If you are of medicare age, you know that each year you have to choose which medicare and drug plan you want for the upcoming year. You can use traditional Medicare and a Medicare, supplement plan, A drug plan or a Medicare Advantage plans (Medicare Part C) which includes both medical and drug coverage and are managed by an insurance company funded by Medicare and may or may not have a premium depending on the level of coverage and the state you are in.
I choose to keep Traditional Medicare with no restrictions or approvals needed for specialists as long as they take medicare assignments. Since Medicare only covers about 80% of the cost most people buy a Medicare Supplement or Medigap policy that covers some or all of the remaining costs and or deductibles depending on the level of coverage and premium you want to pay. Then you also need what is called Part D which covers your drugs. That is the one that you really have to pay close attention to during the December open enrollment. Every company has a different list of drugs they cover at various levels of payment. You have to input all the drugs you currently use and then figure out which plan provides the best overall savings between deductibles and premiums. I chose a company with no deductible and a higher premium so my drug expenses are spread across the whole year and not a bunched in a front end $450 deductible. So all that leads me to today's insurance company battle today over a prescription I picked up on Sunday. I take Symbacort as a preventative inhaler for my asthma. It is generally very expensive and they charged me $142.23 for a generic version. I have never had a generic version in the past so I was concerned if it would be as effective and the price seemed to be way too high. After looking at my notes and spreadsheet when I chose my drug plan I was convinced the price was too high. I went online and confirmed on the website that the price for Symbicort should have been $47. So I called the drug insurance plan and talked to the first person that agreed it should be $47 but send me to the pharmacy side. They also agreed and then sent me to billing to see how to get a refund. I knew that was not going to help, but told them my story too. They then transferred me to another department and that person could actually see the drug that was fulled and told me that yes, the price was correct for GENERIC but if I got the brand name it would be $47!!! Go figure. Fortunately I had not opened the package so I went back to CVS and told them it was the wrong medication. They told me that Florida law requires them to fill with generic if available as a cost savings. I explained that in this case I needed the brand name and the pharmacist plugged in the info and in 3 or 4 minutes had issued me a refund and charged me the $47 for the Brand name drug. I was very impressed with CVS fixing it so fast! But all this takes time to sort out. I probably spend 3 hours researching my notes, checking into the website, an hour on the phone and a second trip to CVS to sort it all out. How on earth do people manage the process who are not as technologically inclined, or familiar with the whole process, or not mentally challenged due to age and disease. Editorial soapbox comments! It seems to me that if anyone thinks Medicare for all will be the answer to the healthcare crisis I believe it is not that simple. Figuring out Medicare is not that easy and I have worked int he insurance marketplace and still find it very complex and difficult to manage. AND Medicare is not FREE! Everyone pays a part A and B premium that mostly comes out of the Social Security check. Then there are deductibles and copays for traditional medicare, so you need a supplement/ medigap policy to cover that. The public will need another tier of people to help individuals navigate the mess and collect all the copays and deductible. It will be a mess and really not much different that what happens now with traditional health insurance. Ok, off my soapbox now!
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Author: Penny
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October 2020
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