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  #1  
Old October 8th, 2009, 01:02 AM
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Default Medicare

I'm setting up this topic in the hopes of addressing questions and concerns about Medicare. That said, I think there's only a handful of HTers who are old enough to qualify for Medicare so this subject may just disappear into the sunset!

I'm now beginning my 3rd month with this coverage and I already have a coupla beefs!

1. I take 3 meds on a daily basis. None are on Medicare's formulary list so they're out of pocket for me. One, even as a generic, is very expensive. I now have to buy the higher dosage that's very affordable but I'll need to split the capsules in half...that is, pour out the powder, determine how much equals a half then pour each half into separate capsules. Gotta have excellent fine motor skills to complete that task! Yet another med isn't available in generic and is expensive. I have to now buy outside the country for that one. The 3rd med is a brand name but inexpensive. No problems with that one!

2. Now...this one irks me: A few weeks ago I needed a short term med that is on Medicare's formulary. It's generic and inexpensive. If I didn't have insurance I would've paid $17. Since I have Medicare, I paid $5. So far, so good, right?! I just received the statement of benefits. Medicare, for that particular med, negotiated a price with the network pharmacies of $5.23. So...I paid $5. and the gov't paid 23¢. I don't have a problem with that. However I do have a problem with the entire $5.23 counting against my yearly maximum (approx. $2300.); an amount, that once a patient hits it, the pt. then becomes responsible for 100% of drug costs up to another level...the so-called "donut hole". That's a brief overview but my stand is...if the gov't pays 23¢ then that's what should apply to my maximum! Otherwise I feel like I'm paying twice. And, no, I don't expect to hit that yearly maximum but one just never knows. Maybe I should just have a self-imposed policy of paying out of pocket for any drug that's under $20. We'll see!

/vent...and I now return you to your regularly scheduled programming!
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  #2  
Old October 8th, 2009, 01:31 AM
Barry Barry is offline
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Default Re: Medicare

What can I say ?


Sorry for your probs with getting your medicationsn

Here the NHS is free. I have certain pills and if I ring up my doctor then the pills will be delivired within an hour or so.
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  #3  
Old October 8th, 2009, 03:42 AM
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Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
Maybe I should just have a self-imposed policy of paying out of pocket for any drug that's under $20.
That is similar to the problem I've encountered with the way some dental insurance plans cover for "exams". Some only allow one exam per year. So, if you use up that one exam with a quick checkup by the dentist when you have your cleaning, insurance pays for a $30 exam. But then if you need to see a specialist, that exam might run $90. Yikes, if you've already used up the "annual exam benefit" for the year, you have to pay the full $90 out of pocket. So, if my regular exam is early in the year, I'll pay that cheap exam out of pocket, and save my annual benefit in case a more expensive specialist exam is needed later on.

[The are just example numbers, not actual numbers, but you get the idea..]
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Old October 8th, 2009, 10:35 AM
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Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
I already have a coupla beefs!
Your beefs below are exactly why we need health care reform, especially the public option.

Quote:
I take 3 meds on a daily basis. None are on Medicare's formulary list so they're out of pocket for me.
I would think about changing primary care physicians.

Medicare is not a "free" program. The governement is trying to hold down costs on medicare and therefore there will be some out of pocket expense, more for some than others.

Quote:
Since I have Medicare, I paid $5. So far, so good, right?! I just received the statement of benefits. Medicare, for that particular med, negotiated a price with the network pharmacies of $5.23. So...I paid $5. and the gov't paid 23¢. I don't have a problem with that. However I do have a problem with the entire $5.23 counting against my yearly maximum
The reason is because the $5.23 is a negotiated price, in other words a subsidized cost.

I have none of these problems since I am enrolled in Medicare part C which includes a more liberal drug benefit than Medicare part D which is apparently what you have.

I pay approximately $96 per month for my Medicare coverage. I do have co-pays for doctor visits and medications but that doesn't amont to much on an annual basis. Even if I had a serious, life threatening illness, my maximum out-of-pocket expense would be $3,200 per year. My Medicare part C provider tells me that the governement pays them about $700 per month for the coverage they provide me.

I am just happy I have an affordable health insurance program. My concern is for those people who have no health care at any cost.
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Old October 8th, 2009, 10:39 AM
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Default Re: Medicare

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Originally Posted by Amati View Post
So, if you use up that one exam with a quick checkup by the dentist when you have your cleaning, insurance pays for a $30 exam. But then if you need to see a specialist, that exam might run $90. Yikes, if you've already used up the "annual exam benefit" for the year, you have to pay the full $90 out of pocket. So, if my regular exam is early in the year, I'll pay that cheap exam out of pocket, and save my annual benefit in case a more expensive specialist exam is needed later on.
Could you scheule your annual exam and cleaning toward the end of your insurance year? That way you could use your benefit earlier in the year if you had a serious problem, but if not you could use it at the end of the year for a regular exam.
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Old October 8th, 2009, 10:44 AM
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Default Re: Medicare

I just had my eye exam and ordered new glasses. I got a great deal at Costco for the exam for $49.95. I checked with a opthamologist friend of mine and he said the exams at Costco are more than adequate.

