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Fancy

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Angel
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Reply with quote  #1 
I will be old enough for Medicare this fall. So I am investigating my options. Medicare comes in a bewildering variety of colors and flavors.

First thing I did was call Cancer Treatment Centers of America and verify what flavor of insurance they accept. If I get sick again I WILL go there, and I don't want to be out of network. They told me they accept genuine Medicare--as opposed to one of those substitute plans. Done deal.

Second thing is to figure out how I will pay for precriptions.  This is Medicare part D. Did you know that Femara (and I presume all the other AI's) costs $300 a MONTH??? And further, Medicare will only pay the first $2,510 of prescription costs (about seven months for me) and then I'm on my own until I have paid an ADDITIONAL $4,050 out of my own pocket! This is called "The Gap." Used to be you could get Gap insurance to pay for this, but no more.



Who knew???

On the good side, Fosamax is now available in generic form. That should help some. And Wal-mart, K-mart, Costco and others have programs whereby they will carry generic scripts through "the gap" for the rest of the year. Looks like I'm only gonna be stuck paying the $1,500 for five months of Femara. I now pay $800 a year for Femara and Fosamax with Blue Cross, so that's not really that horrible. The rest of the insurance is lots cheaper. I may actually come out ahead.

Anybody else going through this? I'd LOVE to have sisters to complain to. VBG

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the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
muffy

Goddess
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Reply with quote  #2 
Hi Fancy
I finally became eligible for Medicare this
past June due to my disability from RSD.
 
Since I am a former medical office manager and medical biller and had dealt
with many insurance problems and utilization issues; It was extremely important to me to keep Medicare as my primary and not have a Medicare managed plan.
Since my medical condition is considered rare I needed to keep the widest amount of treatment options open.
 
So, I picked a Medigap plan.  That keeps Original Medicare as my primary.
 
One thing to be aware of if you pick this option. 
If you ever decide to switch to a Privately Managed Medicare Plan ---YOU CAN NEVER SWITCH BACK TO MEDIGAP as as your supplemental.  You have to pick very carefully.

It is more expensive but I'm going to try and keep it like this as long as possible.
 
As for part D---because of Femara I fell into the donut hole very quickly.
My big piece of advise to you is to make all your Doctors aware of this----they often get samples and will be more than happy to help you out.
Most Doctors don't ask patients if they can afford the medication.
 
I told my oncologist I had fallen into the donut hole and he said I should have told him sooner!----HE GAVE ME FOUR MONTHS OF FEMARA SAMPLES TO HELP ME OUT.  ---
My PCP gave me Protonix---then protonix
went generic--now the generic has been withdrawn because the company is afraid
of being sued for patent infringement.--So
I'll be hoping my Doc will again have samples.
 
For part D I went with AARP.  By the way their copay for generic Fosamax is $30.00.
If my oncologist gives me another 4 months worth I will keep out of the donut hole altogether.
What you have to remember is although a medication may have gone generic--when the generic first comes out there may not be a significant difference in price so the total drug costs can still be high build up to that donut hole quickly.
 
So my advise to you --Beg for samples everywhere and make them aware of your situation---They are not mind readers.
Nice being able to read your posts again.
I've always enjoyed them and found them highly informative.
 
Susie/Saluki
 
Fancy

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Angel
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Reply with quote  #3 
I don't know if you're aware, but there is NO GAP INSURANCE this year.  Or perhaps after this year.

However there are some companies--Wal-Mart, K-Mart, Target, etc.--that will give you your generics at the same cost, even AFTER you go into the donut.  That will be a huge help.  Fosamax just went generic.  Femara probably won't go generic for 20 years.  But if that's the only med I have to deal with, I can.

I intend to take AARP's plan J.  It pays all the co-pays and deductables for hospital and doctor care.  That MORE than makes up the difference in cost between J and the lower-cost plans.

Asking for samples is a great idea.  I will talk to my onc when I see him next month.  He's a doll.

I currently pay $550/month for insurance and meds, PLUS the co-pays and deductibles.  Medicare is gonna be lots cheaper for me.  And, plan J covers lots of things that BC/BSM wouldn't even think of.


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the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
Fancy

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Angel
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Reply with quote  #4 
Since CTCA isn't covered by a Medicare managed plan, I will NEVER go there! But thanks. You're really on tip of stuff. See! I knew one of my sisters would know.

ETA--I will NEVER have a managed plan.

