Medicare Part D

[cdale613]

Is anyone going to be registering for Medicare Part D? How is the process going - I know medicare.gov's plan finder only just became available, but was wondering how people were handling the process. Is anyone's drug coverage being switched from Medicaid to Medicare?

Chris 25 w/cf

 

[anonymous]

If you are getting Medicare, you will automatically be enrolled in Part D (if you don't pick a plan, they will pick one for you). Talk to your pharmacy to see what plans they are participating in, as the plan you choose could affect which pharmacy you use - not all pharmacies will cover all plans. Secondly, you could talk to your county health worker to see what plans they are recommending to Medicaid patients.

If you are getting both Medicare and Medicaid, yes, your drug coverage will be switched over to Medicare. However, Medicaid will pay for your premiums (just like they do for your Medicare Part A and B), and any items not covered. Really, you shouldn't see a change in how you get your meds, or how much you are paying for them. It should mostly just be a billing redirection.

--Wallflower

 

[cdale613]

Hi Wallflower,

I don't mean to disagree with you, but your discription of what will happen to people eligible for Medicare Part D is overly simplified and inaccurate.

ONLY dual eligibles (Medicaid and Medicare enrollees) will be automatically enrolled in Part D. As you said, these individuals also qualify for the Low Income Subsidy, which means they will not have to pay premiums or deductibles, will not have to deal with the "doughnut hole" gap in coverage, and will have to pay nominal copays. Even if you are autoenrolled, you MUST check to make sure that the plan that you have been randomly assigned covers the drugs you need. If you are auto-enrolled, you can switch your assigned plan to one that better covers your drug needs.

HOWEVER, those individuals only on Medicare will be responsible for selecting and enrolling in their own drug plan. In most states, people will have over 40 plans to choose from, which will vary by cost, and by coverage.

Every plan sets its own formulary, and not every drug that CFers need is on every formulary. In addition, plans are allowed to require prior authorization for some drugs - generally expensive, rarely prescribed drugs, such as TOBI and Pulmozyme, and are allowed to set quantity limits.

Every plan is different. In addition, drugs will fall into different "tiers" of copayment/coinsurance depending on the plan. Most basic, generic drugs will be the least expensive, but the cost of higher tier drugs to individuals can and will vary wildly from a copayment of 40-60 dollars, up to coinsurance of 30-50% of the drugs cost - which, for drugs like TOBI, could be astronomical.

I posted this topic because I feel that Part D is unbelievably complicated, and will have a real impact on access to medications. I hope that everyone out there affected will take the time to learn about the program and at least try to talk to their pharmacists and physicians (who may not be very well versed in the complexities of the program)

I suggest going to http://www.medicare.gov/pdp-basic-information.asp#whatmpdc for basic information, and playing with the formulary drug list finder and Medicare Drug plan finder to get used to your options and how the system will work.

Anyone with specific questions, feel free to PM me - I work full time, so I will not be able to deal with questions immediately, but I would gladly offer what help and advice I could give. I am not in anyway affiliated with any Drug plan - I work for a government contractor who has been helping CMS prepare for the launch of Part D.

Chris 25 w/ CF

 

[anonymous]

I do think that Chris' description sounds more like the information I received from Medicare re: Part D.
It is very complicated, that's for sure and there are income limits so not everyone that has Medicare parts A&B will qualify. I didn't because they counted my spouses income too.

 

[cdale613]

Hi Anon.

It is very complicated - and I just wanted to make sure that you understand that everyone on Medicare Part A/B does qualify for Part D. The income limits only apply to eligibility for the low income subsidy, and for that, it sounds like you do not qualify - However, that doesn't mean you can't enroll in a Part D plan, and pay the premiums, copays, deductibles, etc.

If you already have drug coverage through your spouses insurance, Part D is probably not for you. There are gaps in coverage, and it is far more complicated than it should be. HOWEVER, if you don't have any drug coverage at the moment, something is usually better than nothing.

Hope this helps.

