Okay, I talked to my mom about the new drug plan

[I_Make_Mistakes]

Here is the way I understand it, there are 3 plans offered by insurance co's and within each plan 3 tiers.

Since the overriding factor is the prescriptions you take, you have to start there first.

She only takes 3 med's, 2 of which the generic work well (blood pressure generic, was actually the best for her, after several name brand tryouts) and Fossilmax (sp? I only know it from hearing it) which is to new to have a generic.

The first thing to do is try to see if generics will work for you. You have time so try them out.

Also, if you buy a 90 day prescription, you will only incur 2 co-pays not 3 which saves significant money.

She is going to sign up for a plan that has no $250 deductible, generics are free so she will only have to pay for the Fossilmax.

The interesting thing is at the free seminar offered by her insurance co. Continental (which she is leaving for Advanta, Philly area) she learned of a Pharma (free drug based co.).

The details, Senior RX Support, Inc (Dallas, TX) receives free medication from the Pharma's and charge $5/mo or $60/ year per prescription for processing costs. They are supposed to help the less fortunate, but there is no income information on their paper work, so alot of people are using them.

There is no information on what will happen to this in May, but until then, it maybe worth your while to check them out! There is a one time $20/ filing fee. They don't have a web site (according to her, I didn't search) but, here is the phone # (it maybe wrong, I was writing with a pen that was spent and will follow up tomorrow)
972 387 -0427.

[nosmokes]

1. some companies you can't get a 90 day scrip, only a 30

so you have to make the co pay. but depending on the benefits of the plan it may be worth it.

let's face it - the plan is a joke. it's overly complicated and needlessly full of hoops that you hafta jump through in order to benefit the insurance companies and big pharma, which should come as no surprise because that's who the real benefeciaries of this plan are. to be sure, it's better than what exists now- nothing- but it's nothing that anyone would copy as a model of how to set up any sort of system to do anything anywhere. it's ludicrous and it could have only been born in the halls of the US congress. and for sure that's no compliment.

[I_Make_Mistakes]

3. I agree and she does too! They still have to buy the prescriptions

so let them do what they have to do, until we change the Congress and President!

She figured, she Will save money and that is all she can so for now.

Did you also see the co., below, it will still save her even more money until May!

By the way for clarification, yes, Pharma got a gift, but things always change. I interviewed with SBC in the mid 90's and they had an incredible compensation plan, (part of which was a yrly bonus, which even then they knew the gov't was looking into limiting their excessive compensation).

The best thing WE can do is to get the Repukes out of Washington!

[aquart]

2. What happens if your Mom's prescriptions change?

[I_Make_Mistakes]

4. We have no doubt they will! You can only make a decision based

on the information in front of you. Please read further down, about that co. that you can get a $60/ per year max on a prescription drugs till May.

[I_Make_Mistakes]

6. You can change once per year after accepting a plan, so, I guess

she would just find the plan that works for her if and when it happens!

[Rosco T.]

5. Senior RX Support, Inc - Danger? Danger?

http://www.oag.state.tx.us/oagnews/release.php?id=1005

Attorney General Abbott Sues Fraudulent Mail-order Prescription Drug Service

Senior RX Support allegedly exploited needy seniors

AUSTIN - Texas Attorney General Greg Abbott today sued a mail-order prescription drug service for exploiting seniors who need reduced-cost drugs by asking them to commit fraud by lying to drug companies about their income.

Drug companies offer programs in which qualifying seniors can obtain free prescription drugs. Each drug company has different income qualifications for their programs, but these are not solely dependent upon the person’s Social Security income.

In this case, the Attorney General accuses Senior RX Support of Dallas of offering to short-cut the process by filling out discount forms on consumers’ behalf for a fee, then asking them to report only their Social Security income in order to obtain the discounts. The company failed to tell consumers that drug companies already offer reduced-cost programs for consumers based upon their total income and not Social Security only.

“This company duped seniors into paying for a service that was already available for free, then made matters worse by asking them to lie about their income to obtain discounted drug prices,”said Attorney General Abbott. “This practice hinders needy seniors from obtaining their medications, and it will not be tolerated in Texas.”

