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Old 10-04-2010, 05:36 AM   #1
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Exclamation A insurance plan-d question that is affecting many people

Most of you have allways been great help to me ,and I thank you for it. Yesterday I got a notice in the mail that brought me to my knees.MY INSURANCE CO. said it will effect everyone on this particular part-D PLAN. I am severly disabled due to so many pelvic surgeries. I have spent the last 4 years trying to climb out of this hell, and just when I get my life (somewhat) back. I get a letter that says as of Jan 1st my plan - D will no longer offer the COMPLETE part of the INS. "This is CRAZY" I desperately need my "complete"plan because when I go into the doenutt hole IT STILL COVERS MY GENERIC MEDICATIONS. Meaning I have always been able to pay more to get the plan that covers most all GENERIC MEDICATIONS though the entire year. I am on the Fentanyl Patch , and I have my life back, (BUT), as of Jan 1st. they no longer offer the COMPLETE part of M-part-D. They want everyone to go back to the (PLUS) plan. The PLUS plan ONLY pays 2,840 dollars ayear before the patiant hits thier limit. (Without the plan that covers GENERIC meds. through out the entire year) "MY HEALTH is in SEVERE RISK". Because my INS. CO is in compatition with others they told me they can't give me names of other INS. CO. that might still offers the complete part. WHAT DO I DO?? If I can no longer get the Patch in 3 months WHAT THEN?? I don't want to go on methadone just because it's CHEAP, because I take other meds that I need,and mix ok with fentanyl, BUT DO NOT MIX as well with methadone. Please has any one got this TERRIBLE letter in the mail?? My insurance co. said its becaus of all the health care changes, and they are trying to get prepared for the chaos in the future. I know I'm not the only one PLEASE HELP.

 
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Old 10-04-2010, 02:16 PM   #2
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Re: A insurance plan-d question that is effecting many people

I am so sorry that this has happened to you. Unfortunately, I don't know how to help. Hopefully someone will come by that will know how. I do know that the world of health care is making many,many changes. I recently changed from Medical Mutual to Kaiser because of the expense. I was paying over 2300 dollars a month for my premiums-did not cover eye, dental or psych.And, this premium was just for me;one person! My husband, and kids had Anthem. I was also on Oxycontin which worked very well for me. Well, when I switched over to Kaiser, guess what? They won't pay for Oxycontin! I had two choices left-Methadone or the Fent. Patch. I had already tried all the other meds that were left. First I tried the Methadone and I hallucinated twice on it. Now I'm on the Fent. Patch (Duragesic;I can only use this kind) and am having several problems with it. I see my pain management on Monday and I honestly don't know what else we can try?? Sorry for going on like this but it is so hard when you finally find something that helps, and then it's taken away from you. Hope you get the help you need!!....janiee

Last edited by janiee08; 10-05-2010 at 11:49 PM.

 
Old 10-05-2010, 03:13 PM   #3
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Re: A insurance plan-d question that is effecting many people

Quote:
Originally Posted by painbegone View Post
Most of you have allways been great help to me ,and I thank you for it. Yesterday I got a notice in the mail that brought me to my knees.MY INSURANCE CO. said it will effect everyone on this particular part-D PLAN. I am severly disabled due to so many pelvic surgeries. I have spent the last 4 years trying to climb out of this hell, and just when I get my life (somewhat) back. I get a letter that says as of Jan 1st my plan - D will no longer offer the COMPLETE part of the INS. "This is CRAZY" I desperately need my "complete"plan because when I go into the doenutt hole IT STILL COVERS MY GENERIC MEDICATIONS. Meaning I have always been able to pay more to get the plan that covers most all GENERIC MEDICATIONS though the entire year. I am on the Fentanyl Patch , and I have my life back, (BUT), as of Jan 1st. they no longer offer the COMPLETE part of M-part-D. They want everyone to go back to the (PLUS) plan. The PLUS plan ONLY pays 2,840 dollars ayear before the patiant hits thier limit. (Without the plan that covers GENERIC meds. through out the entire year) "MY HEALTH is in SEVERE RISK". Because my INS. CO is in compatition with others they told me they can't give me names of other INS. CO. that might still offers the complete part. WHAT DO I DO?? If I can no longer get the Patch in 3 months WHAT THEN?? I don't want to go on methadone just because it's CHEAP, because I take other meds that I need,and mix ok with fentanyl, BUT DO NOT MIX as well with methadone. Please has any one got this TERRIBLE letter in the mail?? My insurance co. said its becaus of all the health care changes, and they are trying to get prepared for the chaos in the future. I know I'm not the only one PLEASE HELP.

