Medicare Drug Coverage

[dbroyles9002]

I turn 65 in August, and will be eligible for Medicare. I have a good insurance policy now that covers all of the drugs so far (main ones now are Lupron, Zytiga and RU225.) My concern is that some will not be covered under the Medicare drug plan. Does anybody have any info on this? Would I be better off just keeping my existing policy? Is that even possible?

[Dan59]

Can you keep your current coverage asw a secondary, Medicare does not cover everything and you need a secondary anyway, Thats what I did, and my other insurance is cheaper as a result.

[rxearl]

My copay for zytiga is $550.00 a month with Medicare and Aarp supplement.

[Dan59]

I was able to keep my policy as a secondary, In that way I have no co pays for anything, I am on the expensive drugs too. I am very sure that my previous plan was glad I went on medicare, that saved them a lot of money, now they pay the percent medicare does not.

[Hidden]

I have Blue Cross, Blue Shield. When I went on medicare part a, BCBS contacted me and told me if I signed up for Medicare part b, they would cover all my co-pays, deductibles, etc. They weren't lying, they do.

As far as being able to keep your current coverage, you really need to contact them and ask. I'm lucky enough to be able to keep mine for life. I currently have BCBS, Medicare A & B, and VA health insurance. I pay nothing and I get bone scans, ct scans, and mri's every 6 months. All my meds are also covered. My upcoming Provenge treatment (100K) will cost me nothing.

[Hidden in reply to Hidden]

Mail order specialty drugs is great also with Blue Cross Blue Shield ... we have the same and where in Virginia to

[Litlerny]

It’s possible, but more info is needed about your specific situation. Are you still working? Or, are you retired? If retired, can you carry over your health insurance including Rx coverage into retirement?

Like Bill48162, I have Medicare A & B as my primary insurance, and Blue Cross Blue Shield (mine is a Federal plan that I was able to carry over into my retirement from the Federal Gov’t.). Between them, they pay nearly all of my medical bills including prescriptions for Lupron/Eligard, Bicalutamide, and other Rx drugs. Also, my Blue Cross coverage includes an option for mail order Rx thru CVS/Caremark where (with Rx from my doctor) I can get a 90 supply with 3 refills for which I pay zero copay for bicalutamide, and zero or $10 for all other generics.

The Medicare drug plan is Part D, which is optional. If you can continue your private insurance coverage including Rx coverage you may not need Part D, for which you pay additional premiums in addition to your Part B premiums.

In 2018 Part D still has a “donut hole” where after Part D has paid $3750 in covered drug expenses you pay 35% of brand name and 44% of generic drug expenses until you have paid $5000 out of pocket before exiting the donut hole, and “catastrophic coverage” takes over. At that point you will pay 5% of your drug costs for the remainder of the calendar year.

Legislation was recently passed to further modify and “close” the donut hole effective 2019, where you only pay 25% of covered drugs while in the donut hole period.

Both the Medicare (medicare.gov) and AARP websites are great resources for researching your prescription coverage options.

[leo2634]

You can also look into what's called a Medicare Advantage plan they differ in what area you live in but we'll worth it. I have Aetna and the cost to me is $30.00 a month $10.00 Primary care doctor visit and $35.00 specialist. My medication Zytiga has a $542.00 copay a month but I have had the good fortune of getting that reduced by my Doctor and his incredible staff. I thank God for him daily.

[leswell in reply to leo2634]

Helpful discussion here. For comparative purposes, we paid $2564 for the first month of Zytiga and will pay $498 per month henceforth. I don’t think becoming “catastrophic” will alter that. I’ll keep everyone informed if we get a further reduction. Go Janssens—I mean go Leswell’s hard-saved teacher IRAs. I guess we make too much in SS and his teacher pension to qualify for mercy or compassion. Mrs. S. P.S. We’re with UCare Senior Value Plus in MN which is combined with Medicare and is in charge of everything. We aren’t allowed to have any additional health or drug insurance. Premium is $141 per month for each of us.

[louschu]

Medicare comes in two flavors. Medicare and Medicaid Advantage. Stay away from the Advantage plans. They are cheaper but can deny providers and procedures that Medicare covers.

[BrianF505]

For any of you Vets in this group, I encourage applying for VA Health benefits. I’m a Cold War Vet 76-79 and never thought I’d be approved. But I was. I’m in Priority Group 8 and have to pay the highest tier in co-pays. But this is really nothing in the big picture.

It was a bit of a pain to get it all coordinated with my private MO, but with the help of my VA Primary Care doc and VA Urologist, I now get all my meds through the VA. To include my Xtandi. Co-pay for Xtandi is only $22.00 a month.

[dbroyles9002 in reply to BrianF505]

Thanks for the info!

[CalBear74]

I will echo Leo's recommendation because of my positive experience with the Medicare Advantage plan from United Healthcare/AARP here in Florida. If available where you live, it offers a drug coverage plan as a "Complete PPO". It is a richer package than their HMO product and requires $70 monthly in addition to the medicare payment they receive from the government. I had Aetna but found this UHC plan gave me more flexibility on physician selection and the drug formulary selections.

[leo2634]

It works for me Calbear. I have Aetna PPO prime elite plan so far so good like I said I pay $30.00 a month nothing has been denied and medicine has been covered. Leo

[Kimmilemo]

Anyone that lives in Missouri I can help.

314-283-3439 Kim