Medicare – Plan D

[COLOR=red]Medicare part D is working for me so far, but they are giving me trouble about covering my Prilosec. Hope this isn’t the infamous “donut hole” I’ve heard about! Well I guess I’ll be putting on the fighting gloves soon.[/COLOR]
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[COLOR=#ff0000]I need my Prilosec![/COLOR]
:confused:

We have heard so many horror stories that we all need to be prepared for which plan is best… I am looking forward to other posts…

Aimee
(CIDP diagnosed 8/24/05)

[QUOTE=marguerite]I think the more commonly prescribed meds aren’t a problem; the corporate prescription plan required that my doctor prescribe nexium (used to treat stomach pain) and every prescription used to treat pulmonary problems–some of which are fairly expensive–are in the 75% coverage group.

Is Prilosec a pain killer? What is the usual cost?

Regards,
Marge[/QUOTE]

Hi Sis,

Prilosec is an antacid. They have a certain strength that can be bought “Over the Counter” or a stronger one by prescription.

Welcome back, Dave. The “gap” or “donut hole” swallows you :rolleyes: when you and your insurance company have paid a total of $2250. What happens then depends on the plan you signed up for. How much you pay for each prescription depends on your insurance company. It could be different percentages for brand vs. generic or just flat copays. I am using Aetna and had a choice of different plans. So far so good. Prednisone 90 tablets was about one dollar. I am just waiting for the axe to fall when I get IVIG again in 10 days under the new plan.

Oh, I can hardly wait to apply for Medicare in the near future.

Medicare and Social Security are so confusing at times. But then again it’s not hard to confuse me. I’m laughing weakly too Sis.

[COLOR=red]I take 80 mg/day of Priolsec to treat/prevent stomach ulcers. I don’t want to change meds because Prilosec seems to work, and I don’t want to fix what ain’t broke.[/COLOR]
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[QUOTE=Brandy]Oh, I can hardly wait to apply for Medicare in the near future. Medicare and Social Security are so confusing at times. QUOTE]
I wouldn’t worry. I’ve been on SS and Medicare for 6 years now and it works like a charm. The only problem with Medicare is that not every doctor accepts Medicare patients. They lose too much money because of the huge discounts Medicare imposes. To give you an idea: The charge from the U. of CO hospital for one day of IVIG was $9000. Medicare reduced it to $912.

Of course, the new Medicare part D for prescriptions is a mess — but I don’t want to get into politics here. You get my drift? :rolleyes:

I have opted for Anthem blue Cross . I am just getting started. So far, so good. I thought the plan I chose did NOT have a doughnut hole, but there may be some diacrepency. I know that I will hit it. I will keep in close contact with my Canadian provider incase of that event. I agree, it is a mess.
Mary Ann

[QUOTE=norb][QUOTE=Brandy]Oh, I can hardly wait to apply for Medicare in the near future. Medicare and Social Security are so confusing at times. QUOTE]
I wouldn’t worry. I’ve been on SS and Medicare for 6 years now and it works like a charm. The only problem with Medicare is that not every doctor accepts Medicare patients. They lose too much money because of the huge discounts Medicare imposes. To give you an idea: The charge from the U. of CO hospital for one day of IVIG was $9000. Medicare reduced it to $912.

Of course, the new Medicare part D for prescriptions is a mess — but I don’t want to get into politics here. You get my drift? :rolleyes:[/QUOTE]

Norb, I was only joking around, sorry if I made you think I was really confused.
See I have worked for Drs for many years as a manager of their Billing depts and I know exactly how the system works. Here in New Jersey and New York there aren’t many Drs who don’t take Medicare. I also managed my husband’s Medicare and his secondary Ins. Aetna for him, because they really confused him.His Meds were paid for by his secondary Ins Aetna, he wouldn’t have had to switch until his 65th birthday. He was only 58 when he passed away, so he still had many years of Aetna paying for his meds.

Sorry again for the joking around, it was really meant for Marge, she and I are really great friends and often make jokes to each other.

Medicare Part D should be all ironed out when I’m ready for it, now that’s a joke. Laugh or I’ll be mad.;)

No problem, Brandy, I couldn’t tell you were joking. I had to switch to Emeriti Health as secondary insurance in January managed by Aetna. So far I am not impressed by Aetna.

Have to be honest with you, we never had a problem with Aetna, had more problems with Medicare. The Aetna plan is through Verizon where Frank worked for 35 years. I still have it until the end of the year, then I’ll start to Cobra my medical,dental and prescription plans for awhile.

[QUOTE=K C’s Mom]I I thought the plan I chose did NOT have a doughnut hole, but there may be some diacrepency. I know that I will hit it. I Mary Ann[/QUOTE]

Mary Ann, All the plans based on Medicare part D have a doughnut hole or gap. But depending on the plan and how much premium you are paying, there is some provision to help you through that gap – more or less. In my case – Aetna’s plan #1 – I have to pay a higher percentage while in the hole until I hit the “catastrophic” limit of $3500. After that I pay nothing. I’ll probably reeach that with my next IVIG. Byby savings 😮 –

[QUOTE=Brandy]Have to be honest with you, we never had a problem with Aetna,.[/QUOTE]
Most of my problems I had occurred at first. I had to fight with them because they kept rejecting claims for CIDP related charges as pre-existing condition. It’s solved now. The next issue will be Rituxan which they consider as experimental for CIDP antiMAG IgM. Bu this appears to be the only thing that may help me. Allaug in Norway got it. She has the same condition I have. She called it an outrage that I cannot get it here in the US.

[QUOTE=marguerite]Norbert,
Sorry if we upset you.
Marge[/QUOTE]
Upset? Not in the least. I am just having another drink and everything is OK. After all, Carol is finally coming back tomorrow after her trip to CT to watch her other three grandkids.

