The New Medicare Rx Plans - USM Forum -- Message Board

Date: Dec 4, 2005

The New Medicare Rx Plans

Date: Dec 4, 2005

For viewers who don't understand what this is all about, after January 1, 2000 the state retirees medical plan will no longer cover prescriptions for those on Medicare. With some exceptions, state retirees who are also on Medicare must select one of many Medicare approved but privately administered prescription plans. Private insurance companies are currently competing for this business. You may have seen their advertisements on television or seen their brochures in local pharmacies. The monthly cost, benefits, and drug formulary varies from plan to plan. To help offset the cost of these prescription plans, the monthly premiums for the current Mississippi retirees' hospital plan will be reduced beginning January 1.

Date: Dec 4, 2005

The change will take place on January 1, 2006, buddy - not January 1, 2000.

Date: Dec 4, 2005

proofreader wrote:

The change will take place on January 1, 2006, buddy - not January 1, 2000.

True. Jan. 1st 2006 it is. But state retirees who are also on medicare are selecting and signing up for their plan now. There is a deadline they don't want to miss or they will be subject to a higher premium.

Date: Dec 4, 2005

I've been researching this also. The plan that PERS is recommending is PacificCare. There is a link to it on the PERS website under PERS Updates (on the right). http://www.pers.state.ms.us/

I'm retired and Medicare eligible on the state plan paying $220/month. On January 1, 2006 my cost will be $137/month (a savings of $83) and the deductibles will reduce to about zero.

The cost of the PacificCare "Saver Plan" is only $32.89/month. If you purchase your Rxs @ Three-Month supply (90 day) via "online-mail order" you effectively get one month (30 days) free. However, they only list the pharmacies in your area (zip code). You will only be told the name(s) and address of the "mail-order" company when you apply. I have yet to apply.

Date: Dec 4, 2005

Reporter wrote:

I've been researching this also. The plan that PERS is recommending is PacificCare. There is a link to it on the PERS website under PERS Updates (on the right). http://www.pers.state.ms.us/

Reporter: I'm also looking at PacificCare for myself. Do you know why PERS endorsed this particular plan?

I'm retired and Medicare eligible on the state plan paying $220/month. On January 1, 2006 my cost will be $137/month (a savings of $83) and the deductibles will reduce to about zero. The cost of the PacificCare "Saver Plan" is only $32.89/month.

Reporter: On January 1 my deductions for retiree's state health insurance will be $81.00 per month (about the same as yours will). I am seriously considering Pacificare, but if I do select them I don't know whether to subscribe to their Saver Plan ($23.80/mo.), Select Plan ($37.87/mo), or Comprehensive Plan ($42.00/mo.). Whichever I take would be well within the $81.00/mo. savings. I am considering their Comprehensive Plan ($42.00/mo) because it closes the "doughnut hole" that occurs when drug costs exceed $2,250/annum, but I'm relatively healthy at the present time and am not sure it would be worth it (except for peace of mind).

If you purchase your Rxs @ Three-Month supply (90 day) via "online-mail order" you effectively get one month (30 days) free. However, they only list the pharmacies in your area (zip code). You will only be told the name(s) and address of the "mail-order" company when you apply. I have yet to apply.

I see from their promotional material that the Pacificare "formulary" contains more than 1,900 Rx drugs. Do you know how that number compares with the formularies of other providers?

Date: Dec 4, 2005

Reporter: I meant to say that in January my Mississippi retireee health care plan will be reduced buy $81.00/mo.

Date: Dec 4, 2005

Also a retiree wrote:

Reporter: I'm also looking at PacificCare for myself. Do you know why PERS endorsed this particular plan?

No, I don't, Retiree. I heard they were recommending PacificCare from a non-university state retiree, so I called and was told they couldn't endorse any plan. However, today I saw they have the link up.

Reporter: On January 1 my deductions for retiree's state health insurance will be $81.00 per month (about the same as yours will). I am seriously considering Pacificare, but if I do select them I don't know whether to subscribe to their Saver Plan ($23.80/mo.), Select Plan ($37.87/mo), or Comprehensive Plan ($42.00/mo.). Whichever I take would be well within the $81.00/mo. savings. I am considering their Comprehensive Plan ($42.00/mo) because it closes the "doughnut hole" that occurs when drug costs exceed $2,250/annum, but I'm relatively healthy at the present time and am not sure it would be worth it (except for peace of mind).

