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I would like to hear from anyone who is familiar with medicare part D. I have very limited knowledge of it, so if I'm misunderstanding anything, I apologize in advance. From what I understand, everyone on SS, or SSDI, who participates in medicare part D pays a different amount based on how much prescription medication they use, and how much their particular medication costs. In my case I take some very expensive drugs, including Enbrel, and Celebrex, and a few others. I was told my medicare part D fee, if I enroll would be several hundred of dollars per month. Can anyone else elaborate on how medicare part D works? I called SS, and the person I spoke with sounded clueless.
I was told my medicare part D fee, if I enroll would be several hundred of dollars per month
No, no, no, no.
No surprise, the SS person was clueless.
United HealthCare has a very good Part D Plan which shouldn't cost you more than $30/month or thereabouts. Copays vary, depending in which tier your drug falls. Yes, if you have top tier expensive drugs, you will still pay plenty for the drug itself, not the insurance. There are many other companies which offer Part D coverage, also at minimal rates.
United HealthCare has a very good Part D Plan which shouldn't cost you more than $30/month or thereabouts. Copays vary, depending in which tier your drug falls. Yes, if you have top tier expensive drugs, you will still pay plenty for the drug itself, not the insurance. There are many other companies which offer Part D coverage, also at minimal rates.
Thank you. Is United Health Care considered an HMO for prescription drug coverage? I think AARP has a United Health Care plan. Keep in mind, this Enbrel is extremely expensive, my rheumatologist told me this drug will probably never go generic. What happens if the prescribed drug medication changes? Can you only receive drugs you initially listed when you applied for the part D plan? What if drugs are added later on?
Is United Health Care considered an HMO for prescription drug coverage?
Did you read the link? UHC and every other Part D carrier states it has an approved pharmacy list.
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Each Part D plan decides which pharmacies plan members may use. This is the plan's pharmacy network. Some plans may limit your pharmacy network by state, while others may offer nationwide coverage.
AARP has a UHC Advantage Plan. AARP also has a UHC Medigap Plan. Advantage plans offer drugs, Medigaps are Supplements to Medicare; Part D coverage needs to be purchased separately.
Check out who does business in your state. There are many other Part D providers besides UHC. Google Medicare Part D providers in your state.
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Keep in mind, this Enbrel is extremely expensive, my rheumatologist told me this drug will probably never go generic.
Which is why you need to check the formulary and parameters of the company from which you purchase Part D insurance.
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What happens if the prescribed drug medication changes? Can you only receive drugs you initially listed when you applied for the part D plan? What if drugs are added later on?
No, you are not locked into your specific medications at the time you enroll. UHC won't even ask you about your medications. It is up to you to know if UHC's (or any other insurance company, for that matter) formulary covers your meds.
Review the UHC formulary. It is HUGE. Chances are whatever your doctor is prescribing now or will prescribe in the future is on their formulary list. Review the formulary for other companies.
If your medications change and your medication is not in your insurer's formulary, you will need to change carriers. If that happens, you can only change carriers once a year during open enrollment. More info, here:
There is medicare site that you can enetr your prescription that will advaise on which plans over your drug best or you can call. It really depends o what you take as to which fits you best .They do not all cover everything.Be sure before signup.Go do a serch on mediare part D and find the site.
Ariadne22 knows more about this stuff than I do, but I will add just two minor points:
1. Social Security and Medicare are two separate (different) agencies, which is why the SS representative was clueless. The OP was asking a Medicare question of a SS employee. There is confusion about that because SS collects the Medicare Part B premium for Medicare by deducting it from our SS retirement benefit payment and forwarding it to Medicare.
2. If you opt to enroll in a Medicare Advantage Plan, then the Part D coverage will be included automatically - you don't have to enroll in it separately. However, the same caveat applies; you need to check the formulary of the specific plan you are considering to determine if your specific drugs are included and to check what the copays will be.
What may have confused you is the difference between "fees" and total costs.
There is no actual Part D "fee"from Medicare
If you get a Part D plan separately, you will pay the monthly premium that particular company charges.
Regardless of what the premium is you may end up spending hundreds of dollars a month with expensive meds due to co-pays.