[QUOTE=marguerite]Norbert,

Brandy and I are somewhat bizarre at the best of times. The empty hours since the system crashed have been filled with shopping and other craziness. New Jersey Trivial Pursuit and our doo-wop group make even less sense. Sorry if we upset you.

Regards,
Marge[/QUOTE]

We’re [B]Bizarre[/B], I didn’t know that.:rolleyes:

I thought we were normal. Oh, that’s right, remember back in the Fall, Frank said he was having us commited for being “Crazy Italian Women” 🙂

I swear I haven’t bought anything in awhile, I swear, I swear. No I am not lying Gepeto, as my nose grows.:D

Sorry girls, it’s been fun chatting with you. I’ts almost time for Jay Leno, it’s 10:15 here mountain time. Way past your bedtime in the east:D . Time for me to turn on the boob tube.

Medicare part D,
I am using Blue/Cross Blue shield as my supplemental as well as prescription coverage and have had no trouble getting my scrips. I have found that if you get your scips for 3 months at a time they wave the 3rd month copay at certain places, like Walmart(yuk). I would almost bet that some of the other plans do the same thing but you have to check as they do not tell you this unless you ask. The most co-pay that I have had to pay is $60.00. The only trouble is that I am going to fall in the donut hole about July. There are some plans that cover the hole but I have not checked out the price to see if its worth the cost.
LEA

[COLOR=red]Brandy[/COLOR]
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[COLOR=#ff0000]You have a long wait for Medicare, aren’t like 39 or something young like that?[/COLOR]
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:rolleyes:

If anyone is having problems with prescrptions and is interested in learning about drugs from Canada or other options, contact me. There is no obligation or fee to you. I’am a CIDP sufferer and had been getting a number of medications from Canada. I’m now getting generics so get them all locally. My company, Save On Meds, is a member of the Chicago Better Business Bureau.

[QUOTE=FiremanDave][COLOR=red]Brandy[/COLOR]
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[COLOR=#ff0000]You have a long wait for Medicare, aren’t like 39 or something young like that?[/COLOR]
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:rolleyes:[/QUOTE]

Oh what a flatterer you are. I wish I were 39 again.:D I actually can collect widow’s benefits next year. I haven’t decided if I am going to do it, it depends on the job market.

[QUOTE=mjport]If anyone is having problems with prescrptions and is interested in learning about drugs from Canada or other options, contact me. There is no obligation or fee to you. I’am a CIDP sufferer and had been getting a number of medications from Canada. I’m now getting generics so get them all locally. My company, Save On Meds, is a member of the Chicago Better Business Bureau.[/QUOTE]

mjport,

The Foundation does not allow any solicitaions for meds on these forums.
I know you are trying to help, but if someone wants to talk to you about this, they will contact you through a private message here.

Welcome to The Group

I’ve been wondering about that, too. Brandy, you’ve known Frank for 36 years or so, right? According to Dave you were 3 years old when you first met him. Wow, I’ve heard of highschool sweethearts. You must have been pretty precocious.
😎

I am using First Health Premier (Medicare gave them to me) and they cover my 20mg Prilosec, the only problem with them is they will not cover my Procrit shots at my house or even a doctors office, only in the hospital.

[QUOTE=norb]I’ve been wondering about that, too. Brandy, you’ve known Frank for 36 years or so, right? According to Dave you were 3 years old when you first met him. Wow, I’ve heard of highschool sweethearts. You must have been pretty precocious.
:cool:[/QUOTE]

Yes Norb, I met Frank when we were both 3 yrs old. 🙂 What can I tell you, I’m a true believer in babyhood romance. We even slept together at 3 yrs old when taking naps. 😀 Oh I miss the days of babyhood.

Well, scary.We are taking care of our 13 months old granddaughter 3-4 days a week. If you were anything as cute as she is, we better be on the lookout when we take her places, never leave her out of our sight, no sleep-overs anymore.:D
P.S. What has this got to do with Medicare part D? :confused:

Marge, That’s a lot you have to pay for drugs, ugh. With AARP do you have to pay 100% in the “donut hole”? But that should be OK if you only reach it in 4 months, shouldn’t it? That’s the end of the year and you would start all over. I don’t think I am anywhere close. Fortunately, the immunoglobulin is not counted toward drugs since I am getting IVIG at the hospital. I was sweating that one for a while until the first statements started coming in this summer.

This whole thing is not making sense to me–Medicare Part D

AARP-United Healthcare paid $299.57

Your Co-Pay – $129.99

Just my personal opinion is that co-pays should not count towards the initial cost and deducted from the coverage limit of $2250.00.

Just another bull sh_t way of the government sticking it to the people who can least afford the out of pocket expenses for medications and deducting it from your yearly coverage.

No wonder people are dying, they can’t afford the meds they need the most to survive. 😡 😡 😡 😡

I hate the way the whole thing works. First of all, it stinks that the government turned it over to private insurance companies. Then, each one has their own confusing plan based on Medicare Part D. I am with Aetna and had to chose between three plans, each one combined with a different medical plan functioning as secondary insurance. I had to go with Aetna because my former employer dropped insurance for all retirees January 1 and gave us as the only option a plan called Emeriti Health administered by Aetna. Talk about complicated and being a hassle.

Oh, the donut hole with Aetna works the same way as AARP. They count what I pay plus their part toward the limit. Only difference with Aetna, while in the hole I just pay a higher copay, not 100%

[COLOR=red]I talked to my Medicare D provider and they told me not to worry because I’m poorand have a reduced co-pay. We’ll see.[/COLOR]