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Sun May 12, 2019, 12:56 PM

Medicare and Prescription Drug Co-Pays

For this year, I was forced to change my Medicare supplemental coverage, due to a change in rules. I ended up choosing a Medicare Advantage from Aetna that is connected to the healthcare system my regular doctor is part of.

In past years, I had opted not to sign up for Medicare Part D coverage, because the generic medications I take were so inexpensive. Well, last year, that changed. Suddenly, I found myself paying over $200 for a 90-day supply of those medications.

So, the Aetna Advantage plan required prescription coverage, and I had to pay a penalty each month for not signing up for Part D when I first went on Medicare. Still, my monthly premium now is half as much as it was before with a traditional supplemental plan.

When I signed up with Aetna, I learned that there would be a $5 copay for each prescription in their Tier 1 list. That included the three medications I take. So, I was surprised when I went to the pharmacy today to pick up my second 90-day supply. No charge. I asked the person at the pharmacy why there was no co-pay, and she said that Aetna had changed its policies and their agreement with my pharmacy, removing all copays for Tier 1 generic drugs. "Good deal," I said. "Yes," the pharmacy worker said.

That was a surprise. I'm more used to co-pays and the like unexpectedly going up, not down.

So far, I'm pleased with this new Advantage plan, and with Aetna.

Once again, as a Medicare recipient, I want something similar to be available to everyone. Ask just about anyone on Medicare how they like their healthcare. Most will tell you they like it just fine. In most cases, care is either at no cost or you pay only a small co-pay.

We need universal healthcare. We will get it only when Democrats have the White House and both Houses of Congress.

Vote for Democrats!

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Response to MineralMan (Original post)

Sun May 12, 2019, 01:00 PM

1. Thanks for the heads up!

My husband has 7 prescriptions and I have 3, all the 90-Day eternal type. When we get to Medicare in 3 years the cost of prescriptions will be the #1 priority.

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Response to Freddie (Reply #1)

Sun May 12, 2019, 01:09 PM

2. Yes. Check the coverage for different plans for all of the drugs

individually. That's an important calculation to make. Different plans have different costs. Also, be sure to use one of the plan's recommended pharmacies to get the lowest possible price.

It takes some work, but you can find most of the information on the plans' websites.

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Response to MineralMan (Reply #2)

Sun May 12, 2019, 01:37 PM

5. Can you do the 90 day mail order?

We do that now with BC, its great.

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Response to Freddie (Reply #5)

Sun May 12, 2019, 01:40 PM

6. Yes. For me, though, there's no advantage, and I prefer

using a local pharmacy. That way, if there's a problem of some kind, I can go there and deal with it. With some medications, it's cheaper to use the mail order, but, since I have a zero copay, there's no reason.

The pharmacy at the supermarket I used regularly happens to be a preferred pharmacy for my plan. It's very convenient, actually.

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Response to Freddie (Reply #1)

Sun May 12, 2019, 06:40 PM

10. I' m on Medicare, no drug insurance, and what saved me was the discount coupons.


Huge savings in some cases. even with generic scripts, I saved a lot of money printing off the coupons onlne.

One site is goodrx dot com.

another is https://rxsaver.retailmenot dot com

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Response to MineralMan (Original post)

Sun May 12, 2019, 01:13 PM

3. I am on Aetna Med. Advantage and most of my drugs are zero cost.

Now for the Breo, inhaler shit, is 230 for 3 mos. Now THAT is pricey. My insur before I retired it was $50.

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Response to CurtEastPoint (Reply #3)

Sun May 12, 2019, 01:30 PM

4. I'm lucky that I'm only taking common generics.

I'll keep my fingers crossed that I don't need newer expensive medications. They can cost plenty.

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Response to MineralMan (Original post)

Sun May 12, 2019, 01:55 PM

7. Medicare patients generally do like and appreciate it

Unless they have a hard to treat diagnosis that requires specialized meds or experimental treatment. Or have a prolonged illness. Insurance companies are hardly better.

I can tell you hospitals and providers are under-reimbursed by Medicare we struggle with Medicare rules such as HCPCs and bundling, and with the coming provider and nursing shortages. I strongly suggest anyone who thinks M4A is a good idea, take on reforming drug companies first, as they have a great deal to do with driving up costs. Its worth noting that any number of medications are NOT manufactured in the continental US, a number come from China, simple things like normal saline came from Puerto Rico. As long we have that creep in the White House, I expect things to get worse before they get better. We need to make a plan for enough providers to care for everyone (Doctors, nurses, PAs, ARNPs, PCTs, radiology techs, social workers ect) we need more available clinics in rural communities. In poor communities.

We absolutely need universal healthcare. I work in one of those hospitals that gets the underserved. We eat a lot of costs. A lot. If universal healthcare was implemented (Im a fan of improving the ACA and adding a public option) there would be less financial stress on hospitals and clinics.

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Response to ismnotwasm (Reply #7)

Sun May 12, 2019, 06:54 PM

11. In my red state, the docs/ cops are complaining that they can't get emerg. MH services


esp. emergency MH evaluations after hours.

It's the job I did before I retired, provided for by the Mental Health agency here in town.On-call after hours/weekends.

and paid for by......Medicaid, which is mostly funded by the state.
The state has slashed MH services drastically.

I take great pleasure in politely educating the complaining docs as to the reason for loss of a very important service.

And I wonder to myself why they haven't figured that out by now.


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Response to MineralMan (Original post)

Sun May 12, 2019, 05:22 PM

8. Part D is still a bad deal, needs to be redone.

Tier 1 is ok, but beyond that, forget it. The passage of the bill was a travesty, with the voting kept open into the wee hours so the pharmaceutical reps could buy more congressmen, including a number of Democrats, with campaign contributions and promises of jobs for members and staff.

Medicare should be forced to negotiate drug prices, not prohibited from doing so.

To get anything done, we'll need a Supermajority in the senate.

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Response to JustABozoOnThisBus (Reply #8)

Sun May 12, 2019, 05:31 PM

9. I don't disagree at all.

I was just offering one piece of data.

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