Sun Mar 2, 2014, 10:03 PM
DesertFlower (11,649 posts)
this is the first year that i have medicare part D.
i pay $12.60 a month to humana. yesterday i picked up a RX for eye drops my opthamologist prescribed. i paid $185.86. i asked if the insurance picked up part of it. she said "about $40.00" which means the actual cost was $225. i'm pissed. i'm also finding that most of my prescriptions are costing more than the plan i had through IBM which was discontinued.
for those of you who think medicare is great -- it's not -- it doesn't cover everything and the supplemental policies can be very expensive.
|
22 replies, 3044 views
![]() |
Author | Time | Post |
![]() |
DesertFlower | Mar 2014 | OP |
elleng | Mar 2014 | #1 | |
DesertFlower | Mar 2014 | #2 | |
elleng | Mar 2014 | #5 | |
madamesilverspurs | Mar 2014 | #3 | |
DURHAM D | Mar 2014 | #4 | |
Cleita | Mar 2014 | #6 | |
enough | Mar 2014 | #7 | |
doc03 | Mar 2014 | #8 | |
IphengeniaBlumgarten | Mar 2014 | #9 | |
DesertFlower | Mar 2014 | #11 | |
okaawhatever | Mar 2014 | #12 | |
okaawhatever | Mar 2014 | #13 | |
Auntie Bush | Mar 2014 | #10 | |
SoCalDem | Mar 2014 | #15 | |
Auntie Bush | Mar 2014 | #17 | |
SoCalDem | Mar 2014 | #18 | |
Auntie Bush | Mar 2014 | #20 | |
SoCalDem | Mar 2014 | #21 | |
LiberalArkie | Mar 2014 | #14 | |
hedda_foil | Mar 2014 | #16 | |
WinkyDink | Mar 2014 | #19 | |
winter is coming | Mar 2014 | #22 |
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:07 PM
elleng (124,006 posts)
1. Medicare IS great for many things.
It covered virtually 100% of my husband's last hospital/surgery bills.
(I have a good supplemental which covers my prescriptions, and sorry that others don't have similar RX coverage.) |
Response to elleng (Reply #1)
Sun Mar 2, 2014, 10:13 PM
DesertFlower (11,649 posts)
2. after so many years of having great
coverage through IBM i guess i'm shocked -- even though their deductibles and out of pocket expenses went up almost every year.
they covered my husband at no cost. i paid under $100 a month for mine and that included a great prescription plan. they discontinued the plan they had for retirees in 2013, but they did give me $1,187 HRA -- so it pays my premiums with a few bucks left over for other things -- like dental cleanings. |
Response to DesertFlower (Reply #2)
Sun Mar 2, 2014, 10:22 PM
elleng (124,006 posts)
5. I understand, and sympathize.
I/we had great coverage too, through Fed govt, as employees. Now I'm a retired annuitant, + continue to have good coverage via Medicare, + Feds as 'supplemental,' for which I pay monthly (and more than for me alone, to include daughter for 'self+family.)
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:15 PM
madamesilverspurs (15,451 posts)
3. Different plans pay differently.
My Med D prescriptions never cost more than $6.50. When I had the shingles, the first two meds alone retailed for $310 and $300 - my cost was $11. Some of my regular meds are issued in 3-month supply, cost is same as for 1 month.
In truth, my economic circumstances warrant that I am in the category to receive 'extra help'; but I have many friends whose circumstances are much better than mine and their Med D prices aren't much different from what I pay, and a couple of them reported the same kind of problems with Humana. Here's hoping you're able to shop and find a better deal when that window comes around again. |
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:21 PM
DURHAM D (32,254 posts)
4. My Part D is $42 a month.
Last year I had one prescription that cost $475. My part was $75. All other meds were covered 100%. Depends on which plan you pick.
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:22 PM
Cleita (75,480 posts)
6. Medicare by LBJ is good in spite of all the holes shot into it by the Republicans.
Bush's Medicare part D is a wrapped gift to big pharma. I pay a lot more than you in premiums for part D but they do pick up the whole tab when I need drugs. I think part D needs to be fixed once we a real socially progressive congress.
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:25 PM
enough (12,992 posts)
7. Each Medicare Part D plan is different, and the amount of research you have to put in to figure out
what will work for you is ridiculous. But I do think you can find a better plan than what you are describing. You may pay somewhat more per month, but if you have expensive prescriptions, you will be able to find a plan that will give you a much better deal than this.
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:54 PM
doc03 (33,278 posts)
8. My Medicare Advantage plan calls for a $15 co-pay for a thirty day supply
but all my prescriptions are cheaper with my K Mart prescription savings club card. So the insurance covers nothing.
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 10:57 PM
IphengeniaBlumgarten (328 posts)
9. Go to www.medicare.gov...
Under medicare drug plans tab, is a pull-down menu. One of those choices lets you compare different plans that are available to you. If you will take the time to enter in all your prescriptions and dosages, it will compute the actual annual cost to you, considering drug cost, copay, premiums and deductible, for all plans in your locale.
