I have strictly Medicare, all parts....A, B and D along with a medigap policy that covers the 20% that Medicare does not pay as well as the co-pays. It is hell, I won't lie to you, to navigate through. Definitely utilize your social worker to help you through this. Also, check out Medicare.gov site as far as policies go, your options etc along with the prices each will cost you. You can opt for HMO's that has prescription coverage or the original medicare with part D separate. I opted for the later mostly because I want the freedom to choose whatever hospital I want to be treated at and not be limited by HMO's. I live near 3 states, have docs in those three states and it would have been very confusing for me to change them around, besides, I love the docs that I have now and feel that original medicare is a good fit.
If you go for original Medicare, know that you will be responsible for 20% of doctor visits, in fact, anything under part B you would be responsible for 20%, that includes DME such as O2. It would be wise to consider a medigap policy in that case. Each medigap policy has it's own price, tiers which has their own level of coverage etc....For instance, I have mutual of omaha medigap policy plan G which was oddly enough, the cheapest but had the most coverage. Go figure...this particular policy covers the hospital deductibles with each benefit period (over a grand each time, I am in 4 times a year so that is good) as well as copays, my part B expenses such as my pulmozyme, vent rental, O2 rental etc..If I had to pay 20% of my DME stuff alone, it would cost me well over 1,000 out of pocket a month. I also have part D which is the prescription plan...be aware of the infamous doughnut hole though. I am covered for both brand and generics up til something like 2750 (for the actual amount, go to medicare.gov), after that, only my generics are covered under my particular plan, which is Medco until the catastrophic stage (which occurs after you pay approx 4650 out of your own pocket) and then the cost of your meds are 5% of the cost, some are less than that. There are going to be changes in this in the coming year though, from what I understand, after this year, brand names will be covered 50% while in the doughnut hole. I received a letter this summer outlining these changes. With each passing year, the doughnut hole is going to close more and more until there will be not more gap, which is awesome.
I won't lie to you, prescription coverage gets really interesting and I have become very creative regarding getting my meds. My insulin, my primary doc gives me samples so I don't have to pay the full cost of insulin while in the doughnut hole. IV's, I have had my docs pre order covered antibiotcs and IV fluids so I can have them on hand. When my cultures come in, my doc will tell me to start so and so antibiotic...no waiting as I have a por a cath. That way I avoid a hospitalization. Medicare does not cover home IV's...they cover the nursing aspect, but not the supplies or drugs...go figure. But if you are creative, you can get generic IV's and have them in house for when the time comes to be put on IV's I have avoided a few hospitalizations that way. I get most of my meds generically as they are covered through the doughnut hole on my plan.
I hope this helps, if you have any questions, please let me know...
Jenn