(Your numbers should be Saver-$32.89, Select-$48.37 and Comprehensive-$53.97 according to the literture I received.)

I'm in the same boat as you. Everything I read says that unless you move to another area you can only change plans once a year. I see no reason to pay extra to fill the "doughnut hole" until that is necessary. I figure the worse that could happen is I have an accident requiring a lot of drugs and have to wait until next January to fill the hole. I believe I can make due for a few months.

I see from their promotional material that the Pacificare "formulary" contains more than 1,900 Rx drugs. Do you know how that number compares with the formularies of other providers?

No, I have only a very little information about other companies. I imagine it would be very a difficult task to calculate all the possible benefits to get the optimal plan and company. When I checked the cost of plans on WWW.Medicare.gov, the PacificCare was very expensive, but then I realized the program didn't allow the option of the "mail-order" 90 day supply. I only found that from the literature.

Date: Dec 4, 2005

Reporter wrote:

Your numbers should be Saver-$32.89, Select-$48.37 and Comprehensive-$53.97 according to the literture I received.

Reporter: The difference in cost is because you and I reside in different states.

When I reviewed the plans of various companies I noticed that many of them (including the one endorsed by AARP) do not provide the choice from three plans.

When I checked the cost of plans on WWW.Medicare.gov, the PacificCare was very expensive, but then I realized the program didn't allow the option of the "mail-order" 90 day supply. I only found that from the literature.

I didn't know about the "mail-order 90 supply" deal until you mentioned it here on the board. I did notice Pacificare's higher price as compared to some other plans, but mail-order purchases you pointed out would help Pacificare meet or beat some other prices.

I called Pacificare directly, and also PERS, to ask some questions about the Pacificare plan. My contact with PERS was very satisfactory. The customer service representatives at Pacificare were articulate and seemed eager to answer questions. After I made those calls I reread the October, 2005 (Vol. 2, No. 3) issue of PERS Forward (a newsletter for PERS retirees) and found the statement "PERS and Monumental Life are in the process of negotiating a plan to sponsor Mediare Prescription Drug coverage for all PERS Medicare retirees." I then called Monumental directly. I was told by PERS and by Monumental that they endorsed the Pacificare plans.

One of the reasons I am seriously considering Pacificare is because of a statement in the November 18 letter Pacificare/PERS sent to retirees stating that the Public Employees' Retirement System of Mississippi and Prescriptions Solutions from Pacificare have "joined forces," and the fact that Mississippi's retirement system is a strong one and seems to try to take care of its retirees.

Many thanks for your comments. They are helping me think through this complex selection dilemma.

Date: Dec 4, 2005

Thanks for your explanations, Also a Retiree. I also had a hard time finding the "90-day mail order deal". I only found it in their literature after a long search because the non-university retiree I mentioned told me it existed. It makes all the difference for me. I'm still sort of concerned as to why they wouldn't tell me the name(s) of the mail-order company or their URL.

Date: Dec 4, 2005

This whole procedure is unconscionably [sp?] complicated and confusing. I'm trying to help my mother make this decision, and the pressure of the time limit vs. increased cost really raises the anxiety level. As a "young" old person, she doesn't take many drugs, tho they are horribly expensive and I worry about the future. This whole program is such a mishmash, it almost looks like it was created by Congress. Oh, wait . . .

Date: Dec 5, 2005

I agree with LVN. The entire procedure is unbelievably complicated. I know some elderly persons who will undoubtedly throw up their hands in resignation as they try to figure it out. At the present time privitization of this aspect of Medicare does not seem to be working. But there is some good news: I took a list of the few prescription drugs I currently take to the pharmacist at my drug store and she plugged the names of those drugs into their computer which spit out a list of Medicare approved prescription plans which would cover those drugs. I think that many drug stores are able to generate such a list.

Date: Dec 5, 2005

I don't know if is helpful but I will share it hoping that it is. My mother was not wealthy but she paid for the best BC/BS supplemental plan to Medicare that she could afford. Although pricey, it provided her with extensive care beyond Medicare and greatly reduced her anxiety in the last years of her life. Regarding prescriptions, she was a homeostatic balancing act because all of her various ailments required contraindicated medications. Her personal physician managed to find the complicated and sensitive formula, which required name brand drugs and not their generics. Something that I did not know until we had to deal with it is that when a patient goes in to rehab, say after a hospital stay, the medical team at the rehab center and not the personal physician determines the drug profile for the patient. In my mother's case, the rehab team switched her medications to generics and that slight change resulted in a major disruption to the balance of her drug effectiveness and health. It was resolved but not before a serious complication arose. This may be too off topic and anecdotal for the original question but it is certainly something I wish I had known ahead of time.

