USAA does not offer Medicare Part D themselves ... in fact, if you request it through them when asking for a Medigap policy, it turns out that they use Humana.
If you use that Part D tool on the Medicare web site, it will pull up the insurance companies that offer policies where you live.
USAA has a really good Medigap policy. Based on what has been discussed here in the past, I don't know if you could get Medigap until your husband is older. But if you were interested, you could call and discuss it with them. I'm pretty sure they offer policies in every state.
Medigap pays what standard Medicare doesn't. That means the deductible and co pay. It's nice when you walk out of the doctor's office and just wave-nothing to pay. Jane who used to post often was a genius about insurance. She advised getting the standard Medicare even though it seems to cost more. With the standard plan you have the choice of doctors and facilities. It also gets you to the top of the list when you need an appointment with a specialist. You also don't need a referral or permission to see a doctor.
Kadee, are you talking about something that you see when you're looking at Medicare Part D drug plans?
Medicare Part D is a really, really weird type of coverage. Do NOT ask me why the Government set it up this way.
Most (all?) Medicare D drug plans have a coverage gap, often referred to as a "donut hole". First, you pay a deductible (let's say, the first $250 worth of prescriptions). Then, if you continue to need prescriptions, you only pay a co-pay while the insurance pays the rest. BUT this only lasts for a while. When you hit a ceiling in the amount of money you AND your insurance policy have kicked in (let's say, $2,400) in any given year, you enter The Gap. While you are in The Gap, you have to pay 100% of drug costs ... until you hit another milestone, let's say $5,000, which is called the "catastrophic limit". If you STILL need prescriptions, then your insurance kicks back in, and pays 95% of your drug costs for the rest of the year.
This is, of course, wildly confusing and it becomes extremely difficult to calculate your costs per year for each insurance policy, since they differ in what they charge for premiums and copays during the pre-gap period.
So the nifty tool that Medicare has set up will show you what your total costs, including premiums and copays and gap and post-gap costs, will be (a) if you start mid-year (because you're much less likely to reach The Gap in a shorter period of time) and (b) what your total costs will be every full year after that.
Sunshyne, I don't think anyone could explain Medicare Part D so anyone could understand it. It is just ridiculous making something so confusing. But look at the Income Tax Forms!!!!
Ridiculous it may be, but I got well over $2000 of meds paid for, for about $500 - $420 for the year and $100 before it kicked in. I got all the way up to the brink of the donut hole at the end of the year.
I did too, briegull, but dh went clear through the donut hole and I bought most of his prescriptions late December for 5%. His meds were costly last year so I am maybe going to itimize. Got to get that done too......
Yep, you can count all the co-pays and all the insurance costs.. Why were his meds so very costly? Have you looked for generics? Is it to do with the stenosis? or the parkenism?
Most of his meds do not have generic available including Aricept, Namenda and Wellbutrin XT (24 hrs.), He has flexeril and Neurotin and rynatan (allergy). I am going to change the Wellbutrin XT to Celexa when he runs out. He has enough at 5% to go until next month. He was on a few others before stopping or changing to generic. I think this year will be more stable.
briegull-- Even with generics the costs can be sky high. My Dh has a generic and at his dosage a month costs $500. He went into the donut hole about late June, and through it--over $5000 total on his scripts last year--Thank Goodness he's in our state's Medicaid Waiver program. We could never pay the $900-$1000 a month even for the couple months to get through the donut hole. Of his 10 scripts, one is not generic., yet. Two months of my premium, on the other hand, costs me more than what my one script's co-pays cost for the year. I chose that plan because there is no deductible and I have full access to the whole formulary. Just a precaution in case something were to happen to me, requiring more meds.
No wonder, I am confused about this whole thing, it is very confusing. I always wondered what the donut hole was. I am going to need to check about generic brands that is for sure.
The Medicare site is helpful as Sunshyne mentioned to lay out all the Rx options w/cost comparisons. We had AARP at first, then Humana, and now AdvantaRx because of lower cost all 'round.
For medicare supplement, we had AARP first, but the cost has gone up quite a bit over 2 years even w/discounts they toss in. We've had the F plan through State Farm for 2 years, and it works well for us. Supplement plans in one category, like every company that offers F, G, H, or whatever, has the same coverage, but cost is different--at least that's what we've been told and looks like the booklet from. Service is probably different, too.
One thing I was ignorant about: I thought the supplement would pay whatever medicare didn't, but that's not true. If medicare doesn't approve a procedure or charge, the supplement won't either. I learned that when my hsbd was scheduled for prostate surgery w/no gen'l anesthetic. Dr. requested EKG and chest X-ray prior to surgery. Gal at the office said it wouldn't be approved by medicare so our supplement wouldn't pay; she was correct. I recently had cataract surgery (both eyes); insurance gal said medcare wouldn't pay for the refraction test for glasses after surgery; so supplement wouldn't, either. Right she was.