(more at link)

[I_Make_Mistakes]

7. You are the man! The people she spoke with WOULD NOT LIE!

They were not asked to! The paper work asks nothing about their financial situation. Thanks for the heads up, I guess nothing is for free. I hope mom didn't send the paperwork off yet!

I just want to clarify these people did not lie about their income, I suspect the employees enhanced the applications!

[godai]

8. Here's a general outline of the new Rx plans

I'm trying to figure this out for my inlaws. It's complicated and not everyone will benefit. Seems to work best if an individual has about $2000 in Rx expenses per year (Check #4 for if you go above $2250). I estimate up to $1000 savings but there may be other catches that lower this. Need to be careful that the drugs you need are included in the specific plan you choose. And, who knows what new drugs might be prescribed during the year, and perhaps not included.

This is unnecessarily complex and fits the old story that a camel is a horse designed by a committee.

Here’s an overview of Medicare’s standard benefit design.
1-You pay a monthly Medicare premium for Part D prescription drug plan coverage. (eg $30)

2-You have a $250 plan deductible. This means you pay the first $250 of your plan-approved prescription drugs.

3-Once you’ve met your $250 deductible, the plan then pays 75 percent of the costs, and you pay 25 percent. This continues up to $2,250 – so there’s a $2,000 difference between your deductible and the end of this phase. That means the plan pays $1,500 (75 percent of $2,000) and you pay $500 (25 percent of $2,000).

4-If your prescription drug costs rise above $2,250, you pay 100 percent of your plan-approved prescription drug costs between $2,250 and $5,100. This gap in coverage is often referred to as the “coverage gap” in the Medicare Part D prescription drug benefit.

5-After you’ve spent $3,600 on covered drugs, Medicare and your prescription drug plan pay 95 percent of your plan-approved prescription drug costs. You pay only 5 percent of the cost.

[annabanana]

9. The complexity of these plans is the direct result

of the contortions Congress was willing to go through to keep obscene profits in Big Phama and Big Insurance pockets.

What are sick seniors without an advocate going to do with all this crap?

[I_Make_Mistakes]

13. It is disgusting that they pull this crap on some that are not capable

of understanding this stuff. God, I hate the Congress right now!

My mom is young, all faculties are present and a retired Controller water authority GAO, so she has some prior experience with gov regulations and financial considerations. She still said she has been studying this for months.

[godai]

11. Some calculated savings

If I've got it right, here are some estimates, based on a $30 a month plan, plus $250 deductible. That's $610 fixed cost for $250 worth of drugs.

Rx per year; Plan costs; Savings
$550; 685; -135 (no savings)
$1050; 810; 240
$1550; 935; 615
$2050; 1060; 990


So if you happen to spend $2050 on covered drugs, you'll save $990. The break even point is about $800 yearly Rx costs, where you begin to save more than the plan costs, if the drugs are all covered by the plan.

What I did was add 25% of the Rx cost above the $250 deductible to $610.

There 0% coverage between $2250-5100. Then 100% coverage starts. I think that these calculations are correct, based on a $30/month plan.

I think there are other possible options in plans that I am not aware of, so this is just one estimate as a guide.

[I_Make_Mistakes]

12. Actually, she said she doen't have to pay the $250 deductible.

I will have to follw up and confirm, but she was able to chose a plan that she believed won't incur the $250 dedectible.

[godai]

15. You're correct, some plans have no deductible.

I learned this from an article in the WP yesterday. Monthly premiums vary widely. It will probably be the plans with high monthly fees that have no deductible.

"The typical beneficiary nationally will pay $32.20 a month for Part D coverage, according to Medicare officials. In the District and Maryland, PDP premiums range from $6.44 to $68.98; the average is $33.63. In Virginia, premiums range from $8.81 to $68.61, with an average of $34.19."

Actually, 1 plan has no monthly premium, Humana Gold Choice, but I'm sure coverage is limited in some way.

So, there are no standards to simplify this. It seems every insurer has the option to tweak the plan as they see fit.

From today's WP:

"Betty Sicher, 71, a nurse from Spring Valley, N.Y., has already made her choice. She will skip the Medicare benefit and keep paying $150 a month to buy her drugs from Canada, she said.