Date: Dec 5, 2005

What's in a name wrote:

I don't know if is helpful but I will share it hoping that it is. My mother was not wealthy but she paid for the best BC/BS supplemental plan to Medicare that she could afford. Although pricey, it provided her with extensive care beyond Medicare and greatly reduced her anxiety in the last years of her life. Regarding prescriptions, she was a homeostatic balancing act because all of her various ailments required contraindicated medications. Her personal physician managed to find the complicated and sensitive formula, which required name brand drugs and not their generics. Something that I did not know until we had to deal with it is that when a patient goes in to rehab, say after a hospital stay, the medical team at the rehab center and not the personal physician determines the drug profile for the patient. In my mother's case, the rehab team switched her medications to generics and that slight change resulted in a major disruption to the balance of her drug effectiveness and health. It was resolved but not before a serious complication arose. This may be too off topic and anecdotal for the original question but it is certainly something I wish I had known ahead of time.

This information is very helpful. I will make further attempts to determine the number of drugs various plans have in their formularies.

Date: Dec 5, 2005

Reporter wrote:

The plan that PERS is recommending is PacificCare............ If you purchase your Rxs @ Three-Month supply (90 day) via "online-mail order" you effectively get one month (30 days) free. However, they only list the pharmacies in your area (zip code). You will only be told the name(s) and address of the "mail-order" company when you apply.

After I saw your post about saving money by purchasing through mail I called Pacificare directly. I asked about the prescription mail-order vendor and was told said it is located in San Diego. I didn't ask if that is the location of the mail-order pharmacy or the location of a Pacificare office. Do you know if any other plan offers a 33-l/3 percent savings with mail-order purchases?

Date: Dec 5, 2005

Medicare spouse wrote:

Reporter wrote: The plan that PERS is recommending is PacificCare............ If you purchase your Rxs @ Three-Month supply (90 day) via "online-mail order" you effectively get one month (30 days) free. However, they only list the pharmacies in your area (zip code). You will only be told the name(s) and address of the "mail-order" company when you apply.

After I saw your post about saving money by purchasing through mail I called Pacificare directly. I asked about the prescription mail-order vendor and was told said it is located in San Diego. I didn't ask if that is the location of the mail-order pharmacy or the location of a Pacificare office. Do you know if any other plan offers a 33-l/3 percent savings with mail-order purchases?

You learned more about the mail-order (or online order) from them than I, Medicare Spouse. I'm still researching, but haven't received the literature from other companies. I was more worried about the availability of the "Gap" filler. I do know that CareMart (Birmingham), the online (mail-order) now used by the State Health Plan, will be with the SilverScript Company. But I don't have their drug pricing.

Date: Dec 9, 2005

Anyone who needs a number of prescriptions filled every month needs to find out whether, and at what level, those prescriptions are covered by a particular plan. For example, I use five drugs regularly -- the Pacificare plan would cost me about $7800 a year (!!! -- at least that's what they told me) but the Humana plan would cost right around $2000 (very close to what the state plan has been costing me). If you need name brand drugs that are not covered by a given plan, then that plan is probably not good for you. Most plans will tell you whether your drugs are covered, and at what cost, if you call them. (But it can take an hour to get them on the phone...) In some cases, you can go to their on line site and find this information too...when the site works. In my case, taking the most expensive Humana plan will cost me less in the long run than taking a chaper one.

Date: Dec 9, 2005

another retiree wrote:

Anyone who needs a number of prescriptions filled every month needs to find out whether, and at what level, those prescriptions are covered by a particular plan. For example, I use five drugs regularly -- the Pacificare plan would cost me about $7800 a year (!!! -- at least that's what they told me) but the Humana plan would cost right around $2000 (very close to what the state plan has been costing me). If you need name brand drugs that are not covered by a given plan, then that plan is probably not good for you. Most plans will tell you whether your drugs are covered, and at what cost, if you call them. (But it can take an hour to get them on the phone...) In some cases, you can go to their on line site and find this information too...when the site works. In my case, taking the most expensive Humana plan will cost me less in the long run than taking a chaper one.

