Caregiving resources for every stage of the disease.
RSS Feed Print
Can we talk about prescription insurance?
JustLikeMom
Posted: Saturday, August 5, 2017 7:22 PM
Joined: 2/7/2012
Posts: 348


Since we're coming up on the annual enrollment period, I wanted to get your input on prescription insurance.

Although I feel like I now have a good handle on how Medicare and my Mom's supplemental policy operate, I have a ways to go to understand her prescription coverage. 

Considering that most of our LO's are likely on the same/similar mix of medications (dementia and a-fib or dementia and high blood pressure), is there anyone here who feels like they are getting a very satisfactory deal from their med insurer?  Namely, I wonder if there's a better policy provider than Humana that pays more for the meds?

Also, are there risks (beyond financial) in switching the prescription med insurer?   For example, can switching cause my Mom to be denied coverage if we ever wanted to return to Humana for some reason? 

Any input is appreciated. 

 

 


Twin Mom
Posted: Saturday, August 5, 2017 7:29 PM
Joined: 12/9/2015
Posts: 247


My DH has Humana and his copays are under $10.  We can also get meds through the VA...all for $8.  I tend to get everything from Walgreen's because it is significantly less hassle when there is a problem with a refill...and for the most part it is about the same price.  That being said, I have never looked at anything other than the Humana policy after we got it.
jfkoc
Posted: Saturday, August 5, 2017 7:41 PM
Joined: 12/4/2011
Posts: 12866


All of our insurance is through USAA and their Plan D is Humana.
JustLikeMom
Posted: Saturday, August 5, 2017 7:59 PM
Joined: 2/7/2012
Posts: 348


Twin Mom -- Thank you for your reply.  I wonder if you'd indulge me with some specifics as paying $8-$10 out of pocket with Humana Part D coverage is such a foreign concept to me.

For example, one of my Mom's most expensive meds is Namenda, a common Alzheimer's medication.  A 28 day supply costs my Mom $152 out of pocket.  Humana insurance pays the pharmacy $128 ( for a total negotiated prescription cost of $280).   

What am I missing as far as how to get that $8-$10 co-pay? 

(This reply isn't limited to Twin Mom.  Anyone whose LO has Humana Part D and is on Namenda, please share your out of pocket experience!)

 


dayn2nite2
Posted: Saturday, August 5, 2017 9:11 PM
Joined: 6/20/2016
Posts: 1008


I'm pretty sure that your options for Part D or Rx coverage with a managed care plan for Medicare with Humana depend on where you live.
JustLikeMom
Posted: Saturday, August 5, 2017 9:48 PM
Joined: 2/7/2012
Posts: 348


Day2nite2 -- i'm going to show my ignorance and say that I don't know what you mean.  Are you saying that Humana customers may have a variety of coverage plan options depending on where they live and that some of those plan options could pay more for meds than the particular Humana plan my Mom has?
dayn2nite2
Posted: Saturday, August 5, 2017 9:54 PM
Joined: 6/20/2016
Posts: 1008


JustLikeMom wrote:
Day3nite3 -- i'm going to share my ignorance and say that I don't know what you mean.  Are you saying that Humana customers may have a variety of coverage plan options depending on where they live and that some of those plan options would pay more for meds than the Humana plan my Mom has?
Yes, that's what I'm saying.  Depends on your state and sometimes even your county.  

JustLikeMom
Posted: Saturday, August 5, 2017 10:04 PM
Joined: 2/7/2012
Posts: 348


Interesting ...and...ugh!! That makes research difficult.  I guess I'll need to talk to Humana ito see if there's a better plan option available to my Mom.  And, I hope others here will offer other companies I should check out, too!
chrisp1653
Posted: Saturday, August 5, 2017 11:05 PM
Joined: 1/23/2017
Posts: 623


I'm gonna just throw in my thoughts and speculate that every company has more than just one plan available. Most companies ( I think ) have a range of policies with different co-pays , deductibles , and max coverages. Won't those variables affect your out of pocket costs for prescription meds ?

