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A MyMSTeam Member asked a question ๐Ÿ’ญ
Pawtucket, RI

Medicare part D. What part D has people taking and the supplemental that you can purchase? Dire need, Obama care kicked me off because I'm to expensive. Need to get partD asap.

Thank You

August 9, 2017
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A MyMSTeam Member

@A MyMSTeam Member, if you are currently have original medicare part A and Part B, you can supplement that with medicare part D which helps cover prescription drugs. People usually get a medicare advantage plan, for which you elect an insurance plan that manages your medicare Part A (hospital coverage), Part B (outpatient medical coverage, Dr.'s office visits etc.). You still pay for your medicare, approx $104.90 per month plus+ the insurance plan ( That you choose's) premium, which basically covers the medicare part D medicine coverage. I use Humana and pay $53.00 a month premium for part D and the $140.90 per month for medicare part A and B. All plans and premiums are all different depending on the state and County you live in ( they're all different). Medicare part D is extremely difficult to understand and explain (I think thy like it that way, lol ๐Ÿ˜‚ .). There drugs are classified on special tiering system: Tier 1, Tier 2, Tier 3 and noncovered drugs, for which you can appeal for if you really need to take it. It also has stages: stage 1= the deductible stage, which is the amount you pay 100% out of pocket for until you pay that certain deductible amount, the stage 2 part, they allow you to spend a selected amount of "Total cost of the drug" which is the amount that the insurance company pays for the drug not your out of pocket. For example mine was $3,700.00 total drug cost this year ( *during, my first year I had to pay 100% of the total cost until I spent $4,500.00 total cost and out of pocket). Before I reach $3700.00 Total cost, my tier 1 and tier 2 drugs are $0.00 (I take all generics), tier 3 drugs I pay 80%they pay 20%, Stage 3 is the Gap ( first year was, 100%, second year was approx 65%, third year about 55%, and this year is 53% of the total cost of the drug) I stay in this stage until I spend $4500.00 OUT OF POCKET not total cost. Then stage 4 is the castrophic phase where you pay approximately 5% of the total drug cost. Very confusing right? Whatever, plan you choose you have to make sure all of your drugs are covered in their drug formulary list, make sure your MS med is covered , the monthly premium is affordable, and make sure you neurologist MS doctor is in their network. More info can befound on my mymedicare.gov the official medicare website, some people qualify for extra help that you can apply for. If you are having trouble affording your MS medication call the drug company that manufactures your drug and sometimes you can get for free or at a discount depending on your situation. Good Luck, hope this helps.

August 10, 2017

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