Dear Tom and Alan:
I read your column with interest and thank you for writing it.
I am about to step into Medicare coverage and I take an extremely expensive medicine ($2,000 to $4,000 per month at retail) and wanted to ask you how I can best navigate this financially.
My wife will soon be joining me into Medicare and she has the same challenge awaiting her.
Most or all of the Medicare supplemental plans have caps on how much they will cover for the year so I’d like your opinion on how to approach this.
P.S. If you want to publish my note at some point, that’s fine with me. But I’m hoping I can hear back from you soon as I need an answer. Thanks again.
Tom: OK, for our readers, each of us sent an email to “Larry” to answer his questions. Here’s kind of a summary.
Al: Larry, thank you for reading our column!
I have three thoughts on your expensive medications:
1. Go to medicare.gov and do a drug search to see which companies, if any, best cover that specific Rx.
2. See if the manufacturer has any kind of trials or subsidies that can offset the cost.
You have free articles remaining.
3. Take a look at Global Pharmacy to see if they cover it (Global is Canadian).
If you’re not on Medicare A or B yet, you probably know that whichever drug plan you apply for is guaranteed coverage when you apply three months before your 65th birthday, the month of your birthday and three months after.
Open enrollment for Medicare Part D prescription drug plans is Oct. 15 to Dec. 7.
Tom: A minor correction on “caps.” If you are on a Medicare Part D plan for 2019 and reach the threshold of $5,100 out of pocket, you pay 5 percent of the costs until the end of the calendar year. This is the fourth part of drug coverage and is called the “catastrophic phase” and there is no limit to it.
As for Medicare Supplements, they don’t exactly have caps either.
We frequently hear the statement, “If Medicare covers it, then the supplement has to cover it.”
Also, Medicare Supplements do not have drug coverage. They used to, years ago, but since 2006 supplements and drug plans are two separate entities.
Al: Many people are unaware that Medicare does not cover anything outside of the United States.
Some supplements will pay a little to get you back to the country in case of an emergency, but, Medicare itself, zilch.
Another limit is days in a hospital. If you have a cumulative 365 hospital days (and are still alive!), you’re on your own. Also, you get up to 100 days in a Skilled Nursing Facility (SNF), then you’re on your own.
This is where it is beneficial to have long-term care insurance, but that is a whole other column.
We hope this is helpful to Larry.