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Medicare & Prescription Plan D Any Suggestions

beccab35
1 Recommendation

Dear Friends, Thanks for your openness and sharing. It's been immensely helpful and comforting to know you are there.

I am 60 and have been on disability for 2 yrs. (6 years since diagnosed stage IV - constantly on chemo - currently Doxil). As required, I will move into Medicare in November, luckily I can convert my work health plan to my supplemental plan but there will not be prescription coverage.

With the multitude of prescriptions (and high costs) it is scary to me to pick a prescription plan that will be best for my situation. Anyone in a similar situation? Any ideas for Prescription plans that might work for or what to look for in a prescription plan?

Rite Aid Pharmacy had a great booklet that I got good info with a website that helps you find out which plans are available to you by zip code and prescription www.riteaid.com/medicareadvisor. It really has advanced my search.

Gee, seems like only yesterday I was waiting to get my drivers license & picking out prom gowns .......now I have a Medicare card. I really must say, Thank the Lord !

Thanks for your help.
Love, Rebecca

Explore topics in this discussion:

Cancer Chemotherapy Counseling Aromasin Breast cancer

11 replies

blanche149

My sentiments exactly! I couldn't even fathom being this old when I was a teenager.
I've been on Medicare now for a little over a year and have been fairly happy with it. (Except for the hassle I got when my onc ordered a PET scan. They didn't want to cover it - so we had to play some "coding games" to get it approved.)
As for prescription drugs - be SURE that you sign up for SOMETHING. First of all, the drugs you receive in chemotherapy or that are received in a hospital setting (such as Zometa for bones) are covered under Part B, not under a prescription plan.
From what I understand, your local social security office will help you go through the Part D prescription drug plans to see which one will cover your current meds the best. The problem is with us metsters - those drugs can change at a moments notice and you can only change plans once a year - between November and January.
Consequently I chose a plan offered by Blue Cross and Blue Shield in my state that covers a wide variety of prescription drugs. That way, if I have to change prescriptions, I bring in the formulary from BC/BS and my doctor can check all the options.
So far, it has worked pretty well.
This product (at least in Montana) is sold separately from my Medicare supplement plan. So, I would check in your state to see how Blue Cross/Blue Shield handles Medicare prescription plans.
Hope this sheds some light on the subject for you.
Oh - one last thing. You probably know about the donut hole in the Medicare prescription plan. After you and your insurance have paid out $2,700 for prescriptions in a year, there is a gap of $1,650 that you must pay at 100%. Then coverage kicks in again.
I am on Aromasin, which costs a little under $1,000 every three months. To avoid the donut hole, I ask for free samples at my cancer center. With the free samples, I am able to get by this year without hitting the gap.
Good luck,
Blanche

beccab35

Blanche, Thanks so much. Glad to hear it is working for you. The sample is a good idea. God Bless you.
Love, Rebecca

frannyv

The easiest way to determine which part D plan is best is to first, make a list of your medicines. Then you can go to the medicare website and log in with your prescription list and they will list the plans for you in order of least cost to you. Yes, sometimes our drugs can change and then you might have to pay more for a particular drug than another plan, but overall, it is at least a starting point. I chose to select a plan with no deductible, but the costs of the prescriptions might be a bit mor expensive. I prefered to spread the costs over the whole 12 months instead of a big deductible in January. If you have a computer and can go on the internet, you can find the best plan for yourself.

Shanti

Hi Rebecca,

I have been researching the same subjects as I have been on disability and thought I was eligible for Medicare in Oct. It turns out I have to wait until March next year but that is another story.

During my research I met with a wonderful volunteer from an organization that offers free counseling and advocacy for senior citizens, but they were happy to meet with me and help me understand my options when I will be eligible for Medicare.

One of the great pieces of information she gave me was a list of insurance companies that are required to offer Supplemental Insurance Policies to people like us who are going on Medicare due to disability not age. My understanding from her was that not every company has to offer us coverage but there are about 20 on a list she gave me that have to offer it in California where I live. I am sure there are differences state to state. She also gave me a list of companies with their phone numbers and web site addresses that offer the part D drug coverage. You can find policies that cover generic drugs during the horrible "gap" period. They cost a little more monthly but they might be worth it to some people. Here is a copy of the email that the volunteer sent me after I asked her for information to share with other metsters.



The national SHIP (State Health Insurance Program) network has a great
website, with a drop-down menu to find the toll-free number to call for
medicare counseling/info in each state - go to:

https://shiptalk.org

in the left column under "About Ship" - click on "Find a State Ship" and it
will bring up the drop down menu of states

Most states will have one 800 number for the whole state, but it will route
the call to the office that covers the county from where the call is made.
Alternatively, click on "Find a Counselor" and the drop down menu will show
the local agency sponsoring the SHIP in that area.

Many of the agencies are targeted to the senior population, but SHIP serves
anyone who is on Medicare. Hope this helps!

beccab35

Thank you Franyv - no deductible - something to consider.
Thank you Shanti - good info and website. I will try it.
God Bless you both.
Love, Rebecca

mspeedy

I, too, always reach the 'donut hole" early in the year. This year, it was in May. I just thank God that my Ongologist gives me free samples to get me through. The pharamcutial companies that offer help, but only if you have NO insurance, and of course, I have Medicare. Let us hope if health care reform does go through, it does something about that gap in coverage we experience, as the meds that we with metastatic breast cancer must take to keep us alive, are very expensive, as you all know!

frostbite

I've been reluctant to say anything as the U.S. is not my country but...your health care system leaves a lot to be desired. No one should have to go through what you women have to just to access your health care. I wish you all lots of luck with the proposed reforms and I hope they make it easier for you (and not harder)

frannyv

Shanti,
Good point about needing a supplemental plan. I went on Medicare in Sept, 2007 and I selected a supplemental plan from AARP. I remember, there were very few options for those of us on SSDI. Because our treatments are so expensive, it is cheaper to get a supplemental plan then pay the 20% that Medicare doesnt pay, or even the Part A Deductible for hospitalization, but it isnt cheap. Also remember there are no pre-existing conditions if you get a supplemental plan within the 6 month grace period when you start Medicare. I have plan i through AARP and pay 345 per month. (that is in addition to what is deducted from my SSDI for medicare part B and Prescriptions plan part D) The combination of Medicare and AARP gives me excellent coverage. Hope this info is helpful to you all!

LaGata

I am on Medicaid and was told that I will automatically be switched to Medicare four months on my 65th birthday. With a disability income of $727 per month (house payment is $650) and I'm allowed to earn up to $700 per month additional income when I can, how the heck will I be able to afford what Medicare doesn't pay???

beccab35

Thanks Franyv - I will try AARP and also checked the SHIP and got a number for counselor in Phila.

Thanks MSpeedy - I learning more about the donut holes that is scary.


Thanks for all your help.

beccab35

Lagata - thru this process I found a few assistance programs. Patient Assistance 800-955-0989 which is the Pennsylvania number but I am sure they'll give you the number for your state. They help you get meds from the drug companies either free or low cost.

Plus another assistance # for 65 and older is 800-225-7223.

I hope others have ideas for you.

Love, Rebecca

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