First of all, nothing that's supposed to be HELPFUL should be so complicated.
She went to the computer and gave me a print-out of what my 'scripts would cost (approx) AT MY CURRENT PHARMACY.
...But if I can get them cheaper elsewhere, I'd be willing to drive a little further...
I live in one State, my current doctor is in another, next-door....
...But if I can find a cheaper plan requiring me to stay in-State, I'd be willing to switch doctors.
Whether or not you use the standard, traditional, public plan, you have to pay for it.
Want to cover out-of-pocket stuff? Medigap can help. But just not entirely.
Need drugs? You'll need Part D. How much does it cost to have it? It all depends on your choices, including OTHER choices not directly connected to prescription coverage.
And none of the information, particularly re: the private option, "Part C," is presented anywhere in a way that makes sense, so that comparisons are straightforward.
You guys who are not eligible yet: be prepared for this rigmarole.
She DID provide me with her email address, though--- so that I could formulate and ask some questions that make sense, and hopefully get some REAL answers. She mentioned also that unless I had a favorite plan going-in, she'd recommend BC/BS because in Massachusetts, it's gonna end-up being my best overall option.
So much of the (hypothetical) info you get depends on prior assumptions. It's based--- in other words--- on a lousy CONSUMERIST model. "Have it YOUR way. About EVERYTHING, and ALL of the time." You don't have to make any changes. How CONVENIENT! It will just end-up costing you more if you DON'T make any changes. (Shit!)
Comments
Still, once I've pruned the list down to a half dozen, I have wound up making a spreadsheet so that I can look at all of the finalists in detail on one page.
If you use a Part C plan, your Part B premiums are going to the insurer to pay for your coverage. For many plans, that's it, no extra premium.
The amount that Medicare pays the Part C insurer depends on your health. That is, the premiums they charge (to the government) are somewhat medically underwritten.
I mention this here because insurers try to game the system. They'll offer you a free, at home, health consultation (or whatever they call it). It's not to help you - it's for them to build up as long a list as they can of your medical "problems", so that they can claim you're not in good health and charge Medicare more for your Part C coverage.
Regardless of the drug plan/insurer you select, keep in mind they can change their formulary at any time, so the best laid plans .... I've had a generic medication of mine moved from "okay" to "step therapy required". Fortunately (or perhaps not so fortunately) I'd recently been switched to that drug from another because of new adverse effects with the other drug. So it was a relatively simple matter to show that the step therapy requirement had already been met.
Still, a waste of time and effort, on my part, on the doctor's part, on the insurer's part, on the PBM's part. Just one small example of the overhead in "the best healthcare system in the world".
What I did; I signed up for the standard A and B and got a fairly cheap supplemental plan. Total cost, $135 monthly for medicare, $35 monthly for the supplemental insurance. There were actually $0 cost options for the supplemental policy that offered a bit less "insurance". There are also much more expensive policies that I didn't need, and at the 2 insurer sponsored work shops I went to the speakers pretty much said nobody needs.
This works for for me, but I'm fairly healthy, knock on wood, and do not have a lot of prescriptions. I guess I'd recommend you you sign up for Medicare (which is A and B) and call a health care insurer in your area and ask to sit down with them to compare options for supplemental/advantage policies that take the place of plan D.
Are you aware you need to sign up 3 months prior to the month you turn 65?
Note, I think I may not use the terminology of "supplemental" plan properly. I know there are Medicare 'advantage' plans and supplemental plans and they may differ. I couldn't even tell you which I have.
Good luck in fining some RX coverage.
Derf
Part A - hospitalization; generally free unless you've worked less than 40 quarters.
Part B - doctors; monthly premium is currently $135.50, or higher if you have high income (IRMAA)
Part D - drug coverage; entirely private insurance; premiums vary; there is a government imposed additional premium (IRMAA) if you have high income
Part C = Medicare Advantage = private insurance in lieu of Parts A, B, and (usually) D; you still pay part B premium (which helps the gov pay the insurer); some are offered with $0 (additional) premium, while others charge a premium (in addition to the Part B premium) that you pay to the insurer.
Supplemental Insurance = Medigap = Plans A-N; these fill in "gaps" like the Part B 20% co-pay for doctors and foreign coverage; entirely private insurance, and except for initial enrollment period, insurers can reject you for health reasons
----
The initial enrollment period lasts for seven months, from three months before you turn 65 to three months after. You are not required to sign up for Medicare, but if you don't, you'll pay a lifetime penalty - higher premiums for Part B and Part D if you sign up later. Also, if you don't sign up during the initial 7 month period, you can only sign up during the annual enrollment periods, toward the end of each year.