Thanks for the info, Another Retiree. I just have a short note for you. When you priced the PacifiCare drug cost it will be higher unless you make sure you use the 90-day, mail-order purchase method. That way you get one month (30 days) of drugs free. I agree you need to be in a more expensive plan that covers the "Gap".

Date: Dec 10, 2005

Yes, I am aware of course of the mail order possibility -- though I'm not sure that Pacificare took that into consideration when they gave me the quote. In any case, that's not the biggest problem-- it's which drugs the plan pays for at a reasonable copay. Since one of my drugs was not on the Pacificare formulary, it alone would have cost me over $200 a month for that one drug alone, all year long, no matter which level I had reached. WHen I got through to Medicare (after an extremely long wait on the phone) I spoke with a very helpful and knowledgeable person who was able to tell me which percentage of the total drugs on the market were covered by a given plan. For example, Humana covers -- if I recall correctly -- at least 96% of the drugs there are.
This means important protection in the case of a new malady that might arise during the year for which you need new prescriptions. Good thing we all have advanced degrees to be able to figure this out.

Date: Dec 10, 2005

Another Retiree wrote:

... Good thing we all have advanced degrees to be able to figure this out.

Watch what you say, Another Retiree. USM may the idea to offer an advanced degree in Madicare D.

Date: Dec 10, 2005

I've already enrolled in a plan. After reading what everybody is saying here I'm not sure I picked the best plan for me. Does anybody know if it is possible to change plans before the deadline? I will call Medicare on Monday. Meanwhile, I will worry lot.

Date: Dec 10, 2005

Try to negotiate the system as an out of state retiree--you need more education than I've got.

Date: Dec 10, 2005

I received a reminder from the State and School Employees'Health Insurance Plan. It describes how to compare the Medicare drug plans, and it suggests that retirees make a list of current medications and dose and then compare current cost with the cost under each plan. It said we can get the costs by calling the plan, visiting the plan's website, or visiting www.medicare.gov on the web. It also suggests that we read Mediare & You 2006 Handbook, or call 1-800-MEDICARE. The letter also says other sources of help are the State Health Insurance Assistance Programs and Medicare-related events in the community ("Look for information about these events in your local. newspaper or listen for information on the radio.) NOWHERE IN THE LETTER I RECEIVED TODAY WAS THERE ANY MENTION OF THEIR ENDORSEMENT OF PACIFARE'S PLANS. Did I misread their previous communications about Pacificare? Who dreamed up this confusing Medicare D plan anyway? If we can't understand it, do the feds really think the average man on the street can understand it?

Date: Dec 10, 2005

Old Guy wrote:

Try to negotiate the system as an out of state retiree--you need more education than I've got.

Old Guy, I'm also an out of state and retiree. If this is a first step toward privatizing Medicare, I want no more of it.

Date: Dec 10, 2005

Premature sarcasm wrote:

I've already enrolled in a plan. After reading what everybody is saying here I'm not sure I picked the best plan for me. Does anybody know if it is possible to change plans before the deadline? I will call Medicare on Monday. Meanwhile, I will worry lot.

What I would try is not pay the prenium. Then apply with another company. You might call the company and tell them you made a mistake. I can't believe you are bound before you pay and money. Good luck.

Date: Dec 10, 2005

Note to Premature Sarcasm: according to an article in the latest AARP Bulletin, if you have already enrolled in a plan and want to change, you can change plans before May 15 -- they say that "enrolling in a second plan will automatically cancel your enrollment in the first". But always good to double check it with Medicare or the company you would like to enroll with.

Date: Dec 10, 2005

Reporter wrote:

What I would try is not pay the prenium. Then apply with another company. You might call the company and tell them you made a mistake. I can't believe you are bound before you pay and money. Good luck.

Ohhh..I checked the block that authorized the company to take the premium from my monthly social security check.

Date: Dec 10, 2005

Another Retiree wrote:

Note to Premature Sarcasm: according to an article in the latest AARP Bulletin, if you have already enrolled in a plan and want to change, you can change plans before May 15 -- they say that "enrolling in a second plan will automatically cancel your enrollment in the first". But always good to double check it with Medicare or the company you would like to enroll with.

Whew! What a relief. I should pay more attention to my AARP Bulletin.

Date: Dec 13, 2005

President Bush admitted today to a group of seniors that the new Medicare Rx plan is confusing.

Date: Dec 13, 2005

Foxy old lady wrote:

President Bush admitted today to a group of seniors that the new Medicare Rx plan is confusing.

He was probably trying to figure it out for his father.