Anyone understand the new Medicare Prescription Drug Plan?

[Bob Weisner]

Hi:


Does anyone understand the new Medicare Prescription Drug Plan? For the people that get automatically signed up, are they getting a good deal or are there better plans out there? My concern is that people that are automatically signed up to a given plan may not be getting the best of deals , but the cheapest of plans.

Any opinions?


Thanks,

[Dennis Peacock]

An opinion? You're asking someone who is getting royally raked over the "coals" on medical health benefits come Jan 1, 2006....thanks to the new Lumenos plan that many corporations are taking to because it saves THEM money while costing each associate/employee a bundles each month out of their own pockets.

From my understanding is that the wording of the new plans are such that it takes a small army of lawyers to figure it all out.

[Michael Perata]

I still have three years before it becomes a major thought exercise.

If you do manage to figure it before 2008, please post a synopsis of your understanding.

[Joe Pelonio]

I have still not found anyone that understands it. My wife contacted the Medicaid case worker for her Mom who is 86 and in an adult family home for help, and so far even she has not been any help. Apparently the state is hoping to save money by having the fed program take up much of their current drug expense so they'd prefer you get the most expensive plan but they are not allowed to say that.

[Gary Whitt]

There's like 48 levels of coverage.

Both of my parents (73) just guessed at which fit them the best.

Mom is on 5x the number of medicines that dad is on.

[Jim Becker]

The folks that are going to have a real challenge are those (especially couples) who take a lot of different medications from different manufacturers. Each "plan" has a different formulary, and since the drug companies are involved in the plans, "competitive" issues could come into play. I really like the idea of prescription coverage because drugs are often the most financially challenging boat-anchors to many retired folks (as well as more and more younger families), but IMHO, there are too many special interests for this to be fair to even "most" people.

GMA did a piece not long ago on the complexity of the new system and it was stumping some "really smart" people whom they had take a look at it in detail.

[Bob Weisner]

I think that the part of the new plan where people have to pay $3,600 "Out of pocket" is going to put a financial hardship on the Senior Citizens that can afford it the least.

[Joe Pelonio]

I just talked to my wife about her mother. All she knows is that the plan she signed up for has a $1-$3 per prescription co-pay. If that's true we'll just leave an advance payment credit on her account at the pharmacy to cover them and they can call when it gets low. The guy that runs the adult family home picks up, stores, and distributes all drugs. He apparently did study the whole thing and recommended whatever plan this is as the best for her. Trouble is apparently that if new drugs come out and are prescribed or a person gets some other different medical problems the plan they are in may no longer be the best. What a mess.

[Joe Mioux]

An opinion? You're asking someone who is getting royally raked over the "coals" on medical health benefits come Jan 1, 2006....thanks to the new Lumenos plan that many corporations are taking to because it saves THEM money while costing each associate/employee a bundles each month out of their own pockets.

From my understanding is that the wording of the new plans are such that it takes a small army of lawyers to figure it all out.

Hey Dennis, want to trade plans?

Self employed businesses have some downsides. One of which is providing health ins for his 4 kids, wife and himself with really high deductibles and even higher prems.

My dad and I were discussing this senior healthcare program this morning. He is confounded by its complexity. Although knowing my dad, he probably just skimmed it and is waiting for the "Cliff Notes".

Joe

[Boyd Gathwright]

Hi Don,

.... Well put . Here is the other original thread to this:

http://www.sawmillcreek.org/showthread.php?t=26986

Big government at work. What could we expect when Congress writes the plan? Take a bunch of guys regardless of party whose main concern is getting re-elected and this is what you get. Nothing is going to change until we get term limits so those guys will pay some attention to something besides getting re-elected.

[Tim Wirtz]

I think that the part of the new plan where people have to pay $3,600 "Out of pocket" is going to put a financial hardship on the Senior Citizens that can afford it the least.

That is only with some of the plans. Depending on the premium you wish to pay each month and the level of coverage you want, you can get plans that don't have the 3600 gap. These plans are more expensive (37.50 to 99.90 per month in Minnesota) but they do cover the 3600 gap.

Bob, in the research I have done on my own (on behalf of an uncle that age) and at work (I work for a health insurance company), I have found that the plans vary greatly by company but seems that the more expensive the policy, the more drugs are covered under their "formularies". The biggest difference here is the number of participating pharmacies one can choose to go to with the different plans. One company in this state will let you go just about anywhere while another one has a VERY limited set of pharmacies they consider "in network".

