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Can we talk about prescription insurance?
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 -- 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!)
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 ?
Twin Mom is right. Or you can go to this site and check out the plans yourself.
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.
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%!'
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.
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.
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.
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?