All the private insurance is sold locally, so if you are an expat you cannot buy Parts C or D, or Medigap. (The penalties for not having bought Parts B and D are waived accordingly if you do relocate to the US.)
If you have creditable drug coverage, i.e. drug coverage comparable to what Part D plans provide, you do not need to purchase Part D (and aren't penalized if you later buy a Part D plan). This coverage might, e.g. be part of your retiree benefits. If you buy a Part C plan with drug coverage, you do not (and cannot) buy a Part D plan.
The private supplemental (Medigap) plans are completely standardized; the only notable differences between the offerings for a given Plan by two insurers is the price and the quality of their service. (They are allowed to throw in a few freebies like Silver Sneakers.)
Plan F is the most comprehensive and also the most popular (57% of policies are Plan F). Lots of people find value in this more extensive coverage. (That's not an endorsement, just an observation.)
If you will not become eligible for Medicare before 2020, you will not be able to buy a Plan F or Plan C policy. This is because they provide first dollar coverage (they pay your Part B deductible). Everyone will be able to buy Part G and Part C, which provide comparable coverage except they don't pay the Part B deductible. Also, starting in 2020, Part G will offer a high deductible option to replace the Part F high deductible option.
...I STILL want uniform, universal coverage, not this hodge-podge. At least it's good to know that there are Open Enrollment periods every year, so I can switch, if it will work better for me.
Yup, much of this Medicare related can be complex. Not unlike attempting to position one's investments, one is more likely to have satisfactory results based somewhat upon the time spent from investigation, eh?
Side note: costs for all related vary by zip code, and variations among some states. Also, relative to the supplement insurance plans, one may find 1 plan for $55/month and another for $110/month. Difference......higher deductible and fewer fees covered. The standard insurance product scenario, pay more for more coverage.
--- Medicare supplement insurance plans. @msf has detailed how the supplemental plans may be packaged. A real example of the potential value of supplemental plans. Three years ago we assisted a friend, who was about to start Medicare, through the various options for supplemental plans. She chose plan "F", which is a, covers just about everything plan. Her average monthly premium for the past several years has been about $160. The insurance coverage she received is the equivalent of 13.5 of premiums at her current cost. She discovered a breast lump, which was determined to be active, cancerous. From the day one primary doctor visit, through lumpectomy, to chemo, to post chemo radiation and all of the steps between all of these procedures; her supplemental insurance covered all costs that were not covered by Medicare. This includes all of the drugs/meds; as they were part of the treatment. Without the supplemental insurance, her out of pocket charges would have been $26,000 for the time frame. However one chooses to view insurance premiums, in this case; the $26k paid by insurance amounts to 13.5 years of monthly insurance premiums at the current cost (which will increase going forward).
--- drugs/meds
Whether one has a combined plan which includes drug coverage or a separate purchased Plan D, the GoodRx program can be a winner for cost savings. The GoodRx program may be used from a standard pc or an app. on a smartphone. NOTE: there is no relationship between GoodRx and whether or not one has "drug" insurance or not.
Example: This is a real sample of using GoodRx. A doctor visit and the doctor writes a 'scrip for drug "x". One inputs the medication name into a smart phone and discovers five prices in your area. The price for 20 pills ranges from $200-$21. The 'scrip is sent to the $21 pharma.
Nine things to know before you use GoodRx Also, read the 7 comments.
GoodRx site
Nap time................
Take care,
Catch
As @catch22 pointed out, the reason that the chemo drugs were covered by the supplemental policy (here, Plan F), was that they were part of the treatment (i.e. falling under Part B). The coverage for those drugs was not under Part D.
Medicare Advantage plans must cap Part A and Part B out of pocket expenses. In this sense, they function much as supplemental policies for Original Medicare do. For 2019 that cap must be no higher than $6700. Obviously to get a lower cap you're going to have to pay higher premiums for a Medicare Advantage plan. Part D costs are not capped, just as they are not capped under supplemental plans.
GoodRx is an excellent resource, and I agree with catch - read the 7 comments. They contain what I was going to add about the service. There are several other lesser known companies providing the same type of service as well. Compare them all.
