Let's talk Medicare Part D

[Malibu]

We received notification today that MM's medicare coverage is in effect.  We had his graft installed and started dialysis/home training within the same month which made him eligible for Medicare coverage retro to the 1st of that month.  It is retriactive back to Nov 2009.  So..... I am searching for Part D.  Oh boy, I really don't want an education on this stuff.  I heard that some of the plans are preferred by people with certain ailments, such as ESRD.  :O)  I entered the drugs, answered all the questions...and have waded through countless grids.....don't really know much more than when I started.

You folks on dialysis...which plan did you choose and why?

[dwcrawford]

To choose the absolute perfect plan you must know every medication you will take in the coming year, not only its copay but also the cost the individual insurance company will pay toward the plan and expecially the effects of/ if any exists / the so called donut hole.  You also need to know the category that the individual policy will place each drug into (mostly called Tiers).  And what drugs you may be removed from once dialysis starts to kick in and others that might be administered through the dialyslis procedure.

In short, it is virtually impossible to predict without a really good fortune teller.  Recommendation: get a solid plan with resonalbe cost and no deductible...i like no copays for generics and no donut hole for generic but costs a little more.  If you find a real winner don't be too proud of yoursself because it will be changed by next year.  (I have a policy from United Health Care... chose it because they have a wide selection of options.  It is not the cheapest but generally saves me as much or more than others would have. 

[Jean]

Dan is right, even if you find the " perfect plan" it will change next year, or, your meds will change. A lot of pharmacies here wont give you an estimated cost on a drug, unless you have a RX for it, so its hard to shop that way. Good luck and get the best one for you, if you can.

[Chris]

I still don't understand since it has started. What came down choosing who after checking all the medications was the name of the company. Some I have heard of, some I haven't. One thing to look at is the pharmacies that take your plan if your not going to use the mail order pharmacy portion of part D (It can be a pain in the butt if you have a new prescription to send in).

[Malibu]

Ha!  OK, so everyone is as confused as I am.  Sounds like the best thing is that you can change it in a year.

Funny thing is most of his prescriptions are less than the quoted co-pay.  Except for Renvela....I just paid $707 for it (we have no other insurance).  I take it the pharmacy will give me the lower price. (?) 

I have not found one with no copays for generics but I will look.

Thanks much!

[lizabee]

I didn't opt in to Part D because I have mine and my husband's private insurance, but I am Social Security social worker so I might be able to find out what plans are best for our type of situation.  I have a couple clients with ESRD, and they get Medicare.  I think you might have better luck calling Medicare and speaking with someone, their website is ridiculous.  1-800-medicare

[dwcrawford]

Part D is only medicare involved in that it must be medicare approved.  All policy are will individual companies.  Now, how do I get SS to stop taking about my premiums.  I asked them in July....When are you going back to work?

[lizabee]

I am released to work one day a week for now, I went in today.  All you should have to do is go into the SSA and tell them.  Are you opting out?  Or just wanting to pay it on your own?  do you have private insurance?

[dwcrawford]

If you are talking to me, I've talked to the insurance company and to ssa severall times.  Been going on since July when the state picked up part of the cost provided it was direct pay.  They assure me I'll get it someday.  But it is 78 dollars per months.  I could use it.

[Chris]

Your lucky Dan if they are only taking $78, Medicare usually takes out $96 a month if the state is not paying it for you.

[dwcrawford]

Yes Chris, it is 96 now for Medicare but 78 for the prescription drug part D.  SS  takes it out and pays United Insurance for me (just a convenience thing).  When I started dialysis the state paid 35 but only if I pay united directly.  I starting paying my (78 less 35) but SS continuted to take the 78 out.  Plus the 96 for regular medicare.  It computer crap.  They say they'll stop  (someday) and pay me the difference so I'll get a big check... sometime.  But its  money.  I want it now.

[Chris]

Ahhh, so if they are taking the $78 now, don't pay it to United. Of course I am over simplifying it too.

[dwcrawford]

Well, actually its already paid because I pay by the year (or half year in this case).  I am afraid if I don't pay this time that Texas will stop paying their little part.