I would really advise anyone who can to go to the Medicare website (www.medicare.gov) and use the tools on the site. I understand that it is slow and somewhat tedious to use but it does have the most comprehensive information for medicare recipients based on the location in which they live. Also, even though it may take some time out of your day, it could literally save you or someone you know of this age group THOUSANDS of dollars. Be sure to have a list of the drugs you currently take and the generic names if available, as this will be used to determine which plans are right for you. Also remember that you still have some time to register. The cutoff date for registering is May 15th, 2006 or within a certain time frame if you retire after 1/1/06. That being said, don't put it off past the deadline as the premium you will pay when you do sign up will go up by a percentage per month.

Some insurance companies also have very good question and answer lines and, in one case, I got an actual person answering the phone instead of an automated directory. I was so flabbergasted when someone actually said, "Hello, this is so-and-so with X insurance company.." that I was mometarily speechless.

I know this is stuff you have probably already heard but, as one who deals with it for a living, this is the best overall information I can give you, especially considering the number of plans available and the differences in them.

Hope it helps.

Tim

[Ken Garlock]

Bob, for me it was simple beyond my wildest dreams.

My secondary health insurance from TI is managed by BCBS of Texas. I got a booklet from TI which explained it in terms even I could understand.

1. Our prescription plan is equal to or better than the Medicare prescription plan.

2. If you sign up for the Medicare prescription plan, we will drop you from our medical insurance plan without recourse.

Even the brain dead can understand that.

[Frank Hagan]

Political content removed by Moderator

Anyway, I'll have to get the list of drugs my mother uses and start wading through this thing. Not a pleasant task, I'm sure.

[Bob Johnson2]

There was just an artical about it in the WSJ, pretty much echo's what Tim and Ken say.
1st thing is sign up for something by May 15th.
2nd thing is if your current plan is better or as good, keep it. The plan needs to be "creditable" so you won't get penalized later if you change plans. Doesn't say what "creditable" is though!
Along with using the medicare.gov site you can call 1 800-medicare for a live person (good luck) to run your drugs and see the best plan.
If you have to just pick one that's cheap, just get something by May 15th. If you wait till after the payments are higher.

So says the WSJ.

[Tim Wirtz]

2nd thing is if your current plan is better or as good, keep it. The plan needs to be "creditable" so you won't get penalized later if you change plans. Doesn't say what "creditable" is though!

So says the WSJ.

Credible is a term the industry uses to state that the plan their members are on is as good or better than the basic plans under part D. It doesn't mean they are better then the BEST plans offered by some insurance companies. Every insurance company in the US was required by law to send out a Credible Coverage letter to all its members of retirement age stating whether or not their coverage under the company's plan was as good or better than Medicare's basic plan. My company sent it to everyone regardless of age. I am 37 and got one. As the WSJ reported, a person currently enrolled in a Credible Coverage insurance plan CANNOT be penalized with higher Medicare Part D premiums if they drop their current coverage at a later date and then choose Part D, so long as they choose the Part D plan within a specified time frame after cancellation of their other coverage.

Slightly off topic, most people are familiar with the Medicare Part D part of the Medicare Overhaul of 2003 (called the Medicare Modernization Act)but most are not aware of the other major changes made to Medicare in that bill. One of the biggest was the further inclusion of the private sector in Medicare. For instance, insurance companies are now allowed to act on behalf of Medicare in some situations by offering plans that include all the benefits of Medicare plus extras that Medicare doesn't cover traditionally. These plans are called Medicare Advantage plans and offer a Medicare benificiary an easier way to have claims paid. For instance, the patient can now go to a clinic and the clinic can bill the insurance company directly without having to send the bill to Medicare first. The insurance company applies Medicare's benefit and then any extra benefits under the insurance's plan. The clinic doesn't have to wait for payments from two sources and so it reduces the chances of clinics asking for collections from the patient. It sounds like a good idea but it is a real headache for insurance companies to figure out all of Medicare's rules and regulations, not to mention their pricing methodologies. That's one of the things I am involved with. There are a lot more changes that will benefit Medicare recipients that I wish the press and government would elaborate more on. Again, check the Medicare website.

Good luck with the search for a plan that meets your needs.

Tim