Medicare question

[flutterby]

My SSDI was finally approved and I'm now on Medicare. I enrolled in Part D (the prescription coverage) and they automatically enrolled me in Humana Pharmacy....thing...whatever.

Two questions. The Humana card is a "Walmart Preferred" card, meaning I get special deals only at a Walmart pharmacy. I don't use a Walmart pharmacy and I don't want to. I've had all of my prescriptions at CVS for years - and I have *a lot* of prescriptions. They know me - I don't even have to give them my name when I go in - and they know what I take and if I should be watching for anything. Am I stuck with the Humana, or can I change? And if I can change, do I have to wait for open enrollment this year since this was just assigned to me?

Next, it didn't cover my Klonopin because it's "not covered by law". The pharmacy tech printed the screen that stated that, but she doesn't know why. It's not an expensive drug, so it's not a big deal, I'm just curious why it's "not covered by law". I know it's a benzo and is a controlled substance, but it's not *that* controlled. Is this going to apply to other controlled drugs, or is there another reason why it wouldn't be covered "by law"?

TIA.

 

[TeDo]

I have no idea about either of those questions. I would call Social Security Medicare division and ask them. I know for me, open enrollment either recently began or recently ended, not sure since I didn't change. I THINK you can change within so many days of being assigned. Don't hold me to that but definitely give them a call.

 

[susiestar]

You NEED to call the number on the card for member svcs and get them to send you the policies IN WRITING. This includes the formulary for what medications are covered. More and more you can download a pdf, which is great because you can get it updated because they change things qutie offten it seems, at least here.

You MAY be able to change plans but if so you have a short time, a few days or a week, to get more figured out. at least find a mgr at the # on your card and see if they can give you the enrollment dates, crieteria and options.

I am glad you got it even if it will take some time to get used to it.

 

[tiredmommy]

The open enrollment was in Novemeber, I think.

 

[cubsgirl]

I am on medicare. I was told by my pharmacy that klonopin (and any other benzos) are not covered by ANY Medicare plans so I've been paying out of pocket.

They switched my Part D for this month to a different company - fortunately my pharmacy was on the list.

 

[muttmeister]

I deal with Medicare for my mother (next year I will be old enough for it also). Open enrollment ended already but you will be able to change eventually. There is a new thing that you can change more often but I don't know when that goes into effect. Medicare number can advise you. When you are ready to change, the pharmacies around here all have a computer program that inputs your ongoing prescriptions and spits out several options so you can compare what you will pay with each plan. They can't recommend a specific plan but they can get you the info in an understandable form so you can decide. Check with your usual pharmacy to see if that have that.

 

[DammitJanet]

Walmart Preferred just means that is where you get more discounts. You can get your main scripts that you use every month sent through the mail through walmart if you want and that will save you a ton of money on your Part D...do remember the idea is saving money now. It may be worth going to walmart for this year.

I meant to contact you before December 7th but I forgot. That is the date that open enrollment ended for this year. If you had your medicare card before that date, you wont be able to change your Part D again until next year. Humana is the one they normally use simply because it is the cheapest for most people and there is a walmart close to almost everyone but preferred doesnt mean you have to use them.

I had to change mine this year because they increased their price and I would have had to start paying a premium even though I get help for my premiums. Nope. I went to one with a 0 premium.

As far as the klonopin, Medicare doesnt pay for any benzo. They also dont pay for ambien. You can go onto Medicare.gov and do their little medicine checker and see what is covered and what isnt. I had to go through and pick from different companies that would cover my medications and at the levels I take each month. There was actually one company that didnt cover topamax! Obviously I didnt pick them. You should be getting a big book in the mail that is the formulary. Also, you should apply even if you dont think you will qualify for help with the paying part d premium's, fill out the form for that anyway. You never know. I believe the income level for that is fairly high.

 

[flutterby]

My medicare didn't start until December, and I didn't get the cards until after open enrollment ended, but it's probably too late to change it now. I didn't realize it was a Walmart Preferred card until yesterday.

Trying to figure this stuff out is making my head hurt.

