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Too Much Out of Pocket on Medicare for RXs

 
 
Reply Tue 15 Oct, 2013 03:21 pm
My mom just signed up for Medicare this summer and had a guy come out to "explain" everything to her. As I expected, she didn't understand anything the guy said and is now paying twice to three times as much for each of per prescriptions. I've tried to call her RX supplement company and they said it was open enrollment and she could switch to another plan, but every time they want to verify her info and have to talk to her, she won't ask questions, they lead her down another rabbit hole and she gets nowhere. She doesn't have the money to pay for these medications but she's terrified to deal with it. Is there anything I can do for her to get this straightened out?
 
Butrflynet
 
  3  
Reply Tue 15 Oct, 2013 06:59 pm
@cmabc123,
Have her speak to the people and authorize you to represent her so you can talk to them for you.

I have to do this with most of my mother's transactions now that her dementia is progressing.
PUNKEY
 
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Reply Tue 15 Oct, 2013 08:11 pm
@cmabc123,
What did your mother sign up for?

She has A and B medicare and what other supplemental choice?
cmabc123
 
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Reply Thu 17 Oct, 2013 07:34 am
@PUNKEY,
Some CSI company plan F I guess. Then she has an RX plan through Humana that is causing the problem because they will pay $3000 of her rxs and then only 50% until she pays out of pocket $5000 each year, then after that they'll pay 95%. They told her it was a donut hole. She wants to find something that doesn't have this and will pay the majority of her RXs.
0 Replies
 
cmabc123
 
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Reply Thu 17 Oct, 2013 07:36 am
@Butrflynet,
I tried to get her to do this. I handed her the phone to verify the info and the guy just kept talking to her and she was immediately confused but refused to get off the phone because she didn't want to interrupt him. Now she doesn't want to deal with it at all because she terrified of new things or things she doesn't understand, but I know good and well she doesn't have $5000 a year to pay for her meds.
roger
 
  1  
Reply Thu 17 Oct, 2013 09:12 am
@cmabc123,
Now, Medicare has a website that allows one to compare Part D (Rx) plans in your area. I haven't been there in a few years, but I recall it being a big pain in the neck. Once you work your (her) way through it, it does allow you to compare plans. Note that each plan has its own formulary, deductable, and copays. Do not sign with a company that doesn't cover her prescriptions. Don't waste your time trying to avoid that donut hole. You're pretty much stuck with it.

Plan F for medical is a good one. They all offer the same coverage, so the differences are cost and service.
0 Replies
 
CPAT30
 
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Reply Tue 12 Nov, 2013 06:30 pm
@cmabc123,
Yes you can 1st get all your mom medication together write a list of their names and dosage amount. Second question what the cost of each of these drugs will be under the plan . what the plan will pay, what portion she will pay. No matter what plan you take you will reach the "donut hole" where the plan is not paying anything until you reach a maxium oop expenses not including the oop you paid on the covered drugs of 3K. Ok so based on the actual cost of each of her drugs you will be able to determine what preimum amount you should be paying for her coverge. It may work out that only her most expensive drugs are submitted to her plan to maximize her benefit. or vice or versus. It may work better to use it for the less expensive drugs with a minimum premium and plan on paying cash for her more expensive drugs. It's a #'s game. remember unless you acutally put out 3K in oop you will never have 100% coverge with the Rx plans
0 Replies
 
CPAT30
 
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Reply Tue 12 Nov, 2013 06:33 pm
@Butrflynet,
use a land line where both of you can be on the phone @ the same time, this way you can explain what the represenative is saying in a way your mom will understand.
0 Replies
 
 

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