[stevem53]

I got my medicare package in the mail this week..What does it cover in terms of pd meds?..I have no other insurance..I dont even know where to start..Experience?..Suggestions?

I will be eligable for Medicare in June

[colombiangirl1]

I have been on medicare for 6 years. It is very good insurance. It covers about 80% of all medical services (office visits, hospitilization, ambulance, ER, etc.). I was recently hospitilized, and from the ambulance ride and the ER, I only owe $150.00. Medicare is my only insurance too. As far as prescription coverage (Part D), I have been able to get all of my meds for $3.00/per prescription. They do not cover many "new" meds. At all. But, most prescriptions are covered. I also pay a SMALL premium for this part D insurance. It is $5.40 per month. I do not know about specific coverage for the meds. you take. But, most are covered as long as they are not brand new. I got a prescription for AmbienCR and that was not covered. But, if you watch t.v. at all, you know that Ambien is a brand new drug. You might try calling the National Medicare Hotline. Their # is 1-800-MEDICARE. You will need to know which plan you are signing up for though, in order for them to give you the proper # to call for the insurance provider. All of the different plans have seperate providers in different states. Hope I helped some.

Peace, and Love,
-Cgirl-

[Stitcher]

Steve, it is a tangled web, but once you can get through the mess it is okay.

Cgirl has drawn a good picture.

There are two parts to your Medicare...medical and RX. You asked specifically about Part D Rx.

Medical
Things to know:

• What is the date of your SSI award.
• What is the date TWO years after the award date.

Events: SSI award...Two years hence, Medicare kicks in.

So, if you are like me, I was uninsured for a period of time between those two dates. I took the COBRA plan offered by my employer, but it didn't stretch the whole two years.

The Medicare premium will be taken directly from your SSDI benefits payment.

As, Cgirl explained, Medicare pays for most things, but for me I needed to cover the uncovered part...the 20% left over. I don't have the budget (what a funny word) to take the risk of having a large 20% bill to pay.

So, you might want to check out supplemental insurance plans. You can browser search "medicare supplemental insurance"

Personally, I have had AARP Supplemental since my Medicare began. When I check in at a doctors office or a lab/hosp for a test, AARP has never, ever been questioned. I just hear, "You have Medicare and AARP, great." This year I pay $134 a month for the plan, so in combination with Medicare premium...about $200 a month for medical coverage. AARP pays about 99% of whatever Medicare doesn't pay. I never worry about balance-billing from anyone. The only bills I receive are for something that Medicare didn't cover, and that has happened rarely.

Medicare RX...best known at Medicare Part D...the very sticky wicket

Things to keep in mind:

• Medicare ONLY designed the plan
• Medicare does not control the premiums for the plan
• You have to find your own insurance plan...and there are hundreds to choose from
• Insurance plans vary in premium, what they cover and don't cover, co-payment costs
• CHOOSE WISELY...take the time to compare, even if it means formulating an Excell spread sheet, if you like that kind of detail
• Medicare RX has an annual open enrollment. Never assume that the plan you have this year, will not change for the next year
• The premium genrally CAN NOT be taken directly from your SSDI benefit payment.

Go to the Medicare Part D website first to discover what plans/insurance companies are part of the Medicare list. You will need 100% of what you currently take in front of you so that you can build you personal formulary. This is what the Medicare Part D uses to find insurance companies for you that cover you current list of meds.
Part D start page

Medicare Prescription Drug Plan Finder

Formulary Finder for Prescription Drug Plans

When you see the top 10 or so that cover your CURRENT list of meds 100%, go to the website of that insurance company for the details about their plan. I think it is clickable from the Part D page, but if not go there through your browser.

Personally, for 2007 I moved to AARP. My co-payments are, 1) generic $6, 2) brand $28, 3) non-preferred brand $64.75. I avoid the 3rd copayment. I even will take my AARP Formulary booklet to the doc with me, if I think anything new will be rx'd that day. This avoids getting to the pharmacy and discovering that I have a #3 copayment, or something that the insurance won't cover without "paperwork" and "phone calls"

Additionally, AARP covers generics during the middle gap in Part D. The middle gap in Part D is where, per the Medicare design, I am responsible for 100% of my meds cost ($1,500 a month right now; I keep track), before Part D gets to catastrophic. So, instead of 100% cost to me for everything, I only have to pay 100% of anything that is not generic. Some plans don't cover even generics during the middle gap.

Watch the premiums. My Humana 2006 plan was going to be $81 a month in 2007 with no middle gap coverage of generics. My AARP plan for 2007 is better and also covers generics in the middle gap period for $48 a month.

Experience
I have been covered by Medicare since April 1 2003 and I have not had a bad experiece yet. I have not had to seek coverage elsewhere becasue a provider didn't accept Medicare. I began coverage in NY State, then moved to PA, with no adverse effect. I have had expensive medical tests and one ER visit...no problems yet for me.