OK, Am I doing something wrong here??? Beware: medical insurance related!

Kitty 34

Hums in her sleep
Joined
Feb 16, 2000
I almost don't know where to start but here goes........

Soooooo last month I hit the golden age (nothing to do with cereal ;) ) of 65 where my Medicare kicks in and my retired teachers' insurance bumps over to the supplementary insurance. I hope I stated that correctly.

Got all my ducks in a row a few months before; getting the new card saying I'm on Medicare plus the retired teacher's insurance. (Blue Cross) Also, got new cards for dental and pharmacy. So all was good even with the fact that I'm now losing $135 a month out of my small SS check. Oh well I was good with that until today......

I received 4 different letters from my retired school teachers pharmacy stating they won't pay for 4 of my 5 drugs I get a month. I'm a lung disease patient (Alpha 1 for some here that don't know) and really really rely on my Ventolin (an emergency inhaler) and the biggie my Stiolto which really, I feel, keeps me off of oxygen. It's a two puffer in the morning. I was paying almost $200 already for that but without insurance it's over $600!!

I just don't understand why I'm paying more a month now but not getting 4 of my prescriptions??? I've been retired for three years and didn't have any issues until I got on Medicare. I guess I thought Medicare took a little bit more care of us old people. :(

According to the letters I'm to get a hold of my doctors for different scripts which I obviously will do tomorrow but I'm just shaking my head on this.

PS.....keeping my fingers crossed they they will still cover my weekly infusions.

PSS.....thanks for letting me vent. :goodvibes
 
I'm with you. Medicare & a supplemental from United Healthcare. You'd think with 2 insurances at least one would pick up and cover what the other doesn't.
 


Absolutely deserves a vent.

Crossing my fingers your doctor's office knows the super secret magic prescriptions that will straighten things out to your advantage.

Thank you Cabanafrau. It's kind of ironic but about 15 minutes after I posted this thread my primary Dr's office called and stated they couldn't prescribed the Ventolin but could give me a generic script. I said OK but it better be as effective as my Ventolin. I really hate taking medicine so when I find ones that work I don't want to change them just for the fact that no one wants to pay for the "good" ones. I thought by the time DH and I were at this "magical" age, we would be going in the right directions which would be good.
 
I have Blue Shield for medical supplement and Cigna for pharmacy supplement.
They cover everything I take.....6 of them.
We went to a counselor before enrolling. She put all of our medications into a chart and found the one that worked best for me. I am so glad she did it. Very confusing otherwise.
Good luck figuring it out. It sure shouldn't be as hard as it is
 
It sounds like you didn’t choose your supplemental, but your former district rolled you into one? My sister’s district did that-I had to select my own, but she doesn’t pay for hers, I do.
Is it possible to choose another plan during re enrollment periods? We chose a plan not based on what we take now (my husband, nothing, myself, an inexpensive-and generic!-thyroid medicine) but what would be the best coverage if that changes.
I just remembered, when my daughter had pneumonia last year they prescribed Ventolin (I thought it sounded familiar) but the Dr. changed it to the generic version because even with her very good insurance it was very expensive out of pocket. She had a good experience with it, so I hope you will as well!
 


This is a serious reply..check out online pharmacies. I used to work for one and everything was 100% legit. We’d hear stories like yours all the time.

If you decide to explore this route, make sure the website does or has these things-

1) asks for a prescription. Stay FAR away from any place that will sell you meds without a prescription or offers their doctor to give you one after an online consultation.

2) make sure they show their certification on the website. I don’t remember all the initials any more, but make sure they belong to the appropriate associations.

3) make sure they won’t send you more than a three month supply at any one time. That’s all the FDA allows.

4) Make sure all prices are clearly shown and say what funds it’s listed in.

5) Make sure the website shows the country of origin. It’s OK if India or Pakistan is the country of origin,they just need to state it.

6) Make sure it is clearly stated if it’s a brand name or generic.

This isn’t info just for you, it’s for anyone who has considered or, due to cost, has to look online for medication. It can be done safely, and legally. pm if you have any other questions.
 
Let me guess. Do you have Silver Scripts? My husband just got a letter yesterday that he can only get 90 pills instead of 120 of his prescription per month unless he changes the med. So they play doctor? Sometimes generic or changing scripts is not in the best interest of the patient. He called and got it all straightened out without an appeal but still.....
 
I
I just remembered, when my daughter had pneumonia last year they prescribed Ventolin (I thought it sounded familiar) but the Dr. changed it to the generic version because even with her very good insurance it was very expensive out of pocket. She had a good experience with it, so I hope you will as well!
I had to give up my generic Ventolin rescue inhaler a couple years ago and was forced to buy a more expensive (!) medicine because of manufacturer agreements with my insurance. It cost them more and it cost me more but it still cost less than the Ventolin OOP.
 
This is a serious reply..check out online pharmacies. I used to work for one and everything was 100% legit. We’d hear stories like yours all the time.

If you decide to explore this route, make sure the website does or has these things-

1) asks for a prescription. Stay FAR away from any place that will sell you meds without a prescription or offers their doctor to give you one after an online consultation.

2) make sure they show their certification on the website. I don’t remember all the initials any more, but make sure they belong to the appropriate associations.

