurance company (Medicare). For the deductibles, coinsurances and any denials (meds & other things), the providers should then take that Medicare denial and send it on over to the secondary insurance company.
If your secondary policy pays for items that Medicare does not pay for, such as meds, coinsurances & deductibles, they will then send payment directly to the provider. You may actually be covered, but the process is misdirected. This happens all too often!
Would that the pharmacy, knowing your primary won’t pay, could bill the secondary insurance directly but they can’t do it. They have to get the denials first and then bill.
Recommend that you 1.) call your secondary insurance to make sure your meds are covered even though they’re 2ndary and then 2.) speak to the pharmacy and ask them how they do their billing since your secondary should still be paying for those things Medicare won’t (have to put a disclaimer here - Medicare has a whole list of things they won’t pay for & maybe your 2ndary insurance does too, so that’s why you want to find out & go in to the pharmacy armed for bear.)
Good luck!
Do you mean Procepia? Generic Procepia (finasteride) is about $9 with GoodRX coupon and I have had no problem using GoodRx even though I am on Medicare also.
Plan F is already gone unless you were grandfathered. I joined it the last day it was available, Dec. 31st. My area has no Medicare Advantage plans available either.
I think that our secondary ins. now that I’m on Medicare, does not cover my Rx costs.
It’s medical expenses, but not the Rx plan, so I’m stuck with whatever Medicare has for Rx’s.
The one med I am on had a co-pay assistance program that only worked for private ins.
Those on Medicare were not eligible for it, so I lost that. I’ve been sent to other sites but they don’t cover much. Certainly not enough for my Rx costs.
Check out Aetna Health and Life Insurance Company.
AetnaSeniorProduct.com
Medicare supplement Plan G.
When it comes to prescriptions, it pays to shop around for your part D coverage. Different insurers have different “schedules” of what they’ll cover, so look at your particular “cocktail”, and then look for the best coverage based on the available “schedules”.
It’s a pain, but you can save a lot of money by shopping.
I kept the insurance I had when I was teaching as my secondary insurance when I went on Medicare. Attached to that private insurance is ExpressScripts, which is where I get 99% of my prescriptions. Through that, they are very cheap generally.
Yes try GoodRX if you have a prescription
Also, some Part D plans have extra features, like a physical fitness facility membership. That’s why I picked mine (for the pool), but, of course, haven’t been able to use it.
> If you don’t like it you can change between Oct and Dec.
They’ve loosened the rules quite a bit. In some cases like the “5 Star” you can pretty much switch any time. Medicare.gov explains it.
I have Humama for Part C and Rx.
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