Medicare Part D Prescription Plan

Does anybody have this completely figured out yet? I have to make up my mind by 12-31-05 because my employer is kicking me off the employee benefit package (yep, they can do that. I'm "Medicare eligible" because I'm on long term disability.)

I'm just bewildered. I've used up a whole legal pad working out figures. My meds cost about $800 a month and I'll hit that magic $2250 in no time, but I still can't get numbers to work out. Why do some of the companies want to charge you a deductible and others don't? How can some get away with no co-pay for the generic drugs at all. That's giving drugs away for free!

I think the whole plan will cost me over $3600.00 a year no matter what I do. This has me about to panic! When I try to call the 800 numbers for help, all I can get is a computer that says someone will call me back. In a month of trying, not a single company has called me back! Even the 800-Medicare number won't help you. How in the world do you pick a plan? Which one? Do you want a deductible or not? Do you want a co-pay? If so, should it be a small one, or a big one? Do you want to get to the $3600 out of pocket soon or not? I don't know how to decide on any of this.

I'd complain to somebody else, but even my neighbors (they're all seniors) are in the dark, too.

Check with Walmart and see if they have someone set up there to help people figure out which plan will work best for them.

Try http://www.medicare.gov/. It is the most impartial source and fair;y easy to navigate. Some of the Agencies on Aging can also be helpful. Most pharmacies will also help but they tend to be biased toward thier plans. AARP migh be useful, but they also have vested interest. Nothing is free, but medicare (actually congress allocated)is picking limited amount of the tab and they wish to encourage generics. Aditional coverage for the deductables and doughnut hole will cost more. If one is on medicare but healthy to the extent of little or no need for drugs, then one of the very inexpensive basic coverage plans will keep from occuring a penaly when you need to enroll later in life. In your case, you should consider one of the extended coverage plans, but you will have to pay a higher premium. Major point, make sure that the drugs you need now are covered. Some plans pay a percentage of the more expensive drugs, but some don't. Thats why you should use the compare plans feature on that website.

Farmerdill is right. I work for a nonprofit that provides services for the "sage" members of the community and lately this is the biggest thing to ask questions about. I've found the most useful information for my clients at www.medicare.gov. Also, if you have any questions contact your state Agency on Aging or state Long-term and Aging Department. If you go to either the website or make a call, make sure you have a detailed list of prescriptions, with the exact dosage (mm, cc or whatever) and how often you take it (twice a day, once a month). This will help also. Some plans will say that X drug is covered, but what they don't tell you is that it is only covered up to a certain dosage. So check that. And if you find an ideal plan, but it doesn't have one of your medications you can have your doctor write a certified letter explaining why you have to have it and try to get the medication added to the plans coverage. Also, check with you local pharmacies. This is a problem where I live because it's a small rural town. There are only 3 pharmacies in town and they only work with a limited number of plans. Which means that some of the best plans for some of my clients, aren't carried and they would have to travel to the nearest city (3-4 hrs away) to get to a pharmacy that does work with their plan.

Hope this helps. I just finished attending a two day training session on Medicare part D, so you'd think I would know more, but maybe my memory will come back to me after I finish my coffee.

Jess

Thanks guys. I sure appreciate any help I can get.


I heard a Congressman say that he understood this program well and he had spent about an hour Thanksgiving helping his Mom and Dad figure out a plan that would work for them. I thought it was rather odd that it took him "about an hour" when he said he understood it well.

I saw that Humana includes WalMart as one of it's participating pharmacies and they do have someone at our local WalMart who can talk to me. I also called Humana today and the nicest live person talked to me for quite awhile. He sent me to their website with detailed instructions about how to calculate what my actual savings would be with each of the plans they administer. I don't think I'll get to the $3600.00 after all. It isn't as scary as I thought, now. Although, I still want to talk to the representative at WallMart. I did check their formulary and all of my drugs are covered, thank goodness. Some of the other formularies didn't have a couple of them. I take a couple for seizures and am on the best combination I have ever been on before. There's no generic for either yet, so I have to stick with the companies that have these two drugs on their formularies anyway. That would eliminate some of the plans, no matter how good they might be.

Jess, if the caffiene woke up your memory and you can think of anything that might help me, jump back in here. I have only until the 31st. I'll have to enroll by phone if I wait until then, or do it online, I guess.

I've been going through all this trying to find the right plan for my parents. If you are on disability you may very well be eligible for 'extra help' for presc. drugs through social security. I filled out the form they sent my parents and should hear in a week or two if they qualify for any amount of extra help with their meds. I feel certain they will qualify for some amount of extra help. Anything will be a big help as their meds are so very expensive.
Good luck on your search!!


Lin

Okay I'm back. Sorry I took so long Pollyana. The training I did this week was with the State Department of Aging, a government agency, and this is what they are doing with individuals that need help with Medicare part D. They've been going around our state holding enrollment sessions in different towns. These are the steps that they take during the enrollment session with an individual. If you contact a state agency or even call the people at Medicare these are the steps they will take. So, if you have a decent grasp on the internet, you can do it yourself.

1. Make sure the individual has all medications, with details such as dosage, etc with them.
2. Access www.medicare.gov
3. On the website's home page there are several options to click on, but the best one for you would probably be "Compare Medicare Prescription Drug Plans"
4. The next page it will ask you where you want to begin. Click "Find a Medicare Prescription Drug Plan"
5. The next page you enter in personal information...the number on your Medicare card, whether you're enrolled in Medicare part A or B, name, etc.
6. The page after that is your Current Coverage Information
7. After that is a small review and then it asks whether you want to search for Medicare Advantage Plans (contain health insurance plus drug coverage) or if you want to search for just Medicare Prescription Drug Plans.
8. If you're looking for just the Drug Plans, which I assume you are since that's what Medicare Part D is all about, click the link for just the Drug Plans.
9. The next page will tell you how many drug plans are available in your area. It also lets you personalize your search by entering your medications. Do this and be specific about dosage etc. This will weed out a few of the drug plans in your area that don't cater to your needs. This page also lets you limit the plans by annual deductibles, monthly premiums or mail order availability. That might be too many factors at once. I would just focus on the medications for now.
10. After entering medications and dosage, it'll ask you if you want to chose a preferred pharmacy. If you prefer a certain pharmacy go ahead and do that, but be aware that not all pharmacies carry all plans and this could limit your options too much. If you're not too picky about which pharmacy in town you go to, ask long as you get a good affordable plan, then don't choose a preferred pharmacy and click the appropriate link.
11. The last page is the summary page. It will list all of the plans from all different companies that are available in your area that also meet your criteria for comparison. It will give you the cost of each one, the annual deductible, premium, etc. All on one page so that you can compare prices and choose what is best for you.

The whole process takes about 45 minutes. This honestly is the best way to do it. This way you get an unbiased accessment of every plan that meets your criteria. If you talk to someone at a pharmacy or an insurance agency, more than likely you won't be given information on all the plans, just the plans that benefit their companies.

Hope this helps. If there are anymore questions I'd be glad to help.

Jess