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the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
muffy

Goddess
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Reply with quote  #5 
My AARP coverage is for Medications only.
My Medigap insurance that leaves Original
Medicare as my primary is through Independence Blue Cross in Pa--which allows me to go to Cancer Treatment Centers of America or anywhere else since
that is my secondary insurance and covers the 20% that medicare doesn't.
 
 
 
I thought the elimination of the Medigap was as a drug plan portion which would no longer be available--not the supplemental medical coverage but I could be wrong.
 
Before Medigap plans were also allowed to offer part D-but that is now been eliminated and
has to be puchased as a separate stand alone plan when not part of a Privately managed Medicare Plan---
 
I think each state has to offer at least one
Medigap supplemental Plan.
 
Here is a very informative site that may help:
http://www.medicarerights.org/maincontentmedicareoptions.html#hmo
muffy

Goddess
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Reply with quote  #6 
Fancy --The only plans discontinued are the Medigap plans that included prescription coverage- There is no Medigap part D offered
They will no longer be offered so you have to buy a stand alone Part D prescription plan and that is no biggie-----
 
You can get a Medigap plan and keep Original Medicare as your primary---Go to Cancer treatment centers of America and
have everything covered as long as it is covered and approved by medicare.
 
Don't let anyone tell you otherwise.
muffy

Goddess
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Reply with quote  #7 
One more site with info

http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=02110
JoanofArdmore

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Reply with quote  #8 

I'm sorry, I only read the beginning of the thread, but went through the Medicare thing over a year ago and learned some stuff NAMELY that we tend to go for AARP, -=it figures.AARP, Medicare, goes together, right?
I found it incredibly bad and now bear AARP a grudge.I dont believe they are on our side at all, but are out ONLY to make $!
(How ma ny THINGS are they selling?When you read your AARP mag, inserts for CAR Insurance, LIFE insurance, DENTAL insurance.Yadda yadda.And they are all substandard price-wise.OVERpriced and less amenities and coverage.

When Medicare came up for me, I had BCBS.It cost me over $700 a month
So I was happy to get Medicare.
I went to get BCBS MEDICARE plan.
And It ..didnt give ANY coverage in the GAP!!
And generics were too high.
And guess what?
AARP was the same.

Now I dont know about you girls, my my onc's drug reps quit leaving boxes of samples of Femara, (and of Emend, for that matter).They only give him a few now, while before the drugs were ubiquitous, he had LOTS.
And they actually give the few to their truely indigent patients, not $40K a year me.(NOT rich by a longshot, but too rich for aid.)
And the receptionists would say "The drug companies cant afford to GIVE them away!There is a form to full out to get them at lower prices."But $40 K me didnt fit in for "aid".(You have to show your tax return.)

So I went with Aetna.I love that , unlike BCBS, they do NOT make you pay up front and then send you a check for your cost of the drug (a month later).All this hysterical bank-going.
Your druggist has you on file, he simply charges you the copay.Last year generics were free!How awesome is that?
This year they are $8.

AND Aetna covers you in the gap, with your generics.
I know it might be silly to be ranting about generics.But I take Flonase before bed, for my sinus.It comes in generic.
I use Calcitonin nasal spray for my bone density.It comes in a generic.
I take 325 mg HCTZ daily for my bp.Generic.
I take 175 mcg Syntheroid daily.Generic.
If I get sick, I need (generic) drugs.
I had a weird fungus rash last summer.Generic antifungoid powder.
Etc etc etc.
And so this is really very important for me.
And a company that covers  in the gap was my first criteria.Along w/a company that my docs & hospitals are in-network.
So I found it all at Aetna.

And was very disappointed to realize AARP isnt on OUR side at all!


The Femara?Aetna gives deep discounts for buying a 3-pack at Rite Aid, and deeper discounts for buying a 3-pack through the mail.Since I'm too impetuous for mail delivery, I went every 3 months for my 3-pack, to RiteAid.Guess how much it cost for 3! bottles! of Femara! last year?
$50.
I swear to God.
This year the price had tripled.It cost $150 for 3 bottles.(By then I was outta there)But $150 is still half the price of the price of ONE bottle of Femara!

So my advice to you is, check whether your company will co ver you in the gap.
And look and see NOW how much your Femara will cost you.
Also check to see if your co needs a down payment (femara-brain.wrong word.) An amount spent before they begin to cover you.
I might be "rich", but my buget really cant take a lot of hundreds of $s flying away constantly.I do that on vet visits for my dog and I wish HE had insurance.
BCBS had about 3 or 4 hundred dollars which I had to spend on my care before my policy kicked in.It sucked.
So there is advice from one who has been in the trenches, old lady joan.
Good luck, Fancy!