Buuuuut............I just found out that my Medicare part C provides for an annual eye exam for a $15 co-pay. I could have saved myself $35 and taken uaifi out to a nice dinner.

Goes to show that if I don't pay attention, it costs me money! (I'll take uaifi out to dinner anyway)
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Old October 8th, 2009, 03:56 PM
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Default Re: Medicare

I'm only 62 so I have a few more years to go but can you go any drugstore? Is any of your meds on the list of generic drugs for $4/30days at WalMart? I don't have any kind of drug coverage so I go wherever is cheapest, so I even make use of my VA benefits. I recently went to "Long's" to get some antibiotics which were $40.+ but the sales girl signed me up to some kind of CVS thing for free and it cost me $11.66 instead.
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  #8  
Old October 8th, 2009, 05:40 PM
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Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
I think there's only a handful of HTers who are old enough to qualify for Medicare
Interestingly, people with kidney disease (regardless of age), are also eligible for Medicare.


Quote:
However I do have a problem with the entire $5.23 counting against my yearly maximum (approx. $2300.); an amount, that once a patient hits it, the pt. then becomes responsible for 100% of drug costs up to another level...the so-called "donut hole".
Yeah, the donut hole is total bull sh*t, especially how the accounting (at least from the point of view of the patient).


Quote:
Originally Posted by matapule View Post
I have none of these problems since I am enrolled in Medicare part C
Oh interesting. I didn't know there was a part C, but that would explain the missing letter
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  #9  
Old October 8th, 2009, 06:16 PM
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Default Re: Medicare

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Originally Posted by matapule View Post
(I'll take uaifi out to dinner anyway)
You've got one lucky uaifi! Any chance you have a son y'all can introduce me to? Preferably in his 30's, fun and outdoorsy, and at least 5'10"?

Back to topic, I've been going to Sears for my eyecare for years, and they always charge me $100 for the exam alone. Next year, I'm going to Costco!!
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  #10  
Old October 8th, 2009, 07:27 PM
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Default Re: Medicare

Quote:
Originally Posted by D'Alani View Post
I'm only 62 so I have a few more years to go but can you go any drugstore? Is any of your meds on the list of generic drugs for $4/30days at WalMart? I don't have any kind of drug coverage so I go wherever is cheapest, so I even make use of my VA benefits. I recently went to "Long's" to get some antibiotics which were $40.+ but the sales girl signed me up to some kind of CVS thing for free and it cost me $11.66 instead.
I checked into a similar program at Walgreens and Medicare recipients are excluded from signing up. I think this is Medicare's decision, not the retailers. If that is, in fact, the case, then WalMart's will also be excluded. To answer your question, D'Alani, I don't know if any of my meds are included in WM's program because I haven't checked. I do know that my $280./30 caps GENERIC med wouldn't be included on ANY list!!! That's the one I mentioned in post #1...that if I get a higher dose (15mg instead of my well tolerated 7.5mg) it's way cheaper ($14./30 caps!!! Go figure!!!) but then I have to divide and recapsule the contents. My other 2 meds are not available in generics.
Quote:
Originally Posted by MyopicJoe View Post
Interestingly, people with kidney disease (regardless of age), are also eligible for Medicare.
When I called the various Medicare plans that inundated me with mail () the first question I was asked was, "Do you have end stage renal disease?". Because I don't I didn't bother to ask why they asked me that question! Oh, and because we're coming up on open enrollment, I'm getting inundated with mail once again.
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Yeah, the donut hole is total bull sh*t, especially how the accounting (at least from the point of view of the patient).
President Obama is trying to address the donut hole problem!
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Originally Posted by MyopicJoe View Post
Oh interesting. I didn't know there was a part C, but that would explain the missing letter
Part C is Medicare's equivalent of an HMO plan such as Kaiser. I believe it's called Medicare Advantage. Matapule, please correct me if I'm wrong. Part B is the equivalent of a PPO plan. Not all docs participate, however.

