Part 2...Medicare Part D/Prescription Coverage

Stitcher · 12-17-2006, 12:35 AM

Part 2 of...I am preparing a paper (for lack of a better word) to submit to PAN, regarding the process of obtaining, enrollment into and use of Medicare. I need input from anyone who would provide their personal experience.

Your Medicare Part D/Prescription Coverage experience:

What state do you live in?
If you have been eligible (without any employer coverage, or other similar coverage) and have not enrolled, why not?
If you are enrolled in a Part D plan, what was your enrollment experience like...
finding a plan,
determining medication coverage,
enrollment,
etc.
How do you feel about the penalty for those that don't enroll when first eligilbe?
How do you feel about the fact that
the insurance companies have the ability for "re-write" Part D,
set their own premiums,
decide what medications they might cover that are not on the Medicare formulary
If you were enrolled in a Part D plan during any part of 2006, and you are continuing with that same plan for 2007, will your current pharmacy continue to be under contract for 2007 with your insurance company?
If you were enrolled in a Part D plan during any part of 2006, and you are continuing with that same plan for 2007, will your formulary continue to be the same into 2007? If not, how has it changed?
If you were enrolled in a Part D plan during any part of 2006, and you had coverage through the Gap period (insurance company allowed the continuation of co-payment, rather than you paying 100%), is your 2007 plan going to continue to provide the same coverage during 2007? If not, how has this impacted your ability to purchase RX during 2007?
If your coverage during 2006 did cover the Gap, how were you able to continue to pay for your medications during the Gap?
If you coverage during 2007 will not cover the Gap, how will you pay for RX during the Gap in 2007.
During 2006 did you reach the Catastrophic part of Part D?
What has been your physician(s) reaction(s) to Medicare Part D?

Please provide any additional information.

Stitcher · 12-17-2006, 12:50 AM

My answers:

na
Difficult. It took me a couple of months before I began to understand the design. At first I enrolled into a plan that did not cover the Gap in 2006. Another PWP informed me of a plan that did cover the Gap, and I switched to that plan 48 hours before the deadline in early 2006. Enrollment was the easy part, just tell the insurance company and they take care of notifying Medicare so that they can tell SSDI to take my premium out of my disability benefits.
I feel that the penalty was only imposed in order to force all eligible Medicare recipients to enroll. The reason for the forced enrollment is so that premiums can be taken in by the healthier beneficiaries, thereby offsetting those of use who cost the plan like me...over $1,200 a month in RX cost. While I can understand the need for the healthy to offset the not so healthy, I don't feel that it is fair to force people to enroll.
Part D is not complete in its' design. The design should be more like and employers plan would be; no Gap. I was in employee benefits for over 15 yrs and I can't imagine that there in an employer in the US that would design a plan like Part D. Another way that the plan in "incomplete" is that it set no guidelines for insurance companies, who have re-designed the plan to such an extent that is makes people have to wade through plan after plan in search of the best plan, and even when you find what you feel is the right plna, you have not idea if it is the right plan. Nor do you know if the premium is fair, because even the premium runs the gammit.
Fortunately I did not continue with my 2006 plan with Humana. I received a letter just today from Humana telling me that my 2006 pharmacy will not be included with the Humana plan for 2007.
na
In 2007 Humana will not cover the Gap, not even to provide a co-payment for generics. I did enroll in one of the AARP plans for 2007, which allows for generic coverage co-payment for 2007. In 2007, I will have to discontinue a couple of Brands, unless an older generic is available. If there is not generic, like with Azilect, I will simply not be taking the medication once the Gap arrives at my pocketbook.

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