Posted 7/18/2017 9:00 AM (GMT -8)
LSil: I actually work one day a week as a Medicare counselor for my local SHIP provider. SHIP is the State Health Insurance & Assistance Program - a federally funded free state counseling program that helps seniors understand Medicare, Medicare Advantage, Medicare Supplement (Gaps), Part D RX programs, and financial assistance programs for income eligible Medicare recipients. I strongly encourage you to find your local SHIP program and speak with one of their counselors. The decisions you make about Medicare at your initial enrollment are critical, particularly when you know going in that you have chronic and potentially serious and expensive health conditions. This service is free of charge and not affiliated with any insurance company, drug company, etc. It is important that you exercise the same due diligence in this decision making process that you exercise in your treatment process. Some of the information provided in the responses here is good general information; some is incorrect.
First, prescription programs, whether they be free standing or embedded in an Advantage Program, are unique to the region they are sold in as to company, formulary, pricing for premium as well as co-pays, etc. You need information about what is available where you live.
Second, drug plans, whether they are free standing or embedded in an Advantage Plan, can and do change every year. What is covered one year, may not be covered in the formulary the next year, it may be at a different tier, the premium may change, the plan may disappear from your geographic region, etc. It is important that you at least check out the plans yearly during open enrollment - which takes place from mid-October to early December annually. The decision you make now, if you purchase a free standing drug plan, is only valid until December 31, 2017. Make the decision for the next 6 months based on what is the best plan for the drugs your husband is taking now. You can and should revisit this every year as the plans change and his drugs change. What a company charges or covers today, may be completely different in 2018 anyway, so thinking into the future about only drugs is of somewhat limited value right now anyway, particularly with the very expensive specialty drugs on the market as they are the drugs most likely to be impacted by changes in a plan's formulary from year to year.
The premium every month is only a small part of evaluating a free standing drug plan. Deductibles, what drug is subject to the deductible and what drug is not,, what tier a drug falls into on a specific plan's formulary, what drugs are on the formulary, specialty drugs, how the donut hole is managed for the drugs your husband is taking in a particular plan, and preferred pricing pharmacies are all part of the equation for finding the best free standing drug plan for the year.
If you buy an Advantage Plan, this "replaces" your Medicare all together and the insurance company offering the Advantage Plan becomes your insurer as to providers, deductibles, co-pays, out of pocket maximums, and drug coverage. It is all inclusive. Although Advantage Plans are less expensive in premiums every month, the out of pocket costs can become quite high for people who use extensive health care as to hospitalization, doctor visits, tests, etc. If you look at an Advantage Plan, be sure to look at their formularyas they can be even more limited than the stand alone prescription plans. Also, make sure the doctors that are important to your husband's care are part of the company's network of physicians.
As a general concept, we encourage individuals who are financially able to afford the higher monthly premium to purchase a Medicare Supplement Plan (Medigap Plan) to go along with their basic Medicare A & B and then purchase a free standing Part D prescription Plan. As a general rule, this provides the most comprehensive coverage for all aspects of a patient's health care, which is particularly important when you enter the system knowing you have a serious health problem. The most comprehensive Supplement is the F Supplement; which covers all deductibles and co-insurances that Medicare does not pay. All Medicare Supplement Plans of a certain letter are the same no matter what state you buy them in or what company sells them. The federal government regulates Supplement Plans. The only difference is in monthly premium, which can be based on zip code, gender, smoking, entry age and the company premium practices,assuming you buy during your initial enrollment period.
I could go on and on and I am sure I gave you FAR more information than you were looking for! processes should be the same.
By the way, Medicare.Gov is an excellent and very user friendly website. The Prescription Drug Plan section allows you to create your own drug profile and see all of the plans that are available in your zip code (Free Standing and Advantage Plans) and compare each of the plans to see which plan is best for you for that year. You can actually drill down to compare price, cost information by month, cost by drug, etc.
Good luck to your husband in his treatment going forward and in the wonderful world of Medicare!!