Chris

25 w/cf

 

[anonymous]

Thank you for that info Chris. I do have a Rx plan thru my hubby's company insurance and my Part B covers my nebulized meds so I do OK, all things considered. That's good information that I was not aware of.

 

[anonymous]

Sorry my post was a waste of space for you. I thought you were looking for help, so I posted what I knew. If I knew you were just looking to counsel people, I would'nt have bothered.

--Wallflower

 

[wallflower]

Boy, what a snot I was! I must have read your post after talking to my insurance people (who love to tell you how dumb you are, but won't take the time to educate you).

Anyway, I'll be the first to admit when I'm wrong about something (my boyfriend loves that <img src="i/expressions/face-icon-small-smile.gif" border="0">). I got a letter yesterday from the clinic about how Medicare Part D affects those with it and Medicaid. Indeed, if you have both, you will lose all Medicaid drug coverage to Part D! That sucks. They were warning patients that if you don't pick a plan, you will be placed in one at the bottom of the scale that won't pay for all of the cf meds. Indeed VERY differenct from what I was told before.

 

[anonymous]

I'm trying to help my parents pick their plan (obviously, not cf related, just typical medicare over age 65 thing.) Anyway, what I hate is how impossible it is to actually compare out of pocket cost with the plans due to different formularies, different discounts from the pharmacy, etc. Total pain in the butt!! I don't see how even the most intelligent people can make a truelly informed decision since there really isn't enough information to compare the plans apples to apples. But, then, what do I expect, it's the government, right?!

 

[HollyCatheryn]

I just found out from my clinic that the CF Services Pharmacy (<A href="http://www.CFServicesPharmacy.com">www.CFServicesPharmacy.com</A>) is planning to accept any and every plan. The phone number for them is (800) 541-4959. You can call or email and ask specifically about your meds and the plans in your area. You can also get in touch with Beth Sufian (a Disability Lawyer with CF who has been following this and giving seminars to CF clinics) at (800) 622-0385 - that is the CF Information Hotline #. My clinic instructed me that these two sources are the best place to get good information on picking your plan. I went to the Medicare website and it was totally NOT helpful.I haven't had a chance to talk to CF Services yet, so I cannot say anything definitely, though. Call and check for yourself.  

 

[anonymous]

Part D is a pain. My drug coverage thru private insurance sent me a letter stating that I will either have to choose their coverage or part D. If I enroll in part D I will lose their coverage. I am leaning toward just keeping theirs and not enrolling in part D. I have Medicare but not medicaid.

 

[cdale613]

Hi All,

Wallflower... no worries, I wasn't offended.

Anon. - If your parents are just typical Medicare 65+ individuals, I would look for a plan with low monthly premiums, zero deductible, and copayments (flat per-prescription dollar amounts your parents would be responsible for), not co-insurance (percentages of per-prescription cost they would have to pay). If they are on specific drugs, try to find out how much each drug would cost in different plans. Don't let the number of options scare you - just pick a few of the lower priced ones, and start from there. If your parents are on any specialty meds, you may need to consider a higher priced plan for them. Remember, if they already have drug coverage from any other private source, they should keep it, as Part D will not give them more comprehensive or affordable coverage. However, if they are like my grandparents, and currently have no drug coverage, something is generally better than nothing.

HollyCatheryn - I'm glad to hear that CFServicesPharmacy is going to accept plans. People should also make sure that their plans consider CFServices an "in network provider," otherwise, drug costs could be higher than originally thought. Maybe CFservices already has worked this out... I don't know for sure.

Anon#2. Do not switch your coverage from your private insurer. You are virtually certain to have better coverage under a private insurer than through Medicare Part D, considering the "doughnut hole" gap in coverage.

I hope this helps. If anyone would like any clarification, etc. please feel free to pm me.

Chris

25 w/cf

 

[cdale613]

http://hpi.georgetown.edu/rxchanges.html

This is an excellent resource for people who receive Medicare due to disability, and how Part D will affect them. Hope its useful.

Chris

25 w/ CF