The Humana plan as I recall is a good option for people that take very few medications. Even though it has a high deductible it turned out to be a good choice for a friend of mine who has few prescriptions, but most people would want better (and more expensive) coverage. |
Response to IphengeniaBlumgarten (Reply #9)
Sun Mar 2, 2014, 11:22 PM
DesertFlower (11,649 posts)
11. thanks. i'll check it out.
i don't take that many drugs -- so i thought the humana plan seemed okay. i guess it's just this eye drop he prescribed for me. it doesn't have a generic.
when i enrolled in humana a spoke to a representative. we went over all the drugs i was taking. they fall into tiers and that determines the price. i still don't understand how the deductibles work -- some fall into deductibles -- 0thers don't. fortunately these eye drops are for short term use -- they are a steroid. |
Response to DesertFlower (Reply #11)
Sun Mar 2, 2014, 11:29 PM
okaawhatever (9,344 posts)
12. It may be something you need to work with your Doctor and Insurance company on. Sometimes
a physician has to write a prescription a certain way, or show that you've tried other meds first before the insurance company is willing to pay. After the internet, I'd pick up the phone and call the insurance company help line and figure out what you can do to get the prescription covered. If not, you'll know how to avoid it next year. Good luck.
|
Response to DesertFlower (Reply #11)
Sun Mar 2, 2014, 11:31 PM
okaawhatever (9,344 posts)
13. One other thing. You may want to check prices at the local Costco. I find that they're almost half
what the other pharmacies are and you don't need a membership. Just tell them you're there for a prescription.
|
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 11:09 PM
Auntie Bush (17,528 posts)
10. With my plan D I get a lot of pres. free and pay a couple dollars for all the others.
I love it. I used to pay $99 for Ambien...Now I get it for $9.00. I got it for $3:00 for years but it just went up.
|
Response to Auntie Bush (Reply #10)
Mon Mar 3, 2014, 12:42 AM
SoCalDem (103,856 posts)
15. What plan do you have?
I turn 65 in April & my husband retires in June, so we are BOTH in the market.. It's all so damned confusing..and a mistake made in choosing can cost a LOT of money..
Oh, to be a Canadian |
Response to SoCalDem (Reply #15)
Mon Mar 3, 2014, 12:28 PM
Auntie Bush (17,528 posts)
17. I have my plan D from Bankers Life and Casuality
It's deducted from my SS so I don't remember the exact price...but it's around $100.00 a month. I have no deductible and pay very little for prescriptions. They are a nation wide insurance company dealing mainly for seniors....however I don't know if they deal as far as California. Let me know if you want their address and I'll PM it to you. I also get my supplemental Plan B from them and get plan J so I have very little or no medical expenses.
|
Response to Auntie Bush (Reply #17)
Mon Mar 3, 2014, 12:41 PM
SoCalDem (103,856 posts)
18. Thanks.. please PM me the info.. This sounds like something we would like
I would rather "waste" money on the front, than to have a nasty surprise later on and have to wait months to change to another one.
|
Response to SoCalDem (Reply #18)
Mon Mar 3, 2014, 05:22 PM
Auntie Bush (17,528 posts)
20. I sent you a long PM with addresses, phone numbers and web address...did you get it?
I checked my PM's and I don't see it listed.
|
Response to Auntie Bush (Reply #20)
Mon Mar 3, 2014, 06:50 PM
SoCalDem (103,856 posts)
21. Got it.. Thanks n/t
Response to DesertFlower (Original post)
Sun Mar 2, 2014, 11:45 PM
LiberalArkie (15,132 posts)
14. I think all the plans have around $320 per year deductible. You will pay a copay anyway.
But if you reach your deductible I think you will pay less. I never meet my deductible. And yes my Express Scripts from when I worked was a lot less.
|
Response to LiberalArkie (Reply #14)
Mon Mar 3, 2014, 01:39 AM
hedda_foil (16,158 posts)
16. I've never had a deductible.
The first year I was eligible I went into the donut hole. It cost me a bloody fortune. I got extra help from the state (Illinois),which helped.a lot, until the state budget mess eliminated the program halfway through the year. Last year, I researched the hell out of it and found a plan that covered every single one of my scrips, with four out of five costing me nothing at all and the fifth costing $18. The premium was $72 a month, but it cost me so little in co-pays that I spent literally a couple of thousand dollars less than I had the first year. I'm keeping the plan until they decide to drop it or raise costs considerably. But this year, the premium is a little lower, while the pharmacopeia is even better for me. Of course, all my meds are generics, which helps.
|
Response to DesertFlower (Original post)
Mon Mar 3, 2014, 12:43 PM
WinkyDink (51,311 posts)
19. Feel free to pay the full $225.
Response to DesertFlower (Original post)
Mon Mar 3, 2014, 07:02 PM
winter is coming (11,785 posts)
22. The amount you have to pay may be different for different pharmacies on Humana's list.
I dug this up last night at Humana's website, while trying to help my mom: “If a retail pharmacy agrees to accept the mail-order reimbursement rate for an extended supply of medications, you should have no out-of-pocket payment differences. If a retail pharmacy doesn't agree to accept the mail-order reimbursement rate but has accepted an alternative retail/mail-order pharmacy rate for an extended supply of medications, you will have to pay for any difference in charge.”
A way to find drug coverage info is to go to the Humana website and click the link for “Pharmacy Services”. That takes you to https://www.humana.com/individual-and-family/pharmacy/. Then choose the Medicare pull-down menu (scroll over the word “Medicare” and the letters turn purple and a bunch of sub-options come up), and Pharmacy Services (leftmost column; under “Products and Services”), which takes you to https://www.humana.com/medicare/pharmacy/, then “Rx tools”, then “Search drug lists”. That puts you at https://www.humana.com/medicare/pharmacy/tools/medicare-drug-list/. “Drug List Search” will take you to http://apps.humana.com/UnsecuredDrugListSearch/Search.aspx. You then have to enter your Humana Plan ID or Formulary number, which should be on your Humana card. There's also a Drug Pricing Tool, which will give you an estimate of how much they charge for a drug at different pharmacies on your plan. |