Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 I don't understand it either. All of the choices are written such that it takes a Philidelphia lawyer to figure out what in hell is the best thing to do. Also the insurance company over night can just make changes that are no longer covered the next day. My basic health insurance plan covered Humalog pens in July but a month later the Humalog pens were no longer on " their " formulary. So now instead of paying a $30 per prescription refill, it costs me $100. Medicare Plan D > I've been trying to figure out Medicare Plan D with 0 success. The site > provides a link for screen readers, but I find reading the tabular data > all but impossible nonetheless. I'll give them the benefit of the doubt > and believe they really wanted to make the site helpful, but I find many > of the links ambiguous. Apparently they have no clue that many of us get > prescription drugs via medical assistance programs and I was getting tired > of reading how my drug costs might be cut in half. If what I came up with > when my wife and I were on the site the other night is true, I'll be > paying hundreds of dollars more. If anyone has any suggestions on helping > me make sense of this screw ball program I'd be most grateful. > > Dave > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Well folks, don't feel left out. I signed up on one plan which seemed good for prescriptions - but - my out of pocket medical expenses went up like a rocket. When I selected another plan which didn't screw up my Medicare medical coverage my prescriptions went back to just about where they were before I ever heard of " Plan D " . Well, at lest I now know what Plan D stands for - Disaster, Disarray and Deception. Cy, the very confused Ancient Okie... Re: Medicare Plan D I don't understand it either. All of the choices are written such that it takes a Philidelphia lawyer to figure out what in hell is the best thing to do. Also the insurance company over night can just make changes that are no longer covered the next day. My basic health insurance plan covered Humalog pens in July but a month later the Humalog pens were no longer on " their " formulary. So now instead of paying a $30 per prescription refill, it costs me $100. Medicare Plan D > I've been trying to figure out Medicare Plan D with 0 success. The site > provides a link for screen readers, but I find reading the tabular data > all but impossible nonetheless. I'll give them the benefit of the doubt > and believe they really wanted to make the site helpful, but I find many > of the links ambiguous. Apparently they have no clue that many of us get > prescription drugs via medical assistance programs and I was getting tired > of reading how my drug costs might be cut in half. If what I came up with > when my wife and I were on the site the other night is true, I'll be > paying hundreds of dollars more. If anyone has any suggestions on helping > me make sense of this screw ball program I'd be most grateful. > > Dave > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Cy, I didn't find it amusing to sift through all the info on the Medicare site either, but since I didn't already have drug coverage I had to come from the vantage point that most of my meds were " given " to me by the drug companies since I met their income guidelines, but the tradeoff was an endless parade of paperwork to keep renewing the prescriptions. I took a more proactive approach but one which would not be very feasible had I not had some vision to read all the columns of print. I looked at various plans listed in Medicare's tables and picked, at random, three or four different " middle " plans to compare my drug coverage. It turns out that at least for now the plan that best suited me was from Wellcare, which covers all my meds and has no deductible. True, I'm paying out the $88 a month for Medicare and $34.79 a month for the Wellccare drug prescription plan, but this is far cheaper than the cost of my medications if I had to pay for them myself. I just hope they never change the formulary, but if they do, I'll just have to look at other plans the next time I could change enrollment. For now the plan I chose works, but I know that there are far too many people who can't find a good fit for them. And yes the lists are very intimidating, and getting help to make sense of it all is about like trying to get W to admit that FEMA really stands for Futile Effort Managing Anything. Bill Powers Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 And, what exactly does the term " formulary " refer to? Thanks. Dave Medicare Plan D > > >> I've been trying to figure out Medicare Plan D with 0 success. The site >> provides a link for screen readers, but I find reading the tabular data >> all but impossible nonetheless. I'll give them the benefit of the doubt >> and believe they really wanted to make the site helpful, but I find many >> of the links ambiguous. Apparently they have no clue that many of us get >> prescription drugs via medical assistance programs and I was getting >> tired of reading how my drug costs might be cut in half. If what I came >> up with when my wife and I were on the site the other night is true, I'll >> be paying hundreds of dollars more. If anyone has any suggestions on >> helping me make sense of this screw ball program I'd be most grateful. >> >> Dave >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 So, they can change the program just like that? How often can one switch plans? Dave Medicare Plan D > > >> I've been trying to figure out Medicare Plan D with 0 success. The site >> provides a link for screen readers, but I find reading the tabular data >> all but impossible nonetheless. I'll give