Medicare and supplemental prescription plan?

Question

My dad (71 yrs) is on Medicare. Even though he has to take a lot of prescriptions, he did not sign up for Part D and of course, being middle of the year, too late for this year. He has now fallen into the "gap" where he has to pay everything in full (up to $2500, I think). We found a prescription plan on line-1020rx, where the script he just pay $100/week for, would be $25. However, the pharmacist talked him out of using this saying only $25 is now applied to the "gap instead of the $100. Either way, he still has to pay the $2500, but by using the 1020rx, he would only pay $100/month vs. $400. Sounds like they want him to fork out all this $$ upfront and he doesn't have it. What is wrong with using this script plan? Yes, it will take longer to reach the $2500 but so what? either way he has to pay it. My sisters and I are confused. Anyone have experience with this?

add'l info. yes, he did go to a participating pharmacy and we looked up on 1020rx plan and his drug was on there and would cost $26. I don't know about all his meds (he won't make me a list!) but I know the most expensive one is there.

Answer 1

As an agent in TX who specializes in Medicare, I explain this to folks all of the time. The pharmacist who recommended your dad get off the 1020 plan was referring to the "Donut Hole" and Catastrophic Coverage limits. Your dad is in the "Donut Hole" right now. He is paying 100% of the cost of his meds out of his own pocket. The costs get applied to closing the gap towards the Catastrophic Coverage. Catastrophic Coverage provides very cheap RX coverage, when you get there. It is around $3 for generics, $5 for brands, and 20% for everything else. But you need to pay over $3500 out of your own pocket during your "Donut Hole" coverage. The pharmacist wants your dad to pay as much as he can in order to get to the Catastrophic Coverage. Your dad would get there faster if he paid $100 for his meds as opposed to $25.
Now, and most importantly, if your dad paid $100 for his meds, then would he get to Catastrophic Coverage? If he would not, then get a plan that allows your dad to pay as little as possible for his meds. I hope this helps. Good luck.

Answer 2

If he didn't sign up for part D it shouldn't matter where he gets help with coverage internetrx or where ever. I'm assuming this is mail order only service. The only thing you really have to worry about with on line services is to make sure all your orders are done on a timely manner and where they come from. Make sure he has enought for about a 2wk supply before you start with mailorder only because it does take time and keep in mind some holidays there is no mail. Also how much does it cost? How many scrips is he on? Are there generics available, if not talk to dr & see if any can be changed to generics. Even now you can start researching any plans that are available for Medicare Part D for your Dad. Make a list of meds, Name;Strength;qty and go to your nearest CVS Pharmacy. (Thats where I work I'm a pharmacy Tech) there is a computer program available to CVS that can help you chose the best plan out there. Good Luck I hope this helps if not post another question and I'll be glad to help.

Answer 3

I'll be honest with you. It is pretty difficult to understand what you are trying to say, but I think I have an idea based on the hell that I went through with my dad's medicare part B & D situation (he's 72). I looked up the 1020rx plan. It only covers CERTAIN generic and brand name medications. It doesn't cover some drugs. What the pharmacist was probably trying to tell you is the 1020rx does not cover his particular prescription and he will not only pay the 10.00, 20.00, or 40.00 co payment/fee, he may also have to pay an additional difference and in the end he will not be saving anything. When you spoke to the 1020rx representative did you make sure they cover his particular prescription drugs? Did you ask your pharmacist if he/she is a participant in the 1020rx network? If not, then he may have also been referring to an out-of-network fee.

Answer 4

I've been doing insurance for a long time and this plan D is out of control confusing to everyone. The guideling you want to try and use is find a plan that covers the meds. that he is taking now if at all. Otherwise it's a coin flip.