 

[DammitJanet]

If you didnt get it until December, then it may not be. You can call. Heather... go onto Medicare.gov and hit drug or it may be pharmacy checker or part d checker. It has checker at the end. Then on the left hand side there will be this place you will enter your name, medicare number, date you got Part a or Part b. Then you enter all of your medications with the amounts and save them. Then you just follow through all that to the very end of the little program they have there and they come up with a list of different solutions for you. Do you want just a part d program, do you want a medicare plus program with part d, etc. Medicare Advantage? Come to think of it, you might want Medicare Advantage because you are going to go broke paying out that 20% plus the $200.

 

[flutterby]

Janet, I have no idea what I want. I'll have to do that checker thing. Truth is, I have had so much going on that I haven't had the time - or energy - to really look into the medicare thing.

One other question - this is SSDI. They said I should receive my first monthly payment "on or around" January 3rd. I haven't received it yet. How long do I wait to call them?

 

[donna723]

I'm not sure how it works with SSDI but I know on regular Medicare you should have been given a choice of plans to pick from. If you didn't get to make a choice, they may have given you the Walmart plan because that's the cheapest. But if you're just signing up for Medicare, the regular open enrollment period shouldn't apply to you. I don't know how long you have but the open enrollment period is for people who are already on Medicare and want to make a change to their plan. If you're just signing up new, it's different, but I'm not sure how long you have.

 

[tiredmommy]

They may have direct deposited it if you gave them your account info.

 

[flutterby]

I am on direct deposit, but it's not there. I've been checking every day. Going to check into the medicare thing tomorrow.

 

[susiestar]

Call tomorrow. They should have someone you can actually speak to about this and they can help. As you got this after open enrollment, they must let you make some choices but you may only have a month to make them. the time is limited at least.

 

[DammitJanet]

Yeah you are not subject to open enrollment and can change.

Heather, please listen to me right now. I am going to try to put this in fairly simple terms because I know you are tired and it is complicated and when I first got started I swore I needed a degree in Medicare and Social Security.

Medicare alone with only Parts A and B only cover 80% of your medical bills and that is after you pay the first $200 each year. Part A is hospital insurance and Part B is Doctors. That is simplified.

If you have no other insurance you will be eaten alive on the 20% in no time.

You need a Medicare Advantage plan or some sort of Medicare Plus or something like that, that includes covering your doctor's visits for the other 20% and the other 20% of the hospital visits. The hospital also has some tiered stuff that would have put me way over the limits when I was in I was sick.

The Advantage or Plus programs will cost you something but it will be much less than what paying that 20% at the doctors will be.

 

[flutterby]

Thank you, Janet. That is extremely helpful.

 

[DammitJanet]

Do you want me to call you and be on the phone while you go on the webpage and look at the stuff online and try to explain it? I would be happy to do that?

 

[flutterby]

I'm not going to be doing that today. I'll let you know. Thank you for the offer.

 

[DDD]

We have Humana and just last week I received a telephone call from a Rep. She asked me if we were aware that many of our Rx's could be direct shipped to us prepaid and at no cost. Then, which surprised me, she said for example you take generic Fosamax and pay $6 for your prescription. If you authorize us to do so we'll ship it prepaid to your home and there will be no charge. I didn't know that.

husband and I are very comfortable using the same private drug store that we've frequented for years. on the other hand, I am calling Humana this week and getting a breakdown on costs for all our Rx's. I've pulled our monthly statement and will just jot the cost differences. We run a Mom and Pop business and prefer dealing with other family owned business but if the savings are substantial, sigh, we may change out of necessity.

Life is complicated but you really need to protect your finances. You've gotten some great advice. DDD

 

[DammitJanet]

DDD..you really do. If I didnt have medicaid also picking up my medications that werent covered by medicare part D and my donut hole coverage, I would have to use the mail order part of my part d provider because I would hit it in probably under 5 to 6 months if I went to my local mom and pop drug store. I love them. They are only open 8-5 and just on week days but they fill scripts in less than 5-10 minutes tops. If I call them from my house, they are waiting on me as I drive up. They know me, Tony and Billy by sight and they also have the $4 scripts!

Im telling you, medicare and social security is an entity all unto itself and you really have to learn it. You have to have some form of insurance that is going to pay that other 20% of the part B.