them the benefit of the doubt >> and believe they really wanted to make the site helpful, but I find many >> of the links ambiguous. Apparently they have no clue that many of us get >> prescription drugs via medical assistance programs and I was getting >> tired > >> of reading how my drug costs might be cut in half. If what I came up >> with > >> when my wife and I were on the site the other night is true, I'll be >> paying hundreds of dollars more. If anyone has any suggestions on >> helping > >> me make sense of this screw ball program I'd be most grateful. >> >> Dave >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 I will give you my understanding of this program. I personally did not sign up for a Part D plan as I receive prescription drugs through my employer's retirement plan. My mother, however, did not receive prescription plan coverage through any other plan. Accordingly, my sister and I signed her up for a Medicare Part D plan. I was unable to navigate the site. My sister, who is not blind, could. By entering my mother's prescriptions and zip code we got a listing of all approved plans in her area in land - 46 plans in total if I remember correctly. The cost for each of the plans and the cost of my mother's prescriptions was listed. In fact, we got a listing in order of cost. We did not select the cheapest plan, but selected a middle plan from a company that we thought would be there for a while. We also figured that a large, stable company would be less likely to change its drug formulary. I recommend that you get a sighted person to help you. You have to evaluate the plans based on total cost. Otherwise you will go nuts. The plans have different costs, co-pays, and deductibles. Let me repeat, You have to do it on total cost. In land, anyone eligible for subsidized prescription drugs was required to sign up for a plan. This is because the other subsidized plans were all terminated as of December 31, 2005 for anyone on Medicare. In fact, if you did not sign up for a plan, one was selected for you. Due to my mother's income, she receives a reduced plan cost as well as lower co-pays and deductibles. Medicare Part D is saving my mother substantial amounts. I hope that this is of some assistance to you. Marvin Medicare Plan D > I've been trying to figure out Medicare Plan D with 0 success. The site provides a link for screen readers, but I find reading the tabular data all but impossible nonetheless. I'll give them the benefit of the doubt and believe they really wanted to make the site helpful, but I find many of the links ambiguous. Apparently they have no clue that many of us get prescription drugs via medical assistance programs and I was getting tired of reading how my drug costs might be cut in half. If what I came up with when my wife and I were on the site the other night is true, I'll be paying hundreds of dollars more. If anyone has any suggestions on helping me make sense of this screw ball program I'd be most grateful. > > Dave > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Dave, Formulary is basically a directory of what drugs an insurance carrier establishes as drugs it recognizes and will cover in its plan. Each company sets up a formulary of drugs it deems as a covered item and assigns it into whatever co-pay tier it chooses depending on overall cost. For example, in the plan I'm on, a drug like Metformin or Glyburide are fully covered, meaning I don't pay at all for them, while a drug like Cosopt, which is a fairly new eye medicine, will cost me $15 because it's new and there's no generic. There's one drug I take that would cost me $236 a month but I pay $50 for it instead, because it's also new and very expensive. If an insurance carrier decides not to recognize a certain drug, for example, Actos, then you'd have to find an alternative to that or pay for it yourself. Formularies are necessary in order to keep from paying even more sky-high prices for all the latest drugs, for which insurers would have to substantially raise our premiums, thus making us pay for it in the end. Bill Powers Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Dave, Yes the insurers can change their formulary at their own discretion but we can only change plans once a year, probably in December or January. Bill Powers Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 The formulary is the approved list of drugs that are covered by any insurance company federal or state agency. It is subject to change whenever the board members of that company or agency wish to vote on making any change. In other words if you need a drug that has been approved to be on the formulary, you just pay the nominal fee or co-pay and it is covered. If it is not on the approved formulary, then you pay the normal retail price without any discounts. For instance at one time both Humalog viles and Humalog pens were on the formulary, but the board members in Georgia decided that Humalog viles were much cheaper for them to approve than Humalog pens, so Humalog pens were removed from the formulary in Georgia. If you use a tried and proved drugthat is now most likely a generic drug, it is probably approved to be on the formulary. If you are prescribed a new drug like say Levaquin, a newer antibiotic medication, and it is also a brand name drug it is unlikely not approved to be on the formulary, so you get to pay full price for it. As an example my wife was prescribed Levaquin this week, and a co-pay would ordinarily cost her $30, but since it was not on the approved formulary, the ten pills of Levaquin cost her $100. Now your doctor does not prescribe what he believes is the best medication to treat your problem, but he has to know your financial circumstances plus keep