 

Chris


Twin Mom
Posted: Saturday, August 5, 2017 11:58 PM
Joined: 12/9/2015
Posts: 247


When I was trying to figure out what insurance to buy for Medicare Part D...I took a list of all of my husbands prescriptions...and went to the Walgreen's pharmacist...she plugged my hubby's list into their system and was able to show me which plan would be the most cost effective.  I switched to getting everything pretty much at Walgreens for hubby then because it is simpler than the VA and cost was about the same.  Yes, there were a variety of plans to pick from.  What I understood from the pharmacist...is that based on your prescription needs...the plan you are on needs to be re-examined every year..,and the formulary for each drug plan may also change...meaning something that was cheap last year might not be this year.
elruth
Posted: Sunday, August 6, 2017 12:36 AM
Joined: 12/17/2016
Posts: 37


We are on AARP United Healthcare Part D Preferred. 3 mo generic of Namenda  which is called Memantine is $ 90.00. LO's generic of Remeron ( an anti- depressant ) costs 0 and also his blood pressure medicine Ramipril costs 0. Sometimes I go to the Blink site and they have large discounts on some meds and you don't go through your regular insurance.
Taking A Deep Breath
Posted: Sunday, August 6, 2017 8:52 AM
Joined: 7/2/2013
Posts: 454


We are in GA.  My mom 8s on Humana with Part D.  Most of her prescriptions are under $1.00 (antidepressant, sleep, bone, preventive antibiotic, antiviral) and her Namenda is $52.  In January, her prescriptions cost more but after that, I guess her deductible is met and they drop way down.
A losing hand.
Posted: Sunday, August 6, 2017 9:33 AM
Joined: 1/16/2013
Posts: 386


Twin Mom is right.                                                                                                Or you can go to this site and check out the plans yourself.

Medicare Part D Plans - Compare Part D Medicare Plans.

Ad · www.MedicareSolutions.com

ghostdog
Posted: Sunday, August 6, 2017 9:51 AM
Joined: 2/9/2015
Posts: 671


Go to

https://www.medicare.gov/find-a-plan/questions/home.aspx

You don't have to put name or address, just zip.

Fill out the information as prompted including drugs.  On the find a plan page pick the option for drug plans (the first on the list) and on the left side menu toward the bottom select the option for all drugs in formulary.  Add any other limitations you are looking for.

These will be 2017 options -- not the ones for the next selection period but it will let you know how things compare now, and you can do it again in October.

This is probably similar to what the pharmacy does in house, so that is another option.

 


Mimi S.
Posted: Sunday, August 6, 2017 10:30 AM
Joined: 11/29/2011
Posts: 5663


In my opinion, its difficult to compare.  One also has to consider what is covered for doctors and hospitalization. What is covered for the script from month to month varies. There is also what what one pays out of pocket for co pays. 

I have recently been in the hospital three times. The maximum I paid is $1000 per year 

Imagine what it would have cost of I had to a  20%!'


JustLikeMom
Posted: Sunday, August 6, 2017 2:33 PM
Joined: 2/7/2012
Posts: 348


Thank you, A Losing Hand and Ghost Dog!
ilovebutz
Posted: Monday, August 7, 2017 10:55 AM
Joined: 4/16/2016
Posts: 40


My 2 cents:

While most meds fall into a category that is covered by a fixed co-pay, non-formulary drugs do not.  That is why some meds can be very expensive even with Part D. My mom was briefly on a newer antidepressant which cost about $150/month. It made her nauseous, so we took her off of it, but I was shocked at the cost. 


jfkoc
Posted: Monday, August 7, 2017 1:44 PM
Joined: 12/4/2011
Posts: 12866


Also, are you saying that you can be on medicaid and have a supplemental program?
JustLikeMom
Posted: Monday, August 7, 2017 2:19 PM
Joined: 2/7/2012
Posts: 348


Is this question for me, Jfkoc?   If so, yes, my Mom has Part A and B via Medicaid, plus a supplemental policy for doctor and hospital charges that covers the 20% leftover after Medicaid has paid.    It doesn't, however, apply when it comes to claims filed with Humana for my Mom's Part D expenses (prescriptions).
Mom's Baby
Posted: Monday, August 7, 2017 2:21 PM
Joined: 12/19/2011
Posts: 1037


I think there's a lot of confusion here with using the terms Medicaid and Medicare interchangeably. Medicaid does not have "parts," it's a special health care assistance program for the medically needy with low income and assets of less than $2,000. Medicare is the government "health insurance" program for anyone over age 65 or with a major disability. You do not need to be poor to get Medicare.
jfkoc
Posted: Monday, August 7, 2017 5:08 PM
Joined: 12/4/2011
Posts: 12866