Now, here's a 'glitch' my friends who have waited to beyond 65 to sign up for Medicare were not aware of...the part D "Late Enrollment Penalty". That is, if you wait to sign up for the drug coverage you are penalized 1% per month. This becomes a lifetime penalty:
Source
Quote:
The penalty is a 1 percent rise in your premiums, on any Part D plan you eventually join, for every month you delay after first becoming eligible to join a Part D drug prescription plan.
Are we having fun yet?!!!!!
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Old October 8th, 2009, 07:43 PM
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Default Re: Medicare

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You've got one lucky uaifi! Any chance you have a son y'all can introduce me to? Preferably in his 30's, fun and outdoorsy, and at least 5'10"?
Naughty girl!
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Old October 8th, 2009, 08:56 PM
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Default Re: Medicare

some of the drug companies have programs that will assist people with paying for their meds - sometimes even making them available at no cost. if you know the manufacturer of your drugs, contact them & just ask. There is paperwork to fill out to qualify and your doctor also has to sign off on it - but you could also be able to save on your meds.

I hope this helps!
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Old October 8th, 2009, 10:03 PM
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Default Re: Medicare

Have you checked outside sources such as CanadaDrugs.com? It's all legal and according to my doctor he said if it's cheaper go for it. Sometimes they call it another name but it's the same product.
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Old October 8th, 2009, 10:26 PM
Peshkwe Peshkwe is offline
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Default Re: Medicare

The problem with places like CanadaDrugs.com is that they won't deal in narcotic type prescriptions. For anything like that you have to have your doctor hook up with a Canadian doctor. You then become his 'patient' in tandem with your own doc.

He'll then duplicate your doc's 'script with one from his office. By US law you can only get a three month supply at a time, it's all they'll let through customs in one go. They will check if you have a proper perscription from both docs in the packaging as well.

I get one of my daughter's epilepsy drugs out of Canada because it's not FDA approved in the US.
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Old October 8th, 2009, 10:50 PM
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Default Re: Medicare

One of the brand name drugs I take is somewhat expensive...$100./30 tabs. I now go thru a Canadian prescription "broker" who has various international sources. Sounds kinda sleazy, doesn't it!!! My cousin is knowledgeable on this subject, said that this broker status is common and told me that the broker I used appears to be completely legit and to trust his medication sources. It took me a month to get up the courage to go this route! I had to send the broker a prescription and payment. I chose the UK source. The med came directly to me from the UK. The cost, including shipping, was approx. $63./90 tabs. Big difference. Even when I had my HMSA insurance prior to Medicare, and with a $20. discount card from the drug manufacturer, I was still paying $35./30 tabs.

Medicare has caused me to jump thru hoops but at least I've found hoops to jump thru!
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Old October 9th, 2009, 03:05 AM
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Default Re: Medicare

Quote:
Originally Posted by matapule View Post
[...]
I would think about changing primary care physicians.
Just curious...why?
Quote:
Originally Posted by matapule View Post
Medicare is not a "free" program. The governement is trying to hold down costs on medicare and therefore there will be some out of pocket expense, more for some than others.
Correct!
Quote:
Originally Posted by matapule View Post
The reason is because the $5.23 is a negotiated price, in other words a subsidized cost.
Yep, I mentioned it was a negotiated price! And I don't have a problem with that OR that I had a $5. co-pay. I don't like that the gov't uses my $5 co-pay against me by applying it to my yearly maximum. Let 'em apply what they pay! As I mentioned before, I feel like I'm paying twice.
Quote:
Originally Posted by matapule View Post
I have none of these problems since I am enrolled in Medicare part C which includes a more liberal drug benefit than Medicare part D which is apparently what you have.
Yes, I have part D. Is there an online drug formulary for your plan? It would be interesting to see if any of my 3 meds are on it. They aren't on any other plan. Still, I'd rather jump thru hoops with the drug situation then lose my current doctors and start anew by switching to plan C.
Quote:
Originally Posted by matapule View Post
I pay approximately $96 per month for my Medicare coverage. I do have co-pays for doctor visits and medications but that doesn't amont to much on an annual basis.[...]
Ditto for me...altho' I haven't been on Medicare long enough to get an annual total. Next year!
Quote:
Originally Posted by matapule View Post
I am just happy I have an affordable health insurance program. My concern is for those people who have no health care at any cost.
Agreed...on both counts! I had HMSA for at least 27 years so this switch to Medicare is a big change. It's the old dog/new tricks thingie!
Quote:
Originally Posted by matapule View Post
[...]
Buuuuut............I just found out that my Medicare part C provides for an annual eye exam for a $15 co-pay. I could have saved myself $35 and taken uaifi out to a nice dinner.

