Silver Threads - 4/2/2006
The Melancholy of Youth

Learning To Navigate Medicare

category_bug_journal2.gif Now that I am, as of last Saturday, a card-carrying Medicare member, I’ve discovered first hand the pain of selecting a prescription drug program (Part D). There are so many choices, with so many differences that the only solution was to create a spreadsheet. I used these criteria:

  • A plan that can go with me when I move to Maine in two months. That reduced the number of choices by more than half.
  • No deductible. After comparing the prices of a random number of drugs within a sampling of plans, it made no sense to accept a deductible. In some cases, the co-pay was higher in plans with a deductible than without.
  • Monthly premiums in New York and in Maine. The New York cost was minimally important since I soon won’t be here. The biggest difference in premiums was only $7.00 more in one Maine plan.
  • Monthly co-pay for the one prescription drug I use which varied by as much as 50 percent.
  • How much of the standard formulary (drugs covered) the plan includes. Since I have no idea what I may need in the future, I chose 100 percent.

The Medicare Part D website is badly designed and hard to use. Depending on which of the variety of paths you use to follow to the same information, different answers appear. In one instance, I got a list of 47 plans. When I approached it from another starting point, I was told no plans were available.

But if you remain calm and accept that it will take a lot of trial and error to find answers, you can get through the labyrinth without too much hair-pulling. I spent about five or six hours over two days before I completed my spreadsheet.

In the end, I found four plans that met my criteria and were reasonably priced, and I enrolled in the least expensive. In the first year, including both the monthly premiums and co-pays, I will save 50 percent of the full retail price of the drug I use. Not bad. And, I will not get anywhere near the infamous “doughnut hole” where no drugs are covered until you’ve anted up $3100 out of pocket.

The relative ease with which I signed up is due to the simplicity of my current drug needs and because wanting a plan that is in place in both New York and Maine reduced the number of available plans. It would be a nightmare for anyone who takes several drugs and there is no recourse but to plow through the plans, drugs, deductibles, premiums, prices, approved pharmacies, etc. one item at a time.

What I kept thinking through my minor ordeal was how much simpler it would be if we had universal healthcare.


Comments

Oh my! My parents are so unable to do this kind of investigation (as are many who face this dilemma). Each
takes a wicker basket full of meds daily, and my father won't accept the help of my sister or me in computing his business! Go figure.

Choosing the plan which brings the most savings is a tedious and difficult task for anyone, and for someone who is not computer literate, who is no longer at the top of his game, in my opinion it is impossible. I am sure there are many just like my parents who will be unable to research this carefully and who will not make the wisest decision for themselves financially. :(

A move to Maine must be quite an exciting event! Such a beautiful place to live.

I am on disability so I have to pay only $3.00 per drug. :)

If we had universal health care, all of those insurance companies and managed care plans wouldn't be able to profit from our basic needs. Sometimes I think the next thing they'll be selling us is clean air.

Ronni...with the obscene cost of drugs today, I'd say you did pretty well with your plan, so good for you!
BUT....I also have to agree on that universal health care. Makes much more sense all the way around.

Great article. You are always covering wonderful things that are very helpful.

Aye, yi, yi....so what you're telling me Ronni is...no matter what stage of life we're at or how old we are...our Healthcare coverage and all the anxiety around it....really doesn't get any better. Right? No wonder we're all running around in a circle looking like crazed loonies...or, as in my case,....totally in denial to even want to think about it. Instead, I think I'll just focus on my new grandson..born on April Fool's Day...NO JOKE! -Joy

There's no free ride. Even with universal health care there'd be nightmares to deal with. Ask the Brits why those who can afford it will opt for private care. Unfortunately, there's no wonderful solution. Aren't I cheery!

I'm sorry, but I'm going to have to disagree with notdotdot. While it has been pared back over the last 10 years by a conservative government hell-bent on creating a USA style free-market in healthcare insurance, Australia still has a "good to very good" universal health care system. Nothing *like* what Ronni has described above happens here.

You see, the assumption of the free market is that we value "choice" over anything else. Ronni's story above indicates that "it ain't necessarily so".

There is no such thing as a "free market" in any meaningful sense. There is a rigged market in which individuals are forced to navigate through minefields created by those who profit from them.

Such a dilema.. for so many.

We chose Humana. There is no monthly fee and the co-pays are small. A drug plan is included. So far, it works well and costs much less than before medicare!

I am, unfortunately, one who takes several drugs, including Femara for post breast cancer prevention--and these drugs are expensive. I carry a Blue Cross Plan J to supplement Medicare The up to $3,000 coverage (which I exceed) for drugs costs me the difference between $156 for Plan J with no pharmacy and the $332 I pay to get that pharmacy coverage. I'm 68 and did tons of reading before selecting this plan. Then came pharmancy Plan D Medicare and because I am so disgusted with our current administration, I was convinced that anything that came via their leadership had to be screwed. But, I did more than 14 hours research of every single plan available to me--and I went with Blue Cross's plan--and my premium has now dropped to $156 per month. If anyone needs comparison information for the state of California, let me know. You have to take your drugs you currently take and check every one against the formulary. I will be coming out way ahead, at least for now. I'm still waiting for the other shoe to drop.

Take these health premiums, and my fairly minimal long term care insurance I pay $200 a month for, and you can see it's a lot out of pocket. I'm just so damned grateful I worked my ass off all my life to have a decent retirement and that I am one of the lucky ones who can afford to pay these premiums.

Why am I so suspect, however, that this will all be jerked away in a heartbeat? I'm kind of mystified why anyone would stay on any of the Medigap plans with pharmacy coverage when it is obviously cheaper to use Plan D? What am I missing here?

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