3 of my husbands meds have a high co-pay but are not as costly as Humera...between $70 and $90 so 3 times that can mean.....as you put it....several hundred of dollars per month.
Humera,Enbril, etc, if I remember correctly , are a tier 4 drugs and have a co-pay (in our plan) of 25% of the drug cost.
It is easy to reach the coverage gap ('donut hole') quickly too.At this time, that period is reached once the plan you choose has paid $2,970. At that time you pay the full cost until the out of pocket limit is reached
Currently, you come back out of the 'donut hole' after spending $4750 out of pocket.
At the cost of Humera, you will obviously hit those figures rather quickly.
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At that point, coverage begins again with different co-pays and pricing .....The new Health Care Act makes changes in subsidies and prices for those on an escalating basis, year to year.
Overall, your total out of pocket costs for the year is the important number.
The Medicare.gov site allows that to be computed.
There are assistance programs from many manufactures of high priced drugs if you qualify financially and/or some states offer help.
The whole thing is confusing....hope I haven't made it more so
Last edited by old_cold; 05-07-2013 at 03:02 AM..
Reason: clarifications
Many companies have different plans to suit your needs as far as how much you can pay per month and whether or not you want a deductible. You can enter in your medications and see if they cover them.
I had a huge problem with my Humira which was added after I chose my plan. I was going to have to pay an absurd amount of money for the co-pay. Thousands per month.
This is something to watch out for. If there is a medication you think you may be put on I would enter it into the program and see how it is covered.
Luckily I was able to receive extra help and everything is covered. I reached my catastrophic level in February. I can't even imagine how much has been spent....
Here we go. For the month of March my total drug costs were $9,690.57 and as of April 18, my year to date was $19,779.40.
I don't look at that often because it literally makes me want to cry.
Many companies have different plans to suit your needs as far as how much you can pay per month and whether or not you want a deductible. You can enter in your medications and see if they cover them.
I had a huge problem with my Humira which was added after I chose my plan. I was going to have to pay an absurd amount of money for the co-pay. Thousands per month.
This is something to watch out for. If there is a medication you think you may be put on I would enter it into the program and see how it is covered.
Luckily I was able to receive extra help and everything is covered. I reached my catastrophic level in February. I can't even imagine how much has been spent....
Here we go. For the month of March my total drug costs were $9,690.57 and as of April 18, my year to date was $19,779.40.
I don't look at that often because it literally makes me want to cry.
This is what I'm afraid of. These $$ amounts are staggering. Those of us on biologics: Humira, Enbrel, Simponi, Remicade, etc are at a real disadvantage, I'm not surprised other who responded had the same concern surrounding this select group of medications. Were able to receive help on the copays? Or any of the amount paid in during the donut hole period? thank you...
This is what I'm afraid of. These $$ amounts are staggering. Those of us on biologics: Humira, Enbrel, Simponi, Remicade, etc are at a real disadvantage, I'm not surprised other who responded had the same concern surrounding this select group of medications. Were able to receive help on the copays? Or any of the amount paid in during the donut hole period? thank you...
I have been very fortunate. I don't have very much of an income. I worked pretty hard to be able to have the medication approved and then I was going to have to pay thousands of dollars per month.
As far as Humira goes, I called Abbott and they would not help me until I tried to get help elsewhere. If I could get no other help, then they may have been able to help.
There is a place on Medicares website where it says something like apply for extra help, or something like that.
The site looks different to me than it used to look for some reason. Medicare also sent me a letter on how to apply for additional help. You do it right from their site.
I ended up being able to get the additional help and my prescriptions were covered. I only had to pay 3.30 for the lower tiers, and 6.60 for the others. I then fell into the catastrophic area and pay nothing. The donut hole did not apply because of the additional help. If you think it may apply, and you take high dollar meds, I would look into it.
Last year, I did have to deal with the donut hole and all of my income went towards medication, for the most part. I was not taking Humira at that time.
If you are not able to receive it, the drug companies have all sorts of ways to help you, you just have to be willing to fill out some paperwork, and have your dr help as well.
It used to be that the drs offices would search them out for you and take care of all of it, but not any more....
Good luck.
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