medicare drug plan - why? (engage, pills, payment, benefit)
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OK. I get it now. Medicare is all new to me and has been surprisingly confusing with all the options. Mine is all covered through employer but trying to buy a separate Part D for DH has been a nightmare.
And then they should consider what might happen if they become seriously ill and the Advantage program puts them on step therapy.
Exactly why I underlined the word "'consider."
(Personally, the ONLY way I would even consider a Med Adv plan is if I flat out couldn't afford a supplemental plan. Or maybe if I was terminal and didn't want further treatment. Yeah, I know people will disagree.)
At 65, neither DH or I take prescription drugs. We may of course in the future, however I am wondering why we are forced to have drug coverage to avoid a penalty? Can anyone explain??
It is not just the daily prescriptions you have to worry about, it is also the very expensive treatments for certain things. My wife developed osteoporosis and underwent 2 years of treatment that cost well over $100,000. We have secondary insurance rather than part D, and we only paid $120 in total co-pay for her total treatment.
At 65, neither DH or I take prescription drugs. We may of course in the future, however I am wondering why we are forced to have drug coverage to avoid a penalty? Can anyone explain??
My wife needs prescription drugs and if it were out of pocket we would be running well over $2,500 a month. Even with the Plan D we are currently spending just under $500 but $500 is better than $2,500.
And I am sure it has already been said but you are not "FORCED" to take anything.
OK. I get it now. Medicare is all new to me and has been surprisingly confusing with all the options. Mine is all covered through employer but trying to buy a separate Part D for DH has been a nightmare.
You set up an account. You enter your current prescriptions including dosages. You get a list of the plans. One of the colums shows you your TOTAL annual our of pocket INCLUDING premiums will be for everyone of those plans. THAT'S the important column. NOT the cost of premiums.
I do this every year for DH. In the last 10 years, I've changed his part D coverage probably 6 times because they changed the drug formulary and/or increased the premium.
Just curious but when they say "average SS check" such as comparing the states, is the amounts with these medical deductions taken out?
Where did you see such a list ? SS benefits are Federal, little if anything to do with States.
Also, not everyone on SS necessarily has deductions for medical coverage, for a host of reasons. So most likely any such list should use the gross benefit payment before any deductions.
So which part D plan to choose for someone who doesn’t take Rx drugs now? The cheap plan that covers common drugs but not the expensive stuff needed for cancer or transplants, or the Cadillac plan that covers everything at a much higher premium?
Others tell me it’s OK to roll the dice and get a cheap plan, then upgrade as needed once a year. Some cancer chemo is around $30K/session, and that could really hurt financially if the need arose between enrollment periods.
I am in the same situation as you are. I always choose the least expensive plan, which for 2020 in my state is the Envision RxPlus plan at $13.70 per month. I pay it in full in January so that I won't need to bother with monthly payments; $164.40 won't break the bank.
I had cancer while uninsured (before Medicare) and so can speak to your concerns. First of all, chemotherapy does not fall under Part D in most cases. The 2020 Medicare Handbook says that if you receive it in an oncologist's office or freestanding clinic it is covered under Part B. If you receive it inside a hospital, it is covered under Part A.
There are some chemo drugs (typically for a common type of breast cancer) that are taken in pill form rather than by infusion. An example of those is Tamoxifen. Those would fall under Part D. But those drugs do not always incur the high costs that infusion-based chemo entails. For example, Tamoxifen is not that expensive:
The really expensive cancer drugs are the biologics but those are almost always given by infusion and are thus covered under Part B or A depending on where administered. Also, most pharma companies have assistance programs that help with the cost of the very expensive drugs if the patient does not have insurance coverage or cannot afford their copays. In some cases they will supply the drug for free.
Last edited by BBCjunkie; 01-04-2020 at 10:56 AM..
Where did you see such a list ? SS benefits are Federal, little if anything to do with States.
Also, not everyone on SS necessarily has deductions for medical coverage, for a host of reasons. So most likely any such list should use the gross benefit payment before any deductions.
You set up an account. You enter your current prescriptions including dosages.
I think orngkat said her husband isn't on any medications. That would certainly have made it harder for me to choose a plan. So I get it. It's all terra incognito at first.
But because I knew exactly which meds I needed, it was easy. None of the meds are new to me and I have some idea what I paid in the past.
I think at some point all of us are frustrated by having to predict events that we cannot possibly foresee. "Should I take SS at 62, 66, 70...?", for example. I ended up taking it at 66 because my spouse was becoming increasingly flaky in regards to money management. I had no way of knowing that would happen. He's a penny pincher. I thought he could handle it. Turned out he couldn't.
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