Medical insurance, Medicare Part D questions

[GardeningMSer]

I turn 65 in late December and have questions for those of you who know something about Medical Insurance and Drug Coverage.

I live near, but not in San Francisco and am thoroughly confused by my options.

I currently take Gilenya and Ampyra and both manufacturers contribute to my costs - at over $5,000 a month list cost, there is no way I could pay for these out of pocket.

I am currently covered by a good COBRA policy (medical, drugs, dentist, vision) and believe I can stay on it for a year or two at about $650/month with a $2,000 deductible and copays between $25 and $40 per monthly Rx. Because I'm disabled and on SSDI I'm also covered under Parts A and B but paying $101 for the latter/month.

I just went to http://www.planprescriber.com/ where I entered my meds, age, zip code, etc. The only result was Kaiser Permanente .

Although I'm aware a lot of folks like Kaiser, I've heard enough horror stories that I'm dubious. The worst is my slightly younger, employed sister's - she changed jobs and moved from California to Las Vegas where she was hospitalized several days for breathing issues in a non Kaiser facility. As she was in severe distress she was taken by ambulance to the nearest hospital - she now owes them over $100,000 as Kaiser refused to cover the bill.

Right now I'm not even sure what questions to ask.

Suggestions and/or pointers to sites that can help me make sense of this before Nov 30 are greatly appreciated.

[mjan]

HI again~ glad to hear from you!

I too am on SSDI and started Medicare benefit last Sept. After an exhausing search, I ended up with AARP Mediare Complete with United Health care.

They walked me through EVERYTHING on the phone. Checked each and ever doctor, hosp, pharmacy to make sure they were in network. Surprisingly, I have not paid any deductible, only my 20% & co pays 15 for Primary 40 for specialist which I have several. No problem with RX.
For some odd reason I have had little to no 20% to pay either.. I am astonished. They get the $100 off your SSDI check from Medicare to them. So you do not use your Medicare card per se. They pay Medicare contracted costs. I am very satisfied and customer service good. I thiknk they are slow to pay providers. I get a statement re: my Plan D or RX amounts.

So I would call them AARP/Medicare complete. Have your RXs, doctors and questions ready for them to answer.

Good luck~

Jan

[MSer102]

There are so many choices with Medicare plans it's no wonder you are confused!

If you want unbiased information about the different choices it's best if you don't try to get it by talking to someone who sells a plan. They will of course make their plan look the best and downplay the other options. They're salesmen.

The website you went to apparently features the "for sale" plans and doesn't explain original or "straight" Medicare. So again it's no wonder you are confused.

You have a choice between original/straight Medicare and an Advantage plan (which is the only choice the website you went to gave you) and a few uncommon others if you qualify.

Have you been to the Medicare website? I think that's the best place to start especially the explanation of what your choices are: http://www.medicare.gov/sign-up-chan...e-choices.html

When you have decided whether you want straight Medicare and maybe a supplemental plan or an Advantage plan you can use the Medicare site to get a list of insurance companies that sell those plans in California.

If you need help you can contact your local Area Agency on Aging office to get information from their Health Insurance Counseling and Advocacy Program (HICAP). Sometimes hospitals offer insurance information and Medicare seminars as a community service so you might check with your local hospitals.

If you do decide to get information about plans from salespeople be sure to talk to several of them and then compare all of their literature to get the big picture. That can get complicated in itself so I think you can see why it's better to go to the Medicare site or to a seminar that isn't sponsored by an insurance company.

When you think you know what plans you might want then it's "safe" to talk to salespeople.

It's critically important that you understand the differences between straight Medicare and an Advantage (or other) plan. And if you choose an Advantage plan you have to be careful that you understand the plan's restrictions. Your sister's story is an unfortunate example of what happens when someone who is in an HMO doesn't understand and as a result doesn't adhere to the restrictions of the plan.