a listing of approved drugs which he may substitute for the one he would really like to prescribe, since if he prescribes a high cost cost drug not covered by the formulary, you will have to pay full price for it. Medicare Plan D >> >> >>> I've been trying to figure out Medicare Plan D with 0 success. The site >>> provides a link for screen readers, but I find reading the tabular data >>> all but impossible nonetheless. I'll give them the benefit of the doubt >>> and believe they really wanted to make the site helpful, but I find many >>> of the links ambiguous. Apparently they have no clue that many of us >>> get >>> prescription drugs via medical assistance programs and I was getting >>> tired of reading how my drug costs might be cut in half. If what I came >>> up with when my wife and I were on the site the other night is true, >>> I'll >>> be paying hundreds of dollars more. If anyone has any suggestions on >>> helping me make sense of this screw ball program I'd be most grateful. >>> >>> Dave >>> >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 The very best thing to do Dave, is call Medicare heir 800 number and ask to speak to somoeneone. That is how my parents finally figured out what to do. Every State-and every area in every State has different plans that really vary. Medicare Plan D I've been trying to figure out Medicare Plan D with 0 success. The site provides a link for screen readers, but I find reading the tabular data all but impossible nonetheless. I'll give them the benefit of the doubt and believe they really wanted to make the site helpful, but I find many of the links ambiguous. Apparently they have no clue that many of us get prescription drugs via medical assistance programs and I was getting tired of reading how my drug costs might be cut in half. If what I came up with when my wife and I were on the site the other night is true, I'll be paying hundreds of dollars more. If anyone has any suggestions on helping me make sense of this screw ball program I'd be most grateful. Dave Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 A formulary is alist of drugs that a particular insurance company keeps on their list of drugs they provide. Most formularies try to keep expensive durgs off their list-or if they are on the list, you the consumer have to pay dearly for it! Re: Medicare Plan D And, what exactly does the term " formulary " refer to? Thanks. Dave Medicare Plan D > > >> I've been trying to figure out Medicare Plan D with 0 success. The site >> provides a link for screen readers, but I find reading the tabular data >> all but impossible nonetheless. I'll give them the benefit of the doubt >> and believe they really wanted to make the site helpful, but I find many >> of the links ambiguous. Apparently they have no clue that many of us get >> prescription drugs via medical assistance programs and I was getting >> tired of reading how my drug costs might be cut in half. If what I came >> up with when my wife and I were on the site the other night is true, I'll >> be paying hundreds of dollars more. If anyone has any suggestions on >> helping me make sense of this screw ball program I'd be most grateful. >> >> Dave >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2006 Report Share Posted May 7, 2006 I'm determined to get a better handle on this after a less than satisfactory conversation with someone from Medicare yesterday. Anyway, I'm presently only adding 3 prescriptions that are the most costly in an attempt to find a plan that will cover them. At the moment, I'm not getting anything better than 67% (i.e. 2/3 of the drugs). One of these is Humalog pens which will be the most expensive item. Anyway, I am confused by what they mean by tier 1, tier 2, tier 3. Could someone explain this? And, the web site says a company has a relatively short time to respond to a request to add a drug to their formulary, and I wonder how successful I'd be by requesting a company to add Humalog pens or whatever. I'd really like to find a plan that showed 100%, but so far I haven't managed to do that. I'll keep trying. Many thanks. Dave Re: Medicare Plan D >I will give you my understanding of this program. > > I personally did not sign up for a Part D plan as I receive prescription > drugs through my employer's retirement plan. > > My mother, however, did not receive prescription plan coverage through > any > other plan. Accordingly, my sister and I signed her up *snip* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2006 Report Share Posted May 7, 2006 Dave, Tiers of drug coverage have to do with how much of a co-pay you would have for that drug. For example, if a drug is a tier 1 drug it's free to you, if it's tier 2, you have a small copay, anywhere from $5 to $15 depending on the plan you get, and if it's a tier 3 drug it's one of those expensive drugs that means you'll have a larger copay. For exapmle, the plan I use has tier 1 at no copay, tier 2 at $15 a copay and tier 3 at $50. Bill Powers Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 Bill, Thanks. Just what I needed to know. Now I have to determine if I want to enroll or not. It seems the logical thing is to join, but I'm still not convinced. Dave Re: Medicare Plan D Dave, Tiers of drug coverage have to do with how much of a co-pay you would have for that drug. For example, if a drug is a tier 1 drug it's free to you, if it's tier 2, you have a small copay, anywhere from $5 to $15 depending on the plan you get, and if it's a tier 3 drug it's one of those expensive drugs that means you'll have a larger copay. For exapmle, the plan I use has tier 1 at no copay, tier 2 at $15 a copay and tier 3 at $50. Bill Powers Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.