OMG, this is awful. I haven't gotten any notification like that at all from my part d carrier and I have heard nothing about or read anything. Are you sure it isn't just your particular carrier that is doing this? Have you talked to any other companies? I just called my ins. agent because my supplement insurance went up before my anniversary date! Without notice. The new deduction starts Nov. 1 and they didn't even give people notice of this change of premiums.

I have a feeling this is just the tip of the iceberg as these ins. companies are going to do everything they can to make as much as they can before the new rule about covering "pre-existing conditions" goes into effect. As far as I'm concerned, insurance companies have no saving graces.

Carol

 
Old 10-05-2010, 03:30 PM   #4
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Re: A insurance plan-d question that is effecting many people

You got your letter now because you are able to change insurance plans with Medicare Part D during the last 6 weeks of the year without penalty.

The new health care bill slowly closes up the doughnut hole over time so what you will pay out of pocket will slowly decrease if you go out of pocket. I have one drug that is $2500/month so I am watching carefully.

You can go to Medicare.gov and start comparing Part D plans and even list all your meds and see what it can offer.

But I found a much easier way. I went to an insurance agent and asked him to do the exploring and find me a plan that covers what I need. Most independent agents covers several companies and you can always ask several agents to look for you so you get a wide range of coverage options. To thank them for helping you, when you pick a plan that is good for you, let them sign your application for the plan so they get paid....it doesn't cost you a cent more than if you did it on-line by yourself. But they have access and know which companies to trust and can actually talk to the company to make sure your drug of choice is covered as best as it can be covered.

We all play Russian Roulette with the drug plan, don't we. I have certain scripts at one store where I get them for $4/month($10/90day supply...begins with a big "W" and ends with a "mart") but I don't give them my Part D card and then another pharmacy where I get only the drugs I put on the Part D plan. That way I don't build up the out of pocket so fast. Got to get tricky with the plans!

Soon that hole will be plugged and we will all rest a little easier.

Hugs.................Jenny

 
Old 10-05-2010, 05:23 PM   #5
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Re: A insurance plan-d question that is effecting many people

Thank you all for your replies, Yesterday I called insurance Co. untill my home phone went dead. Today I just called M-care, and spoke to the Agent of my situation. She gave me 4 plan-D Insurance Co. to call. One of the 4 companies she gave me was a 5 star rated co. So I called it. Do you know whats strange it was the 21st Company that I called in two days, and I guess that was my Black-Jack (lucky Day), beacause it covers my generic medications through out the whole year,and just because the doenutt hole is at 2,841 they give all people the option to pay for the top premium (choice plan) that cover all generics through out the entire year. They said their goal is to pay for the more expensive generics, because it all works out in the wash, and everyone's happy. I was about to give up, but it just goes to show that perserverence does "eventually" pay off. Now you must understand it cost 30 more dollars a month, but in my situation I just felt blessed to find an insurance Co. that still offered this level of coverage for the "whole" year. Let me tell you something very important. Anyone on stand alone plan-d insurance that is on the patch you need to make POSSITVELY SURE that they pay for the patches the ENTIRE year, and cover all generics not just the cheap ones. You will pay more for this level of coverage, but for me its a dream come true, because all the other 20 companies I called told me yes, they cover the patches ,but after I would reach the 2,841 dollars I had to pay 100%. Why would anyone stay on the patches if in 3-months you have no more coverage. (CRAZY?), The (alleged) Agent was honest she said that other plan-d INS. CO. are hoping you keep your current Insurance, and switch to (alleged) Methadone, because its dirt cheap,and they won't have to pay anything for it. Isn't it sad how things are going. Heres the real truth just because I found a good PLAN-D this year, does not mean they will still cover the generic patches 2012. For now I'm both thankfull, and exhausted. Take care.Painbegone

Last edited by painbegone; 10-05-2010 at 05:36 PM. Reason: spelling

 
Old 10-06-2010, 02:15 PM   #6
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Re: A insurance plan-d question that is effecting many people

Oh, good! I'm so glad your perserverence paid off for you so nicely. It doesn't pay to be complacent these days. I just switched my medicare supplement plan because the one I have raised their rates by $40 a month!. May not seem like a lot, but I'm a widow and liive on Soc. Sec. only so every penny counts. I'm going to also switch my Part D plan next month.

I have an agent who does the research for me. Just going online can make you crazy trying to sort out all the details.

Carol

 
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