3) make sure they won’t send you more than a three month supply at any one time. That’s all the FDA allows.

4) Make sure all prices are clearly shown and say what funds it’s listed in.

5) Make sure the website shows the country of origin. It’s OK if India or Pakistan is the country of origin,they just need to state it.

6) Make sure it is clearly stated if it’s a brand name or generic.

This isn’t info just for you, it’s for anyone who has considered or, due to cost, has to look online for medication. It can be done safely, and legally. pm if you have any other questions.

Thank you, KIM for that info. It means a lot to me coming from my Canadian friend. :love:
 
Last edited:
I actually work for the company who makes Stiolto and it pains me to hear your new insurance won’t cover it, it’s an exceptional drug. Does the company cover Spiriva? I ask because Stiolto is a combo drug made of Spiriva (Tiotropium bromide) and Striverdi (Olodaterol). I’m wondering if the Olodaterol component is the issue as it is a newer medication in comparison. Together they are extremely effective.

Please also look into any discount cards or programs. I’d hate to see you go without this life changing medicine because your insurance company wanted to do a contract with a different manufacturer other than BI.
 
I actually work for the company who makes Stiolto and it pains me to hear your new insurance won’t cover it, it’s an exceptional drug. Does the company cover Spiriva? I ask because Stiolto is a combo drug made of Spiriva (Tiotropium bromide) and Striverdi (Olodaterol). I’m wondering if the Olodaterol component is the issue as it is a newer medication in comparison. Together they are extremely effective.

Please also look into any discount cards or programs. I’d hate to see you go without this life changing medicine because your insurance company wanted to do a contract with a different manufacturer other than BI.

Thank you so much for your info. I am going to call my Lung dr tomorrow or actually I might stop over after my hospital infusion.......I might jot down some of your words so thank you again. :)
 
My DH is on Medicare with a supplemental, along with Part D (prescriptions). He was prescribed Viberzi and Medicare didn’t cover it, no generic. It was over $6,000.00 for a 3 month prescription. From what I understand (very little...lol), if Medicare does not cover something, supplemental will not pick it up either. He talked to the doctor who had been helping with giving him samples and DH stretched out dosing. When open enrollment came around in December, he changed his prescription plan to a higher tier. His meds will now be $200 for 3 months. We are paying considerably more per month for the prescription plan but brings the meds down.
 
Stupid question. Did you sign up for Part D of Medicare that covers prescriptions? Just wondering if Medicare isn't paying anything and only your supplement is paying.
 
A Medicare supplement plan rarely covers more than the 20% that Medicare doesn't cover. If Medicare denies, they deny also. Medicare part D you have to be very careful what plan you choose, since they are not all created equal. Get the formulary for the plan you have and bring it to your doctor for other potential options.
 
I've been retired for three years and didn't have any issues until I got on Medicare. I guess I thought Medicare took a little bit more care of us old people.

Medicare covers medical. It doesn't cover prescription unless you signed up for a Part D supplement or a Part C Medicare Advantage plan. It sounds like your medical is through Medicare, but your prescription coverage is through retiree supplement plan. From whom did you receive the letters? The pharmacy? They may simply need your new cards (the supplement). Or possibly the formulary for the supplement changed - many do change in January each year. I would contact the pharmacy (assuming that's who sent the letter) and ask them to explain why the meds aren't covered anymore. If they simply need your new cards, that might resolve it. If it's a formulary change, print out the formulary and contact your doctor(s). Most likely, you are not the only patient with this issue and they will be familiar with alternative meds. Or maybe a "pre-authorization" is required for those specific meds, in which case your doctor will be able to provide the documentation necessary to get the authorization.

But unfortunately, Medicare is one massive mess when it comes to prescriptions; it is NOT easier than your traditional medical insurance through an employer plan. Also be aware of the "donut hole" if you take expensive meds, because without the right coverage to get through that, you'll have a big out-of-pocket expense after you though things are covered.

Good luck!
 
To answer some of you who have asked about the pharmacy part D. I was told by both my retired teacher's plan and social security to sign up for the plan I signed up with. I talked on the phone with both offices this past fall on what I was "suppose" to do so that's why I'm confused with this whole thing. :(
 
To answer some of you who have asked about the pharmacy part D. I was told by both my retired teacher's plan and social security to sign up for the plan I signed up with. I talked on the phone with both offices this past fall on what I was "suppose" to do so that's why I'm confused with this whole thing. :(
Sounds like you need to call them again and check what you have and from whom.
 
Sounds like you need to call them again and check what you have and from whom.

I know which is always so much fun to do. :sad2:

What's odd was when DH turned 65 last year nothing changed with all his diabetic meds. He didn't have to switch to other "approved" meds. So yes, it does make me wonder what the heck is going on with me?? One of our sons is coming over tomorrow and he's going to help read thru some of the info. He's so better (and patient) with that than DH and myself. I just can't believe I'm the only retired teacher in the state of Michigan with lung issues!
 

GET A DISNEY VACATION QUOTE

Dreams Unlimited Travel is committed to providing you with the very best vacation planning experience possible. Our Vacation Planners are experts and will share their honest advice to help you have a magical vacation.

Let us help you with your next Disney Vacation!





Latest posts

Top