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So I continue to continue
to pretend
my life will never end,
and flowers never bend
with the rainfall.
(Paul Simon)
JoanofArdmore

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Reply with quote  #9 

EEEEEEK!!I'm a chocolate fountain!!!!!!


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So I continue to continue
to pretend
my life will never end,
and flowers never bend
with the rainfall.
(Paul Simon)
muffy

Goddess
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Posts: 160
Reply with quote  #10 
Joan--The Hospital that Fancy wants to use only takes Original Medicare--not the Private Medicare HMO's and POS Plans.
 
So the only way she could continue is to keep Original Medicare and opt for a secondary Medigap plan.
 
The Drug plan is a completely separate issue with medigap.
 
Falling into the Gap in part D is entirely different.
The AARP stand alone Drug plan does a perfectly adequate job until the donut hole
as most of them do.
 
I don't need generic coverage in the gap since most of my meds only come in brand name and those that don't I can get cheaply from Walmart in Generics without a plan.
 
My Medigap from Blue Cross in the same state as you is about $210 a month in addition to what medicare takes from the
SS check.  It is strictly for Medical care with no copays or deductables except for the first $100 of the year which is the annual medicare deductable.
I can see any Doctor anywhere Original Medicare is accepted.
 
If all your Doctors accept a Medicare Managed HMO plan you are interested in you can save money and some of them include part D drug plans--some do not.
 
But if you need to keep the widest amount of options open you are best with Original Medicare--In that case you need to look at Medigap supplementary insurance to cover the 20% Medicare does not cover.--Again realizing once you go to a managed care plan --YOU GIVE UP THE RIGHT TO EVER GET THAT TYPE OF PLAN AGAIN.
 
Be very careful when choosing especially if you want to use CTCOA
 
All any part D plan will cover is generics once you hit the donut as far as I know--so you need to figure out how important it is that you have generic coverage in the donut---for me its so little its a drop in the bucket so I did not get drug plan that covers generics in the donut hole.
 
Joan --I do agree with you that Personal Choice was is an outrageously priced plan
and their Privately Managed Medicare Plan
Personal Choice BC BS was inferior to the Aetna Plan.  Aetna does not offer a Medigap supplemental plan. In this state I would never take a BC BS managed Medicare plan--As managed care goes Aetna wins.
 
Since I am a high medical needs patient I need the widest amount of options now so
Medigap needs to be my choice since some of my Docs only accept Original Medicare and paying them out of pocket would be prohibitive.
 
Happy reading on all your options!

Susie/Saluki
muffy

Goddess
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Reply with quote  #11 
One other thing don't ask the receptionist
for samples---Ask the Doctor and explain your financial situation.
Most patients and doctors are uneasy about bringing it up.
 
Heck, since I had to give up my job I'm living on less than 8000 a year and can't get any help because I have a meager IRA.  If I even touch that I'll be living under a park bench.
 
I was astounded that all my Doc's are trying their best now to give me samples.  And I didn't even think to ask till I fell into the donut hole!
JoanofArdmore

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Reply with quote  #12 
I have always asked.But my onc's reply--"Ask the receptionists if we have any."

Thank you, Susie, for a very comprehensive run-down on medicare plans.
I did my reading a year & a half ago when I turned 65 and wont be doing it again.(And HOPE not to be doing it again.)
My needs are small.Until I was dx with THIS I had never been hospitalized except to have my children, and once for pneumonia.Drugs the same--nada except Armour Thyroid.
It wasnt until menopause that I needed a little hctz.
All the rest came with this.
But I hope and pray to revert to form, and if I dont, I have all the coverage I need.

Thanks again!
PS Mine is a Medicare PPO.I MUST have doctor-going freedom!


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So I continue to continue
to pretend
my life will never end,
and flowers never bend
with the rainfall.
(Paul Simon)
muffy

Goddess
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Posts: 160
Reply with quote  #13 
Joan--At some point I know I will be forced to switch to a Medicare PPO.
 
A PPO would leave me stuck with  20% to 30% of every visit for some of my Docs since they would be out of network--and that would be for me $100 extra bucks a month right now.
 
You can go out of network with a PPO but there is a big financial incentive to stay within.
 
I know I can't keep this up longterm but right now I need the care.
 