Sunsyhne, Yes I was referring to the Part D. Rx plans. I appreciate all the hand holding that everyone has gave me.
Zibby, Thank you for telling me what types you have had & how they have worked out for you. I have tried to ask anyone I can think of what type plans they have. My friend's sister's husband also has State Farm & is pleased with them.
I would love others to tell me what plans they have for RX & supplements to medical. Thanks again to eveyone, you are all such good friends, actually, better cyber friends than my personal.
We have Humana with no problems. I just didn't have the energy or motivation to check out any others this year. Basically, it seems to me if you get a cheaper premium it is made up somewhere else.
Zibby, you are ever so right about Medicare approval being required for Medigap to pay. Sometimes, you can work with the doctor or hospital to get them to provide Medicare with a code that WILL be acceptable. For example, our neuro knew that Medicare would not approve a PET scan for help in diagnosing AD, so she used a code that said it was for help in diagnosing something else (I forget what, I think dizzy spells.) And even after a bill has been submitted and denied, I've sometimes been able to get the doctor to resubmit with a different code.
Thank you, Sunshyne, I'll remember to ask about that the "next" time.
Any newbey reading now: this is THE place to learn first-hand experiences, suggestions from a myriad of experience, and options for spousal to kitty care. <grin> AND everyone CARES! Not like kids who say, "Oh, so sorry. See yah." Thankfully, they aren't all like that. Okay, so I'm rambling....
Kadee, dh is on AARP Healthcare Options for supplimental and AARP United Healthcare for prescriptions. Works well and covers all. I am not eligible for Medicare yet as I am still 64 and Pay BC/BS $750 bi-monthly for my health care insurance. I had breast cancer w/double mastectomy and reconstruction so I have the dreaded "pre-existing condition" and was unable to change insurance companies. I can't wait to get rid of that in the summer of this year. I will look into coverage again for both of us at that time.
I don't mess with DH's coverage--Regular Medicare and an AARP United Healthcare for Part D coordinated with his Medicaid Waiver coverage. They are looking at the Dx as a catestrophic category and look only at his income which is very low. As a result he gets the extra help coverage and we only pay Medicaid co-poays until through the donut hole, then we pay nothing toward his meds. My Medicare is now through Secure Horizons/United Healthcare, covbering Parts A, B. and D. For $39 a month extra I also get some coverage toward glasses, dental, and hearing.
Another question, I did receive my husband's Part B card, however, it doesn't go into effect until July. Can I sign him up with a supplement carrier now or do I need to wait until July? As we are losing our medical insurance on April 1st from his retirement. I think I am going to sign him up with his previous carrier at a rate of over $600.00 a month...I don't know if I can risk nothing happening medically with him until July. Another blow came my way, we are also losing our Life Insurance. This is our only life insurance, hopefully, I can transfer his to a private policy with this company without a medical exam. I know he could not get insurance with any other group. Boy! talk about wanting crawl in a hole somewhere is looking really good about now.
Kadee i would try to keep him insured if monetarily possible while you are in limbo coverage. like you say any thing could come up and its thousands just for an ER visit nowdays. can you call AARP for info about their suppemental medigap insur if he is on medicare in july. i bet they can answer your questions on how to proceed. as for the life insurance maybe you should call them as well and i would just say you dont want to lose it but transfer to an individual policy with no gaps in coverage and ask pricing so you can continue to pay out of pocket? ..i would nt offer any info only if asked, if you get my drift. they may go ahead and reissue it that way. hopefully anway! i dont have any more input, someone else may be better informed how it all works! divvi
Kadee-- I went through the life insurance issue for my DH when he hit 65. The Companmy had to carry him until then as part of Worker's Comp Settlement. The switch to a private policy was defintely possible, but the cost was more, unless we reduced the coverage amount. Had to do some major searching for other options. One my Brother-in-law suggested was to put away $ until I had enough to buy a $500 CD for 6 months. Keep saving and at the 6 mo. mark renew the first and buy a 2nd. At next 6 mo. roll the 2 together for 12 mo. anmd buy another $500 at 6 mo. Continuing to build b ut keeping in $500 and $1000 sizes. That way, if I need to cash one out I only pay penalty on that--not a whole huge one. In the current economy, and without a lumpsum to start with, I can build safely.
Same thing regarding medical coverage--talk to the Insurance Co.s regarding gap coverage. There seem to be quite a few options.