March 26, 2018
I need to apply for medicare and I'm not sure what to do. Do I just apply for Original Medicare parts A,B, and D or should I get the Medicare advantage? I was on my husbands plan through his work and I had just met my out-of pocket cost. He's losing his coverage and he is going on COBRA until he can find something else. I can't go on COBRA it's way too expensive and again I had already met my out-of pocket for this year. It's so frustrating. Here I am with RA, have already met an out-of-pocket this year and now I am forced to start over. Money is a real issue at this point. Any suggestions? I'm due for my biologic in a few weeks. It's so scary.
March 26, 2018
Hi Kerry! Are you on SS Disability? If not, you can apply for Medicare online at www.SocialSecurity.gov or at your local Social Security office. My husband just got on Medicare due to retirement, and after researching Medicare Advantage Plans, we felt that our particular physicians didn't participate in most of the plans. That made our decision for us and we researched companies for Part D coverage based on our medication costs. Hope this helps and good luck! ~DebiSue
March 27, 2018
Yes I am on SS Disability. I checked both Medicare Advantage Plans and Medicare Part D. I agree with you, I don't like the idea of having to see particular physicians (Medicare Advantage Plans) but after talking to Medicare if I use Part D my medications (not including my biologic) add up to $3322.00 a month on the cheapest plan. I'm afraid I might be forced to use the Medicare Advantage Plan. Also, depending on your area, you only have certain Medicare Advantage Plans available and I only have one. It seems so unfair. Thank you for responding, I really appreciate it.
March 27, 2018
Good afternoon, Kerry! My rheumatologist reminds me that the cost of many of the expensive meds may be picked up by the pharmaceutical company itself. I'm not sure how it works, but it's worth asking about. For routine medications, it's worth checking out the GoodRx app. It's been advertised on TV, and there are no coupons required. You simply type in the meds, search pharmacies near you, and compare prices. It's actually similar to what I pay with my Caremark plan. There is only one Medicare Advantage Plan here in TN as well, and I've seen patients turned away because their physician wasn't on the plan. It is unfair!. Just remember, you can change your Medicare Advantage Plan during open enrollment from Oct 15-Dec 7th if it's not working for you. Best wishes! Debi
DebiSue, Unfortunately, the drug company discounts on most meds only apply if you have commercial insurance. They don't apply with Medicare. That seems backwards, as I was a lot more able to afford higher costs before I retired!!! Dave
KerryW, You are correct when you say that the whole thing is scary! However, there are answers to be had. I don't know what area or state that you live in but in my state (NC) there are advisers who will come to you and help you to get set up with the best plans for your situation. I am on Medicare with a supplement plan "G" that pays the remaining 20% after Medicare plans A & B pays their 80%. With the plan G supplement I have a one time per year deductible of around $180. My wife has the same setup. The deductible has been the ONLY out of pocket expense that we have had to pay since we have been on Medicare insurance other than for meds. My wife was in the hospital last November and had a Pacemaker put in, we paid zero out of pocket. The premiums that we pay for plan "G" are affordable. The weak link in the whole retirement Medicare insurance setup is the prescription drug plans. As far as the biologics are concerned, they are covered by Medicare and the supplement plan G if they are administered at a hospital or infusion center (as mine are.) I have been on Orencia for an extended period of time and it is covered 100% with my setup. I hope that you get some answers soon. Dealing with RA is enough of a problem without having to worry about the insurance thing. Good luck! Dave
March 28, 2018
Thank you so much for all your responses. There are very informative. I have been on the phone with Medicare more than fives times asking as many questions as I can. I have also talked with an adviser (who didn't seem very knowledgeable) so I will be going to their office today to try and speak with another agent. It seems you get a different answer from everybody. Medicare is extremely difficult but I won't stop until I figure it all out. I believe a FLARE is on the way. It's amazing to me how difficult and expensive they make it for the Seniors and the disabled. I'm disabled and under 65 and I need many medications, so I will most likely pay a big price. So sad. Thank you, all of you. I love that I can come to this sight and share information about our illness's with hopes to help each other .