>> I need to sign up for Part D <<
RJ.. On the Medicare website there is a set of pages that describe Part D and what is offered. Part D is a bit tricky because of the gap in the drug coverage. I don't recall the exact range of the gap, but I think it's something like $2300 thru $3600 where Part D might not cover. Hence, you need first to sit down and figure out how much you spend annually on drugs and note which drugs you take. With that data in hand, you can then look at the Medicare website on Part D coverage to see which plans would best suit you. The plans range from fairly inexpensive to very expensive, depending upon the deductible, types of drugs covered, and whether or not there is gap coverage.
Before you sight up for a Part D plan and purchase Medi-Gap insurance, you might also want to look at the Advantage plans that offer more or less full coverage including, sometimes, Part D. Here in SoCal, my wife has Kaiser's Senior Advantage which includes prescriptions and she's very happy with it. I canNOT, however, endorse Kaiser in your area (if it's available) since I know nothing about its operation there.
Figuring out Medicare and what's best for you is at best a slippery slope so do your homework first before making the leap. Good Luck!... connie
>> Where can I find unbiased advice on who offers both in New Jersey? <<
I won't say "advice", but information should be available in the annually published [by federal government] handbook, Medicare & You. The most current, dated 2010, has been sent to Medicare beneficiaries in the past couple of weeks. If you did not receive one, you might visit your local Social Security office to obtain one, or you may be able to request online at medicare.gov.
You may also be able to browse the Medicare website to find characteristics and ratings of available plans, as well as comparison tools that allow you to make multi-dimensional comparisons among several different products [plans].
I should note that this information source will cover Medicare D and Medicare Advantage plans, which latter is not a Medigap plan, but is a rollup in one [more or less, MMV] comprehensive plan of at least Medicare A and B, as well often, as Medicare D. Medicare Advantage plans are sometimes referred to as Medicare C. These plans are, in part, subsidzed by a "capitation fee" from Medicare.
AFAIK, so-called Medigap plans are entirely in the private sector, with no involvement or financing from Medicare. Accordingly, I do not believe that Medicare tracks, compares or rates them.
One possible source of further information is a network of volunteer counselors who might be located or contacted through your local Senior Center or Council on Aging. In our area, they are known by the acronym SHINE [for Serving the Health Information Needs of Elders]. Another source might an Independent Insurance Agent (who could be prepared to compare some competing products for you, but might not be able to discuss products from companies that sell only through their own direct agents).
Best regards, 4merCL
From Conrad Msg #2 >> Part D is a bit tricky because of the gap in the drug coverage. I don't recall the exact range of the gap, but I think it's something like $2300 thru $3600 where Part D might not cover. <<
The numbers I find in Medicare & You 2010 (Pg. 66) are a gap or so-called "donut hole" are $2,830 to get in, and $4,550 to get out and be covered by so-called "catestrophic coverage". These would be the minimum Medicare standards, but various (but not all) of the Part D plans, which are all underwritten by private insurers, are configured to provide at least some coverage in the donut hole -- perhaps by covering preferred generics but not brand name drugs, or by charging a sufficiently large premium that they can offer even greater coverage in the donut hole.
BTW, the really tricky part of the donut hole is that getting into it is based on the intial total paid for your prescription meds [any deductible you pay + copays or coinsurance that you pay + amounts paid by the insurance company] BUT, meeting the threshold to get out is based ONLY on payments that you make. So, if you had paid (hypothetically) $830 and your insurer had paid $2,000 [assuming the basic Medicare D numbers] you might have to start paying 100% of costs for the next $4,550 - $830= $3,720 (remember, getting out counts only your out of pocket payments, so the insurance company's $2,000, that helped get you into the gap, does not help you get out).
>> are $2,830 to get in, and $4,550 to get out <<
WoW!.. The gap has significantly increased in size since the last time that I looked. Thanx for the update! I imagine a lot more folks can now fall into the gap before the catastrophic coverage kicks in a $4550.
Fortunately for us, my Mom uses only a few generic drugs and my wife is on Kaiser where prescriptons are included in the package... connie
infmom.net
>> WoW!.. The gap has significantly increased in size since the last time that I looked. Thanx for the update! <<
And, the size of the gap is variable depending on how the Part D plan that you choose is structured and the particular medications that you may need.
If, in your case, your Part D plan pays a greater initial share of your scripts until you reach the edge of the "donut hole", then the gap, or size of the hole will be larger, because you will have paid a lesser amount during the first stage -- and, for getting out of the donut hole, you will have more to pay on your own.
Fortunately, in my own case, the one year that I entered the donut hole, I did so by less than a dollar (and that odd change amount I paid in full myself).
Although the temptation is to be conscious only of the "copay" or "coinsurance" that you must pay, the total cost of each script is important, because it is that total (your share + the plan's share) that is going to carry you toward the leading edge of the donut hole.
>> That's what I'll be investigating next week... <<
Yah... Unfortunately, finding the right Part D coverage is not a find and forget type of thing. As your needs change, so must your choice of coverage... connie
>> you will have more to pay on your own. <<
Obviously, the more that is covered, the greater the cost of the coverage. I think my Mom gets away with the basic $35/month plan so she's tickled pink. OTOH, when I was looking, I saw that there were some plans that cost a few hundred dollars/month. My sister took over the job of figuring out the best coverage for my Mom so I have no idea what the costs of current packages are.
>> the total cost of each script is important, <<
Yep.. That's why I said it's tricky. You really need to sharpen your pencil to get it right... connie
Dot
Life isn't about waiting for the storm to pass; it's about learning to dance in the rain.
--Anonymous
Dear Gretchen,
The types of insulin are based upon their pattern of activity, with:
As you can see, the activity patterns can range quite a bit within each category of insulin type and, when looking at a specific insulin, there's often a broad range of activity, too, which can vary by the individual and the individual's circumstances. Another difference among the types of insulin is that some, such as R and NPH, do not legally require a prescription.
- Paula
>> Another difference among the types of insulin is that some, such as R and NPH, do not legally require a prescription. <<
Insofar as that may be the case, do those formulations become Over The Counter and, as such, not covered by Rx insurances?
>> PMJI, <<
Hey, nothing like first hand experience. You do recognize that I was questioning (not disputing) only insulin formulations that we had been told did not require a prescription. Others that do require a prescription I would expect to be covered by Rx insurances.
Dear Friend,
When I used R and N insulin, I had a prescription for them, but my insurer never asked me about that. I submitted the receipts for the insulin and my group health insurance reimbursed me. As I understand it, some kinds of insulin are available without prescription due to state laws that recognized the life-preserving nature of the medication and the dire plight of being without it due to a prescription running out, travel delays, etc.
