I am retiring January 1, 2019 and am beginning to search for the right Medicare option for me and my wife, who is having breast cancer treatment at MD Anderson. Her cancer treatment drugs are semi-expensive and I am concerned about the Medicare Part D out of pocket. I am a diabetic and using the flex pen with high blood pressure prescriptions. Most of mine are generic, except for the diabetic prescriptions.
What should I do to prepare for this medical insurance change? I will be 70 and my wife is turning 65 by the time I retire, and I want to be sure we do this correctly.
David from a San Antonio
The first topic discussed at a Toni Says® Medicare consultation is what Medicare Part D prescription drug plan or plans cover all your prescriptions. Sometimes, not all medications on a person’s list are covered under Medicare Part D plans.
Many are concerned about their doctors and completely miss if their prescriptions are covered under their new Medicare Part D or Medicare Advantage prescription drug plan. To their surprise, they must pay 100% out of pocket because their generics or even expensive brand name drugs are not covered.
Every Medicare Part D plan has a formulary whether it is a standalone or Medicare Advantage (Part C) prescription drug plan. If your drugs aren’t on that formulary, then you will pay 100% out of your pocket.
When we consult on Medicare at the Toni Says office, our motto is “Medicare is not cookie cutter…One size does not fit all!” Everyone’s Medicare health and prescription drug situation is different and your medical situation as well as your prescription drugs that you take should be considered in your Medicare needs calculation.
Those receiving Medicare Part B for the first time need to understand the value of the Medigap (Medicare Supplement) open enrollment. As I have said before, in the Medicare and You handbook, it discusses “When to Buy” a Medicare Supplement. It states that “the best time to buy a Medigap (Medicare Supplement) policy is during the 6-month period which begins the first day of the month in which you’re 65 or older and enrolled in Medicare Part B”.
During this 6-month window, one can enroll in any Medicare Supplement plan without having to answer any health questions and not be denied coverage. After the 6-month window, then medical underwriting takes place and one may not qualify for a Medicare Supplement.
At the Toni Says® office, we treat receiving Part B like “gold” because of what it offers.
Many new Medicare beneficiaries explore the option of Medicare Advantage plans which is known as Medicare Part C. It is a good option and with health conditions such as you and your wife have, we advise that you speak with your doctor about what plans they accept or if that provider accepts Medicare Advantage plans.