Somewhere down the road I'll have to make that difficult decision.
Fancy

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Angel
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Reply with quote  #14 
Muffy, I don't understand your post.  It is my understanding that straight Medicare is NOT a PPO.  I currently have a PPO, and it does NOT pay for my doctor.  I called the insurance people at CTCA and they are covered by Medicare.  Then I chose a supplemental policy with AARP (this is NOT a Medicare replacement) and for about the same money as the Part B deductible, Plan J will pay ALL deductibles from Medicre Parts A & B.  Talk to your doctor's office.  I am sure that they accept Medicare.  All Medicare is NOT a PPO.

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the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
Fancy

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Angel
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Reply with quote  #15 
I have been researching Plan D's for drugs. Dunno about BC/BS, but the AARP plan D does NOT cover generics in the gap, My generics would cost about $75 a month--not horrific, but on top of the $299.75 I will be paying for Femara, not good either.

You can on online at HTTP://www.medicare.gov and get details on all of the Plan D's that operate in your state. There are several that continue to pay for generics across the gap. And you are NOT required to take Plan D from the same company you take supplemental insurance from. Or at least that's AARP's policy. I am counting, and it appears that I will end up saving about $150 once I get medicare. That's not a lot, but......

In reality, I am now counting the co-pays for meds, which I haven't been, and the $1,800 co-pay for hospital/doctor care, which I haven't been. If you realize that I will not longer pay that $1,800, then I will be saving a LOT of money. On the order of $300 a month.

Hey all y'all who take Fosamax--it's out in generic now.


__________________
the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
Fancy

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Angel
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Reply with quote  #16 
Latest news!!!!

AAPR has a prescription plan which pays 100% of generic meds, even if you're in the gap. For me, that's a clear savins of about $350 a year. I'm killing this snake one small bite at a time!


__________________
the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
muffy

Goddess
Registered:
Posts: 160
Reply with quote  #17 

You are exactly right Fancy--Original Medicare does not have PPO plans!
 
I was just bemoaning the fact that at some point I will have to switch from Original because I will have problems longterm paying for the Medigap supplemental.------This is the insurance I really would like to keep because everyone
loves to take it!
 
Some Privately Managed Medicare PPO's let you go outside the network but you are
heavily penalized because the costs will be higher--and from a medical billers perspective many places don't want to deal with a chance they won't be paid or have hassles getting the payment
so they may only want to take Original with supplemental gap plans.--I don't know on that one whether they have the right to refuse a PPO or not.

 
I picked one of the AARP stand alone plans
because some of my meds in other plans
needed special authorization---
 
I do have to tell you AARP had a strange policy on Boniva---they would only pay for a certain amount of months--very weird.
 
Fancy--I'm sticking with the drug plan that doesn't include the gap because I'm finishing Femara this Sept (5 yrs)---and I'm on a Fosamax vacation--so if I can get a few more months of samples I won't hit the gap any longer.  (Actually, that may not be true if Protonix doesn't become generic again).
 
 

Fancy

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Angel
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Reply with quote  #18 
Weigh your options carefully.  I chose AARP plan J.  It will cost about $135/month.  BUT!!!!!  It covers 100% of all co-pays and deductibles for Medicare A & B.  Best I can tell, I come out even, and I get LOTS more things covered.  Before you switch--because you can NEVER go back--make a spreadsheet and count up how much you REALLY will pay for the co-pays.  I think you'll find you pay more than you know.

AARP has a Plan D that lets you mail-order your meds and pay zero dedcuctible.  The plan's about $45/month; my co-pays are $25/month.  

I am so angry that nobody is helping us folks find out what we need to know.  They answer questions, but you have to know which questions to ask.  


__________________
the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
muffy

Goddess
Registered:
Posts: 160
Reply with quote  #19 
Fancy--I think you've made a very good choice.
 
My choice of Medigap plans are limited because not all Medigap plans are required to offer their plans to people with Medicare Disability.
 
In my state the only one that would was Independence Blue Cross--so I am paying through the nose.  Every state has to offer  one plan that allows the Medicare disabled to join. 
 
You have given me a wakeup call to see if
any company has been added this year.
 
 
Thanks
Fancy

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Angel
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Reply with quote  #20 
And Muffy, just to keep us all on our toes, they CHANGE stuff every year, too. I suspect I'll be revisiting this subject annually, forever.

Good luck, lady. Are you 50 yet? Call AARP. They seem to have about the best plans.


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the Frog's Princess
12/05 ILC 1C NX M0

4/1/08 Stage 4
and looking for NED
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