One of my sisters has worked in the insurance field forever and explained this new Medicare drug benefit more clear than anyone I have heard to date. She knows her business!
So I an going to "try" to explain a little of how it works, as far as I understand it. I am under 55 so this does not really involve me, but what gets me is how in the dark so many old seniors are.
First, there is Medicare part A, Medicare part B and now Medicare part D (the drug one).
Everyone gets Medicare part A when they turn 65. That ONLY covers your hospital stay (room and board in the hospital) and nothing else... No doctors, no services, no surgeries. JUST room and board.
Then there is Medicare part B. That you can get when you are 65, but you have to sign up for it. Its NOT automatic, like part A is. (don?t ask me why)
B covers doctors and services/proceedures/surgeries, from what I understand.
Now they have added Medicare part D, for drugs.
Everyone can have PART A, PART B, PART D ...AND... what they call "a supplement" insurance for PART D.
That "supplement" is the actual insurance company YOU go thru when you sign up for PART D (the drugs).
Say, you chose PACIFIC CARE as your PART D supplement, or maybe HUMANA (maybe have spelled these wrong?).
Then that is where YOU NEED to check with PACIFIC CARE or HUMANA to make sure ?MAKE SURE? they have the drugs listed as covered for the drugs YOU NEED.
That is why some (actually MANY) people who already have, say, BLUE CROSS insurance, then sign up for MEDICARE PART D with PACIFIC CARE.... thats why THESE people are automatically DROPPED from their BLUE CROSS BLUE SHIELD.
Because you CAN NOT have TWO supplements.
So in this case BLUE CROSS would DROP YOU.
Many many people over 65 are being stung by not realizing this.
They find out they were dropped by their old insurance and can?t figure out why. Its been a huge issue with some companies and unions. Many people getting notice they have been dropped by company insurance because of this "Only ONE Supplement" clause.
SO BE CAREFUL!!!
And sign up with a PART D Medicare supplement that DOES COVER the medicine you need at the best cost to you.
Another note, these PART D supplements can STOP a certain covered medicine AT ANY TIME, leaving you out in the cold and paying FULL PRICE. ...And YOU can not change "Supplement" PART D insurance companies FOR ONE YEAR. You are "locked in" for a year. Really bad planning and a big screw over for some senior citizens.
PS.. Medicare PART D has a booklet with their covered drugs, listed in THREE levels.
LEVEL-ONE covers most the whole drug cost on LEVEL-ONE listed drugs.
LEVEL-TWO also is a list of "covered" drugs they help or do pay for.
LEVEL-THREE is drugs they pay something like 50% ONLY on. YOU need to be careful here...
If a drug YOU NEED is only listed under LEVEL-THREE, then that is when you need to check the 'SUPPLEMENT" companies PART D goes thru, to see if that NEEDED DRUG is listed or is covered under the SUPLIMENT company.
IF IT IS NOT, then you will have to pay 50% of that drug cost. or 100% if it is not listed at all under level-one, two or three.
For example, LEVEL-ONE, nor LEVEL-TWO does NOT cover a leukemia drug called GLEEVEC. Gleevec is called A magic bullet in treating CML leukemia, but it also costs $3300 a month for 30 daily pills.
GLEEVEC "is not" covered under LEVEL-ONE or LEVEL-TWO but it ?is? listed under LEVEL-THREE covered. THATS A 50% PAY for GLEEVEC.
So one would have to pay 50% of $3300 A MONTH for GLEEVEC. ($1650 a month out of YOUR pocket to live)
So thats an example where if you go thru a supplement like PACIFIC CARE, you NEED to check that they cover GLEEVEC. If not, you pay $1650 a month, or die!!!
That simple!!!
So I an going to "try" to explain a little of how it works, as far as I understand it. I am under 55 so this does not really involve me, but what gets me is how in the dark so many old seniors are.
First, there is Medicare part A, Medicare part B and now Medicare part D (the drug one).
Everyone gets Medicare part A when they turn 65. That ONLY covers your hospital stay (room and board in the hospital) and nothing else... No doctors, no services, no surgeries. JUST room and board.
Then there is Medicare part B. That you can get when you are 65, but you have to sign up for it. Its NOT automatic, like part A is. (don?t ask me why)
B covers doctors and services/proceedures/surgeries, from what I understand.
Now they have added Medicare part D, for drugs.
Everyone can have PART A, PART B, PART D ...AND... what they call "a supplement" insurance for PART D.
That "supplement" is the actual insurance company YOU go thru when you sign up for PART D (the drugs).
Say, you chose PACIFIC CARE as your PART D supplement, or maybe HUMANA (maybe have spelled these wrong?).
Then that is where YOU NEED to check with PACIFIC CARE or HUMANA to make sure ?MAKE SURE? they have the drugs listed as covered for the drugs YOU NEED.
That is why some (actually MANY) people who already have, say, BLUE CROSS insurance, then sign up for MEDICARE PART D with PACIFIC CARE.... thats why THESE people are automatically DROPPED from their BLUE CROSS BLUE SHIELD.
Because you CAN NOT have TWO supplements.
So in this case BLUE CROSS would DROP YOU.
Many many people over 65 are being stung by not realizing this.
They find out they were dropped by their old insurance and can?t figure out why. Its been a huge issue with some companies and unions. Many people getting notice they have been dropped by company insurance because of this "Only ONE Supplement" clause.
SO BE CAREFUL!!!
And sign up with a PART D Medicare supplement that DOES COVER the medicine you need at the best cost to you.
Another note, these PART D supplements can STOP a certain covered medicine AT ANY TIME, leaving you out in the cold and paying FULL PRICE. ...And YOU can not change "Supplement" PART D insurance companies FOR ONE YEAR. You are "locked in" for a year. Really bad planning and a big screw over for some senior citizens.
PS.. Medicare PART D has a booklet with their covered drugs, listed in THREE levels.
LEVEL-ONE covers most the whole drug cost on LEVEL-ONE listed drugs.
LEVEL-TWO also is a list of "covered" drugs they help or do pay for.
LEVEL-THREE is drugs they pay something like 50% ONLY on. YOU need to be careful here...
If a drug YOU NEED is only listed under LEVEL-THREE, then that is when you need to check the 'SUPPLEMENT" companies PART D goes thru, to see if that NEEDED DRUG is listed or is covered under the SUPLIMENT company.
IF IT IS NOT, then you will have to pay 50% of that drug cost. or 100% if it is not listed at all under level-one, two or three.
For example, LEVEL-ONE, nor LEVEL-TWO does NOT cover a leukemia drug called GLEEVEC. Gleevec is called A magic bullet in treating CML leukemia, but it also costs $3300 a month for 30 daily pills.
GLEEVEC "is not" covered under LEVEL-ONE or LEVEL-TWO but it ?is? listed under LEVEL-THREE covered. THATS A 50% PAY for GLEEVEC.
So one would have to pay 50% of $3300 A MONTH for GLEEVEC. ($1650 a month out of YOUR pocket to live)
So thats an example where if you go thru a supplement like PACIFIC CARE, you NEED to check that they cover GLEEVEC. If not, you pay $1650 a month, or die!!!
That simple!!!
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