Community Chat

[goldensrbest]

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@nagrom wrote:

The donut hole is a stage of payment when you have paid  $3310 for your copays for prescriptions for the year 2016.   This is stage 3.   The costs of prescriptions then become very costly until you have paid $4850.  Then you move out of the donut hole and your meds are very reasonable through the end of the year.  Many meds cost 5% in this phase.   

Prescription copays are very reasonable for tier 1 and Tier 2 drugs.   Tier 3, 4 and 5 meds are very well expensive.  I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies.  I am unable to take the cheaper diabetic meds as I have allergic reactions.  Thus I was forced to go on insulin.   The needles and testing strips are outrageously expensive.  For folks like me there is no choice with the meds we are on.  

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Are you saying that you have to pay ,out of pocket the $3310?

[mima]

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@goldensrbest wrote:

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@nagrom wrote:

The donut hole is a stage of payment when you have paid  $3310 for your copays for prescriptions for the year 2016.   This is stage 3.   The costs of prescriptions then become very costly until you have paid $4850.  Then you move out of the donut hole and your meds are very reasonable through the end of the year.  Many meds cost 5% in this phase.   

Prescription copays are very reasonable for tier 1 and Tier 2 drugs.   Tier 3, 4 and 5 meds are very well expensive.  I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies.  I am unable to take the cheaper diabetic meds as I have allergic reactions.  Thus I was forced to go on insulin.   The needles and testing strips are outrageously expensive.  For folks like me there is no choice with the meds we are on.  

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Are you saying that you have to pay ,out of pocket the $3310?

I'm confused too.  Do you pay $3310 or $4850 out of pocket per year?  Yikes!

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[nagrom]

Yes your out of pocket is $4850 for this year.   I think it may be $5000  next year.  My Humalog says it used to be $47 fifteen years ago. And now $1400 or there abouts now.   This is an old drug and been around for years.   There are plenty of other drugs that are the same.   Canadian pharmacy does not offer it as an option either.

[momtochloe]

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@hckynut wrote:

Neither Medicare or my Secondary Insurer are involved in my prescriptions. That is a completely separate program from my Medical Insurers. It is paid for as on of my retirement benefits after my 33 years with the company.

They are now all generics(but were not for many years), so the cost is much less. Highest price is $25 for 90 days for 2 of my prescriptions. The others range from $2.25 to $10. It for me is a good program that was much more expensive before the plan switched and promoted mail order 90 day prescriptions.

hckynut(john)

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@hckynut I know you were involved in the painful break up of the Bells back in the day but I would ask who actually eventually covered your medical coverage and were unions involved?

[151949]

I am fortunate to take only 3 Rx drugs and they are all tier 1. By the end of the year I will have only paid about $72 in copays.This is one reason we are better off on an advantage plan than a supplement. 

[SharkE]

I've been paying 528 a month on just me monthly for Humana private pay policy. Husband on Medicare.

Well, today, I got a letter saying it's went up 22% and now the new payment will be 650. I just smiled................

I'll be 65 in Dec. 

Bye,bye Humana !!

p.s. always paid by check, no withdrawal or charging any acct. either

[NickNack]

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@goldensrbest wrote:

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@nagrom wrote:

The donut hole is a stage of payment when you have paid  $3310 for your copays for prescriptions for the year 2016.   This is stage 3.   The costs of prescriptions then become very costly until you have paid $4850.  Then you move out of the donut hole and your meds are very reasonable through the end of the year.  Many meds cost 5% in this phase.   

Prescription copays are very reasonable for tier 1 and Tier 2 drugs.   Tier 3, 4 and 5 meds are very well expensive.  I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies.  I am unable to take the cheaper diabetic meds as I have allergic reactions.  Thus I was forced to go on insulin.   The needles and testing strips are outrageously expensive.  For folks like me there is no choice with the meds we are on.  

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Are you saying that you have to pay ,out of pocket the $3310?

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@goldensrbest  and @mima  Here's an excerpt from Medicare's website about the donut hole coverage gap.

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2016, once you and your plan have spent $3,310 on covered drugs, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

[nagrom]

I am on an advantage plan.   I have Tier  3 meds.  The Tier 1 and Tier 2 are not costly.  Tier 3 and above are horribly expensive.    

Who would ever think when you are eligible for Medicare that your prescriptions would run so high.    Now the government is talking about giving you a voucher instead of Medicare that you could bargain and purchase your own care.   No controls about price gouging for prescriptions.

[deepwaterdotter]

We are covered by a plan similar to hockeynut (John).

[nagrom]

Looks like it is better through a Bell company than an insurance company.   My Canadian Bell friends got a sweet deal for their retirement.  Canada has national healthcare so they received phone benefits and I believe pension lump sums.