Goes to show that if I don't pay attention, it costs me money! [...]
Because I was having separation anxiety from HMSA, I overlapped it for one month with Medicare. I moved my eye exam up from Nov. to Aug. and scheduled anything else I could during Aug. Plus I ended up sick on my first day with Medicare coverage and needed 2 ultrasounds. I had no out of pocket medical expenses for August because of the overlap! When I received the statement of benefits from Medicare I noticed the 2 ultrasounds totalled approx. $1300. My co-pay was $20. per ultrasound which HMSA paid. Pheeeeeew!!!
Quote:
Originally Posted by D'Alani View Post
I'm only 62 so I have a few more years to go but can you go any drugstore?[...]
Sorry I didn't answer this earlier. Pharmacies have to be on Medicare's provider list and Medicare recipients are provided a directory. Most pharmacies, as far as I can tell, participate.
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Old October 9th, 2009, 04:06 AM
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Default Re: Medicare

TS - did you notice my post? I also will now check Canadian brokers.
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Old October 9th, 2009, 11:13 AM
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Default Re: Medicare

Quote:
Originally Posted by D'Alani View Post
I'm only 62 so I have a few more years to go but can you go any drugstore? Is any of your meds on the list of generic drugs for $4/30days at WalMart? I don't have any kind of drug coverage so I go wherever is cheapest, so I even make use of my VA benefits. I recently went to "Long's" to get some antibiotics which were $40.+ but the sales girl signed me up to some kind of CVS thing for free and it cost me $11.66 instead.
Alani, you can go to any drug provider you want under Medicare. It is just that you may do better "retail" at the drugstores. The good news is that WalMart, Longs, or CVS "retail" may be less than the Medicare prescription cost.

For example, I take a statin each day. Under my Part C prescription plan it would cost me about $10 per month. However I buy mine at the Costco pharmacy for around $2 per month if I buy 6 months at a time (same price anyone else would pay, including those not on Medicare).

It is all about choice and options. You get to decide where your best deal is
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Last edited by matapule; October 9th, 2009 at 11:47 AM.
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Old October 9th, 2009, 11:19 AM
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Default Re: Medicare

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Originally Posted by turtlegirl View Post
Any chance you have a son y'all can introduce me to? Preferably in his 30's, fun and outdoorsy, and at least 5'10"? !
Well..................I do have a daughter, 37, 6'-0", never married, loves hiking, photography, professional degree and license, volunteers in the Sea Turtle Hatching project. Maybe the two of you could work something out, ya betcha (wink, wink).
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Old October 9th, 2009, 01:20 PM
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Originally Posted by matapule View Post
Maybe the two of you could work something out, ya betcha (wink, wink).
NOW who's the naughty one, eh SurlyGurly? ;_D
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  #21  
Old October 9th, 2009, 03:23 PM
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Default Re: Medicare

Quote:
Originally Posted by anapuni808 View Post
TS - did you notice my post? I also will now check Canadian brokers.
I did, Anapuni...thx. I mentioned a subsidy in post #15.
Quote:
Originally Posted by matapule View Post
Alani, you can go to any drug provider you want under Medicare. It is just that you may do better "retail" at the drugstores. The good news is that WalMart, Longs, or CVS "retail" may be less than the Medicare prescription cost. [...]
This is a good point. It can really pay to call around if you have the time. I've done this and am always amazed at the different prices from the different pharmacies. But, Matapule, it's my understanding that a pharmacy must be on the provider (in network) list to get the best Medicare price. There would be a higher co-pay from an out of network pharmacy...at least for plan D.
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Old October 9th, 2009, 08:06 PM
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Default Re: Medicare

How confusing ! NHS is better.I ring up my doctor and ask for a repeat prescription. The pills are delivered to my door within an hour~ No charge.
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Old October 9th, 2009, 08:23 PM
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Default Re: Medicare

the plan I was talking about was to get your meds for free, not subsidy. Astra Zeneca is one I know does it and most of the other big pharms also do this. It's usually for seniors, uninsured or underemployed.
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Old October 10th, 2009, 12:12 PM
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Default Re: Medicare

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Originally Posted by tutusue View Post
But, Matapule, it's my understanding that a pharmacy must be on the provider (in network) list to get the best Medicare price. There would be a higher co-pay from an out of network pharmacy...at least for plan D.
No, that's not what I am saying. My statins cost me $10 per month co-pay from my Medicare provider (I think the "retail" on this drug is about $50 or $60 per month). I can purchase the same prescription at Costco for $2 per month retail, no co-pay, same price everyone pays at Costco.

I am saying that some pharmacies (Costco, WalMart, Longs, CVS, Target) are less epensive than the Medicare co-pay costs if you participate in their "discount clubs" that are available to everyone. Leave Medicare out of it if you can get your drugs elsewhere at a lower cost than your co-pay.
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Old October 10th, 2009, 12:15 PM
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It can really pay to call around if you have the time..
If you are old enough to be on Medicare, TIME is what you have a lot of!
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