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

[tvguy]

I know which is always so much fun to do.

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!

I'll be in your shoes in about 3 years with Medicare. With my private insurance I have had issues with my test strips. They stopped dealing with the company that makes my meter a year ago, but they shipped me so many test strips, I still don't need more, and now my insurance has changed and that company DOES support my meter.

 

[Gumbo4x4]

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.

Definitely worth a vent. Keep in mind though that while YOU are paying more, your former employer is paying less. You’re not getting the same supplement from them.

 

[Kitty 34]

Definitely worth a vent. Keep in mind though that while YOU are paying more, your former employer is paying less. You’re not getting the same supplement from them.

You're so right there but I just thought Medicare would kick in and continue with my costs seeing it's them that are charging me with a lower SS check. That's where I'm most confused.

 

[lanejudy]

You’re not getting the same supplement from them.

This is the crux of the matter. While OP did what she was "supposed to do" to retain her employer-sponsored retiree benefits, it is ultimately a different plan. And unfortunately that plan doesn't mesh well with her prescription needs. Different plans have different coverage for different products, and it's a royal pain in the backside to figure out which is best for any given individual.

You're so right there but I just thought Medicare would kick in and continue with my costs seeing it's them that are charging me with a lower SS check. That's where I'm most confused.

It's a different plan than what you had previously. Cost really has nothing to do with it. Actually, the $135 you are paying per month is ONLY for your medical plan (Parts A and B) and it not at all for your prescription plan (Part D) - which I'm guessing your former employer is paying for that part.

Hopefully the doctors can prescribe something equivalent that is covered under your new plan. Or get pre-authorizations approved if that might help.

 

[Gumbo4x4]

You're so right there but I just thought Medicare would kick in and continue with my costs seeing it's them that are charging me with a lower SS check. That's where I'm most confused.

Oh, it’s a mess to be certain! Hope it sorts out for you.

 

[Kitty 34]

This is the crux of the matter. While OP did what she was "supposed to do" to retain her employer-sponsored retiree benefits, it is ultimately a different plan. And unfortunately that plan doesn't mesh well with her prescription needs. Different plans have different coverage for different products, and it's a royal pain in the backside to figure out which is best for any given individual.



It's a different plan than what you had previously. Cost really has nothing to do with it. Actually, the $135 you are paying per month is ONLY for your medical plan (Parts A and B) and it not at all for your prescription plan (Part D) - which I'm guessing your former employer is paying for that part.

Hopefully the doctors can prescribe something equivalent that is covered under your new plan. Or get pre-authorizations approved if that might help.

Oh you just gave me hope. I would love if they can just do the pre-approved thing as we have sooooo played the "which inhalers would work the best on my oxygen levels" over the past three years. I felt fortunate that my mesh of meds were pretty good. Right now my infusions and inhalers and a couple of other scripts have been pretty much keeping me off oxygen for now.

 

[lanejudy]

Have your son read through the prescription coverage for your new plan. A pre-auth for what they are considering “2nd line” or “3rd line” products may be all that’s needed. Or maybe you need to order from a mail order pharmacy. If all else fails, have him check if there are any programs run by the pharmaceutical manufacturers to help patients offset costs of meds. Some pharmacies also have discount programs for varying drugs. And be sure your son looks into whether you may be impacted by the “donut hole” so you can plan accordingly. Medicare is SOOO frustrating!

 

[Kitty 34]

Have your son read through the prescription coverage for your new plan. A pre-auth for what they are considering “2nd line” or “3rd line” products may be all that’s needed. Or maybe you need to order from a mail order pharmacy. If all else fails, have him check if there are any programs run by the pharmaceutical manufacturers to help patients offset costs of meds. Some pharmacies also have discount programs for varying drugs. And be sure your son looks into whether you may be impacted by the “donut hole” so you can plan accordingly. Medicare is SOOO frustrating!

Thank you for that helpful info and if none of that works I'm going up there to live with Kim, Jane, Ranandannette and many others of my Canadian friends.

 

[bushdianee]

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 take Spiriva and Simbicort and when I went on Medicare/United Health last summer all of a sudden they said the discount cards couldn’t be used because Medicare is a government plan. I went from paying nothing for one and $10 for the other to $47 each. Then in December the price jumped up to $147 each because they only pay so much a year. Luckily I had an extra of each and was able to wait until the calendar reset in January and it went back to $47 each. That means that come May or June it will probably jump back up for the rest of the year.

 

[Kitty 34]

I take Spiriva and Simbicort and when I went on Medicare/United Health last summer all of a sudden they said the discount cards couldn’t be used because Medicare is a government plan. I went from paying nothing for one and $10 for the other to $47 each. Then in December the price jumped up to $147 each because they only pay so much a year. Luckily I had an extra of each and was able to wait until the calendar reset in January and it went back to $47 each. That means that come May or June it will probably jump back up for the rest of the year.

Is your Spiriva an inhaler? I remember taking that several years ago for pneumonia and it was a weird pill that I put in something to like stab it and then breathed in the particles. It was odd but I felt it worked. That's why my lung doctor prescribed that Stiolto inhaler because it has Spiriva in it. Simbicort and I did not get along.

 

[Suprachica79]

Is your Spiriva an inhaler? I remember taking that several years ago for pneumonia and it was a weird pill that I put in something to like stab it and then breathed in the particles. It was odd but I felt it worked. That's why my lung doctor prescribed that Stiolto inhaler because it has Spiriva in it. Simbicort and I did not get along.

We now make Spiriva Respimat which is the same inhaler as the Stiolto. Some people still use the Handihaler which is a capsule that you insert into the device, which punctures the capsule so you can breath in the powder. Similar to Advair with a breathable powder, just a different device.

 

[Kitty 34]

We now make Spiriva Respimat which is the same inhaler as the Stiolto. Some people still use the Handihaler which is a capsule that you insert into the device, which punctures the capsule so you can breath in the powder. Similar to Advair with a breathable powder, just a different device.

I'm on Stiolto Respimat......is that pretty much the same thing? If not I will definitely ask about the Spiriva Respimat. And yes, that Handihaler is what I was talking about.