Wednesday, November 27, 2013

I've Got Medicare ... Now What?

     As I described over three previous posts -- summarized in Tips for Enrolling in Medicare -- I recently signed up for Medicare.

     I never had to try to sign up for Obamacare. I've been spared that exercise because I became eligible for Medicare just in time.

     Before Medicare, I had my own medical insurance that I purchased through a professional association I belonged to. That's one of the several problems the Affordable Care Act promises to solve: Until recently it was breathtakingly expensive for early retirees to buy individual health insurance ... if they could get it at all. When I left work and had to get my own health insurance, I could not find an insurance company that would carry me. The only way I got coverage was to search around and find an association I was eligible to join, then purchase a plan through the group. It still was expensive, but at least I was able to get it.

     Anyway, a couple of months ago, I signed up for Medicare, along with the AARP Medicare Supplement plan through United Healthcare. But, like many people, I didn't really know what I was getting into. Who reads all that material they send you?

     So I'm here to report some preliminary results -- not on how much it costs, but on what benefits you get.

     I went for my annual physical a few weeks ago. It was free (to me anyway), just like my old plan. I received a flu shot, also for free, just like my old plan.

     Subsequent to that, I had to fill a prescription -- nothing that resulted from my physical, but a drug I've been taking on occasion for the past year or so. How do I say this? It's a performance-enhancing drug, if you get my drift. I'm not embarrassed about it. After all, women use plenty of cremes and lotions and "estra-fem" type products. So why can't men take advantage of modern medicine for their own issues? Anyway, my old private insurance plan offered a modest discount for a bottle of six pills. It cost around $140. However, the AARP drug plan did not cover the drug at all. The same prescription cost me $194 ... which seems ridiculous, but what are you gonna do? Maybe the AARP plan doesn't cover this drug because the issue doesn't come up that often among elderly Medicare patients?

     Anyway, for almost two months, I've been suffering a terrible cough, with some mild pain in my chest. I actually told my doctor about it during my physical. He was not concerned; he said it might be a touch of post-nasal drip, or else a bit of acid reflux. He suggested a couple of over-the-counter remedies.

     Over the past three weeks it got worse, until it finally broke out into what seemed like a cold. Except I didn't get a stuffy nose, just a horrible sore throat and congestion in my throat, and a cough that wouldn't let me get to sleep at night without taking something like Benadryl or NyQuil.

     So I finally decided to go back to the doctor. Saw him on Tuesday. Did I have a copay? I asked. No copay, I was told. My old plan would have required me to pay $35.

     The doctor measured the oxygen in my blood and listened to my chest and peered into my throat. His conclusion: my lungs are fine; I have post-nasal drip, aggravated by the change of season, the dry air and possibly a slight infection.

     But the point is, he prescribed two items for me. One is an antibiotic. The Medicare drug plan paid a portion of the bill. I paid the rest, which was $10. He also prescribed a special cough suppressant. The Medicare drug plan did not cover that at all. Cost to me: $25.

     So what am I to make of my new Medicare plan? It may be too early to tell, but preliminary results say that the coverage for doctor visits is very good, but the drug coverage leaves a lot to be desired. Does this square with other people's experiences? I guess I'll find out more as time goes on.


DJan said...

When I first got on Medicare, I got a supplemental insurance plan, but it turned out to be much more a month than an Advantage plan would have been. The statin drugs I use were covered with a small copay, and now I pay $6 for a three-month prescription. My doctor visits are $25/visit but when I move over from Group Health to Soundpath in January, visits will be $10 and my statin will increase to $6/month. My monthly cost for my Advantage plan, which covers drugs, is the $106 taken from my SS, and another $34/month.

I only take generics and never any non-essential drugs like you are taking, so I couldn't tell you what I'd be paying for that. :-)

Olga said...

I just had my Welcome to Medicare visit this week.
I have a supplemental insurance through my retirement plan that I thought was pretty much identical to my old coverage, but the drug plan is somehow different and somehow totally incomprehensible to me. Fortunately, I don't have major expensive prescriptions. Mike had the AARP United program and used an internet pharmacy, which I thought was a nightmare. The pharmacy part was a nightmare, I mean.

Meryl Baer said...

We have been on my husband's company med plan for years. Drug costs - he is on several - has creeped up every year, now costing us about $400 quarterly (and that's for generics whenever possible). He goes on Medicare beginning Dec. 1 - we will see what happens. And we have to order via internet - one-time only drugs can be purchased at a pharmacy.
All I know it is very confusing.

