Today is going to be a serious blog. It’s about finding the right way to make good decisions and what you may need to know to do that. The decision I’m talking about is picking your Medicare Part D or Medicare Advantage Plan. Hindsight always makes things clearer so I wanted to tell my story. What things did I needed to know to make it turn out much better.The last couple months we have had a few challenges. My husband and I are on Social Security early because of disability. We have Medicare and every fall all seniors on Medicare sign up for the medical prescription program and it has progressed and now it extends to cover Dr. and Hospital bills which is called Medicare Advantage. We were very resourceful and gathered information on the two plans available to us in our area and made a decision. We felt good! We had a nightmare of a year in 2011. The first of December we signed up for our plan. The plan included a mail order medication program. That sounded like a good decision because:
- Mailed right to your door
- $0 Co-pays on generic medications
- Reminders when to refill
We pay less money because of lower copays and less gas money. We input all our medications into the system to make sure they were on their formulary. We were delighted to find they covered all but 1 medication. We sailed through Christmas feeling pretty good and relaxing a bit since our experience in 2011 was almost more than we could take. We had a very rough year.
January 1, 2012 our plan took effect. They told us to make an appointment with our Dr. Have him send all our prescriptions to the mail order program. Step one right? We waited for everything to fall into place. My husband’s medications came back pretty quickly. Mine was a different matter. He has normal aging conditions for the most part. My dosages are irregular and not in the normal range because I am seriously ill. As soon as they received my list, all kinds of warning signals went off. They started calling the Dr. office and telling him they needed clarification. What puzzled me was that they didn’t phone him once with a complete list of questions that needed their clarification but there was repeated calls in a three-week period.Every time that happened it put the order on hold and it was as though it went back to step one They said once it was clarified , it would be a week to ten days before it would be sent. It was a worrisome time as I was nearing being out of my medications.
The persons who answered the calls had no idea about medical things, couldn’t spell the medications, and had trouble finding anything on the computer. This definitely made the whole process painfully slow. I started on the 5th of January and it took till February 16th for me to get all the medications. I had been out of almost all of my medications two weeks by the time they arrived. Here are a list of question you should have your Doctor answer and choices you should make:
- Get the physical prescription and send it to them yourself
- Have your Doctor send a statement that you have not had any drug interactions with the current prescriptions
- Ask the Doctor if the doses are within the normal prescribing guidelines
- Don’t give them a payment method but have them invoice you for the purchases.
Mail Order Prescription Plans can be very beneficial. If you are fairly healthy then you it should be fairly simple. If you are seriously ill the list above should help.
Because of the extreme cost of my medication I have to calculate the cost of my medications to the Insurance Company. I never could get a price quote. Since I am seriously ill and on many medications, I have to know when I’m going into the donut hole. Just in case you don’t know what that is, here is a quick overview of the Donut Hole or Coverage Gap.
- According to the Medicare (or the Centers for Medicare and Medicaid Services, CMS), Standard or Model Medicare Part D prescription plan, the Donut Hole phase of your Medicare Part D coverage begins when your total retail drug costs reach $2930.
- read more at the site below:
- ( http://www.q1medicare.com/PartD-MoreOnTheDonutHolesOrCoverageGap.php )
Last year basically I was in the donut hole by the middle of the year and at that time you pay the full price for some and a percentage on others. Needless to say we struggled most of the year.I know, this is a long, drawn out donut hole saga. How things proceed this year had to be very important and so I ask them about the cost to the Insurance Company.
Once I had the invoice, I was able to see and be able to calculate when I would reach the dreaded donut hole.
I don’t know about you but the whole situation made me nervous and a little bit crazy!
I am back on the medications for a week now and slowly getting back to normal. I haven’t been feeling very well but things are looking up. In a couple of months I will figure out the next step in this crazy challenge.
I’m thankful for my insurance and This year is going to be better. Keep in mind what I said about how they look at your prescriptions and what questions to have answered so that it goes much smoother. Hope this problem never crosses your path but if it does then I hope some of my tips will be of help to you. Thanks for coming to visit. Hope your path is wide and clear of big rocks! 🙂