"I'm truly not so sure that this plan is really going to work for me," she said. "There's no control over the prices of the drugs, so if the drug prices go up, my premiums are going to go up. I'm locked into an insurance company for a year. If they change their formulary and I can't get the drug through them, I have to go elsewhere to get it. . . . I decided it just wasn't worth it.""

Possible useful site: http://www.benefitscheckup.org/

[I_Make_Mistakes]

18. There is a scary side to this. If you are not actively enrolled by

May 2006, there is (I would call it penalty increases) an additional increase on all the benefits.

If, Congress would prevent Canadian importation, then there will be HELL to pay, from these so called Christian reps.

[0007]

10. Thanks for the information!

I'm sure many more changes will be coming down the pike.

[SoCalDem]

14. Can she go BACK to what she had before, if she does not like it?

I thought I read somewhere that once you opted OUT of the plan you HAD, you were DONE, and could only stay with one card or another..

Can she wait to sign up until she actually NEEDS to? It sounds as if she's fine with what she has now.

[I_Make_Mistakes]

19. See my response above. You can opt out, but there are additional

costs (as like a penalty for doing so). If you have no need for the plans now, you should probably select one and then adjust (one time per year) when you need to do so!

[ninkasi]

16. Just an FYI

But the drug your mom is probably taking is Fosomax. I take it too, and it's to help prevent osteoporosis. I already have osteoporosis, but this should slow down the bone loss, and might even help replace bone mass.

[I_Make_Mistakes]

20. I know what it is, just not the spelling. It is a good drug, but too new

for generics (when patents run out, generics come out, there is always a new miracle drug to hook you!).

Thanks for the input, I guess, my point was that any of the bone building drugs are too new to have generic counterparts, so, that was her primary focus.

[Tracer]

17. I feel somewhat railroaded by this Drug Plan.

I take NO prescription medicines, yet think that I ought to sign up with a really low-cost plan just to avoid the 1% per month penalty for NOT signing up -- in case, down the road, I might need some prescription medicine.

And - does anyone know if that 1% penalty keeps adding up indefinitely?

[I_Make_Mistakes]

21. I think you should sign up for a plan that has no deductibles,

so there will be zero out of pocket expense. Then should the need arise, use the one time a year change to find the plan that would work for you. If you have no needs now, and can sign up for free (eliminating the penalty why not?).

Hopefully, the mid-terms will change Congress and the next Presidential election will also change and we can back to "Loving our neighbors as ourselves!".

[SoCalDem]

22. My guess is that if we ever get a democratic pres & senate

this whole fiasco will be scrapped.

What would help would be to start including a "union style" drug plan for edicare, and allow 50 yr+ into medicare. That would take some of the pressure off the employers's costs, and might even reduce the cost (ha!) for younger workers..

The 45-64 yr olds are the ones who really need medical coverage, and it might be cheaper to just roll them into medicare..Admin costs are less in medicare, and with the boomers added in, more doctors might start welcoming medicare patients..

Most people in the 20-40 range do not see doctors regularly (unless they have a chronic illness or are pregnant), so the rates should drop for them.

[dragonlady]

23. Insurance model versus benefit model

This new drug plan works on the insurance model (you bet that something bad will happen to you, the company bets it won't and it can keep your premium). Thus people who have no need for drugs now are being pressured (by the 1% penalty per month for life) to sign up anyway, just in case. Also, you have no guarantee that your particular company will continue to offer your drug, or will offer the drug you may be prescribed in the future. All you can do is hope that you can afford to pay the price of the new drug yourself until you can change at the next annual enrollment. It's all spelled out in the insurance contract freely negotiated (snark) between you and the company.

Contrast that with a benefit model. For example, how about a program administered by the government (lower administrative and marketing costs) where you pay a certain percentage of your income, and after that the program pays the rest. (We could even let the government bargain with the drug companies for the best price.) Wouldn't that be better than the current mess?

[Doc Sardonic]

24. My folks are getting royally screwed...........

They have the same prescription plan that my wife and have through her company. Now with this new piece of chicanery being passed off as a benefit they re going to end up paying way more for their prescriptions now.