Linda Myers said...

For the last three years I have been on my husband's medical plan for retirees. I paid $310 a month for that coverage. Now I'm on Medicare, for $106 from Social Security and $43 for the Group Health supplement.

So far I got a free physical and flu shot, a free bone density test (bones are okay), and a colonoscopy with a $45 copay. My meds are generics and cheap. After the $310 a month I'm pretty happy.

Stephen Hayes said...

I have a few years to go before I'm eligible for Medicare so I can't comment. If I don't get another chance i do want to wish you a Happy Thanksgiving. Take care.

Tom Sightings said...

Unfortunately, I do not have a retirement plan, nor do I have a spouse with a retirement plan. And my medical group does not accept Medicare Advantage, so I had to purchase the Medicare Supplement plan which is more expensive (but still cheaper than my old health insurance).

Fortunately, like Olga, I don't need to take any "essential" drugs. Which all goes to prove: the best and least expensive medical plan is good health. If only we were all so lucky ...

Tom Sightings said...

P.S. And, like Stephen, may I wish everyone a happy Thanksgiving!

Anonymous said...

"Maybe the AARP plan doesn't cover this drug because the issue doesn't come up that often among elderly Medicare patients?"

I feel better having read this. I was upset because they refused to cover my birth control pills. Touche! *laughing*
Cop Car

Anonymous said...

David has a United Health Care retirement plan via Lucent, but it's a Medicare Advantage plan (covers parts A, B and D.

I took myself off his plan because I have my own retirement insurance via Blue Cross/ Blue Shield of the Nation's Capital. I pay several hundred dollars per month for my BC/BS insurance and it is deducted from my government pension. I also have medicare parts A& B which is deducted from my SS.

Expenses associated with my recent hospitalization, drugs, all doctor visits, etc. are covered by the two plans,with no copay, except for drugs. Mostly my meds are generic and inexpensive, but my Celebrex is not and yesterday, I got my 3-month prescription. I paid almost $200 on a $1300+ payment. The drug companies are making out like bandits. I sure hope the ACA don't make it worse.


Anonymous said...

Hi Tom

I am new to your blog but have been following it and enjoying.

You might ask your doctor to find an "organic" reason for you to take the performance enhancing drug. Typically, insurance will not cover these drugs unless you have had prostate cancer, diabetes, spinal cord injury or an approved medical reason to justify coverage. Otherwise, they are considered "lifestyle" meds and are cash. Nothing to do with Medicare or being "elderly". Hope that helps - from an ex Pfizer rep.

And a tip to all - always check the cash price of your generics vs. your copay or coinsurance - sometimes it might be cheaper to pay cash and the pharmacist will not always tell you!

Costco generally has the lowest drug prices, and you do not need to be a member to access their pharmacy.

Finally, please Google any medication you are prescribed (branded) - there are many discount cards and coupons available through the drug company that manufactures them. However, they will not work if you are Medicare since the government considers that price fixing.

Tom Sightings said...

Hi Anon, welcome, and thanks for the good info. But if that's the deal, then I'll pay the $194 rather than get prostate cancer or a spinal cord injury just to get the discount. And so, Cop Car ... I guess we're even!

Douglas said...

"Maybe the AARP plan doesn't cover this drug because the issue doesn't come up that often among elderly Medicare patients?"

I see I am not the only one to quote this... but I suspect I am the only commentor who sees the irony in it. See bold type and think about it... isn't that why there's a need?

Janette said...

Wondering why cpo car needs birth control pills if on

No experiences with this system yet. 17 months until my husband enters the zone. Thanks for all the lead in!

Happy Thanksgiving.

Anonymous said...

Janette--Even at my age (75), a woman has to protect herself. Glad to see that you are not humor-impaired!
Cop Car

Alli said...

I'm finding this late but I wanted to add to the convo that people under 65 with disabilities also use Medicare. I'm 32 and forced to join because my husband lost his job and the Affordable Care Act will not let me purchase insurance since I'm eligible for Medicare. So to those wondering, yes there is a need to Medicare to cover birth control. I can't believe that all other insurance is legally required to cover it for free but Medicare doesn't. Only getting cholesterol testing every 5 years and preventative OBGYN visits every 2 years is also disappointing, especially as a person with chronic disabling health conditions.