There are pharmaceutical company coupons/cards which are completely different. They cannot be used by anyone on Medicare. Like the prisoner's dilemma, they tend to help individuals while raising drug costs overall. Here's one (of many) articles explaining how they work and why you can't use them when on Medicare:
https://www.pharmacytoday.org/article/S1042-0991(16)31400-1/pdf
Regards,
Ted
Depending on medication. Meaning ExpressScripts does not have some 'uniform' pricing across the meds board; no one does (of course).
The gov calculator for total drug costs, and other calculations, is very handy and easy to use, and I turn to it every fall during enrollment, frequently changing part D providers even as my meds list has not changed.
I have read that it's not frequently or widely used by consumers, though.
@Crash, depending on your Mass. county, do also look into Tufts, both their supp and their Advantage. (One thing to note, probably mentioned elsewhere, is that the Advantage programs are HMO-like, meaning referrals and network docs. If for example you wish to go to an orthopedist or similar who does something more up to date procedurally than what your network surgeon offers, to name just one example pertaining to me, get a supplement. I have not found them wanting in almost any respect.)
The inclusion for the GoodRx information is more to the situations of medications that are required on a random basis. Say, a family of five; a doctor prescribes an anti-biotic to be obtained within a few hours at a local pharmacy; versus an ongoing refill of a medicine.
can you explain this a bit? do you have a supp or advantage?
we see (tufts, mass.) the occasional cost reduction and benefit improvement, nothing major, it is true --- lower specialist OV co-pay, more for glasses or something for acupuncture, that sort of thing.
One may use GoodRx, with Medicare, a purchased rx insurance contract, etc. As time allows, make a few phone calls to your local pharma's.
I'll add this from the GoodRx web site. Perhaps this is the confusing part of trying to use GoodRx with Medicare or other rx insurance. We showed the pharmacist the GoodRx app. screen from a smart phone, stated that we were paying with cash, and the transaction was done. No trying to combine with Medicare or other insurance to create a deductible level or any other linkage.
>>>Can I use GoodRx if I have insurance or medicare?
Yes! Even if you have health insurance or Medicare, GoodRx can still help you control your prescription drug costs and find prices that are lower than your typical co-pay. Did you know that GoodRx has been found to beat insurance copays about 40% of the time? It's also a great resource to use when your insurance doesn't cover a drug or if you can't afford your medication due to a high deductible.
You can use a GoodRx discount instead of your prescription insurance or Medicare if the cost is lower. However, GoodRx cannot be combined with your insurance or any federal or state-funded program such as Medicare or Medicaid. GoodRx is not insurance.
If you choose to use a GoodRx coupon or your GoodRx Gold membership, it’s important to ask the pharmacist not to run your prescription through your insurance or Medicare (Beware: This tends to happen often). Ask that the pharmacist use the coupon or Gold card to process the transaction as cash instead.
The example I posted earlier, the $200-$21 price range for 20 pills was a med. for our house. The $21 price was from a pharma at a major grocery store chain. The pharma was well aware of age and didn't ask a single question. The traditional pharma's were generally the higher priced, including one where we have a "rx plan" connection.
GoodRx with Medicare, etc. multi search
IMHO, there's no question that the denials and appeals, changes in formularies, etc. are designed by insurers to minimize payments (and exhaust both patients and providers fighting their system). As a side effect of all this added paperwork they significantly increase the cost of health care. I've filed successful complaints/appeals variously with my state's AG office and my state's regulatory body. The fact that I was successful shows that things should never have gone so far. But that's how fiercely insurers try to avoid paying out.
As @catch22 noted, and I remarked on further above, pharmacy-focused coupons, like GoodRx, or WellRx or any of a slew of others can be used by anyone. They are independent of the drug manufacturers.
In contrast, coupons and cards provided by drug manufacturers are designed to maintain or increase pharmaceutical company profits at the expense of insurers. Worse, they increase the cost of drugs overall (in part by encouraging patients to use brand name rather than generic drugs). The government wants no part of this scam (which would raise the cost of Medicare to everyone even if it saved you personally some money). Thus it prohibits Medicare from participating. Massachusetts concurs; it is the only state to prohibit the use of these cards, period.
Here's another page citing one of the studies referenced in the earlier link I posted on this subject. It's from the Kellogg School of Management, Northwestern University. It's worth reading, though the title alone is pretty clear:
Prescription Drug Coupons Actually Increase Healthcare Spending by Billions
https://insight.kellogg.northwestern.edu/article/prescription-drug-copay-coupons-hurt-generic-competition