I think your mother has Medicare. You will want to buy Plan D according to each companies formulary (sp). Your pharmacy can help you with this or you can go online.
JustLikeMom
Posted: Monday, August 7, 2017 5:17 PM
Joined: 2/7/2012
Posts: 348


Yes, sorry, that was a spelling error.  She has Medicare.
JustLikeMom
Posted: Tuesday, August 29, 2017 5:14 PM
Joined: 2/7/2012
Posts: 348


Having received the monthly statement from Humana motivated me to use the Medicare Plan Finder (gov) link Ghostdog provided so I could compare various prescription plans.  After inputting all the prescription meds my Mom takes, the results indicated that my Mom should expect to pay $1757 out of pocket annually including premiums and deductible.  Interestingly, the latest Humana statement (plus Mom's check register) shows her year to date out of pocket currently total $3922.52!   Reality and that estimate don't jive!

So, I guess my next move is to contact Humana to ask why the actual out of pocket costs are so out of line with the .gov estimation. 

 

 


jfkoc
Posted: Tuesday, August 29, 2017 6:57 PM
Joined: 12/4/2011
Posts: 12866


I am very interested in the reply from Humana. Formularies (sp) vary from year to year but wow, that's a lot!
beaverdams
Posted: Wednesday, August 30, 2017 10:16 PM
Joined: 10/29/2016
Posts: 96


Please go to your nearest Office for the Aging and bring all your prescription bottles and their clerk will enter all the drugs for you into the Medicare computer system and you will be advised your cost for 2018 in any of the plans that you are able to select for your current address.

   There is a large price difference in the so called big box local pharmacies such as Walgreens--CvS and Riteaid.  My Dr sent a new prescription to one of big box stores and their druggist called and advised me I had to pay $48.00.  I asked the Dr to resend the prescription to Walmart and I paid $9.00 for same drug.  Choice and money is yours.  I do not have deep pockets so I will go to most competitive drug outlet which might be 1-2 miles further than the higher priced outlet.

   I pay zero$ a month for my medicare supplement plan this year. 


JustLikeMom
Posted: Wednesday, September 13, 2017 2:26 PM
Joined: 2/7/2012
Posts: 348


I'm back with a non-update update.   In trying to determine why the out of pocket estimate from Medicare.gov for my Mom's prescriptions for her drug coverage plan is so much lower than her actual out of pocket expenses, it seems that the Medicare.gov info is just ....wrong.  I don't know where they got their data and the site doesn't provide enough specifics so that I could drill down into it to see where the issue lies. 

However, I do know that her largest out of pocket expense is because of two medications she takes (both brand name).  I contacted her current insurer, Humana, to find out the standard retail price for these meds to see if her pharmacy was just overcharging to begin with (they aren't). 

I then asked Humana for the names, standard retail prices, and insurance coverage of the generic for those two meds.  One generic was actually going to cost more than the brand name med (!), but the other generic costs substantially less than the brand name.  I then contacted her doctor to see if he would approve of that generic.  He did and sent the order through to the pharmacy and care center.  

I asked the pharmacy if they are aware of other insurance plans that pay a higher percentage than Humana's RX plan.  They said that Humana is easier to work with and reimburse quicker than other plans they accept but recommended I speak with my Mom's care center administrator on prices (they said she has some program she uses that I would find helpful).   

 I also called Humana to determine if there is a different plan offered in her area that would offer a higher coverage amount for her current meds.   I understand they'll have that info in early October for the new year.   I'll also call some of the other insurers listed on the Medicare.gov site at that time for comparison.

So, that's where I'm at currently.   Does anyone have any other suggestions of what I should do to reduce my Mom's out of pocket prescription expenses?


Gig Harbor
Posted: Wednesday, September 13, 2017 7:17 PM
Joined: 3/10/2016
Posts: 257


There is a pharmacy in my area that is a walk-in but also a mail order pharmacy. I have heard that it is one of the busiest and cheapest in the country. It might be worth it to call them to see what they would charge you. They  also have a good website. The name is Costless Pharmacy in Purdy, WA.
 
× Close Menu