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      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ 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Medicare Prescription Plan Is Confusing

7 posts in this topic

Posted

09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

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Posted

I think you can delay taking this plan if you have ChampVA or other drug coverage. I wonder if VA would act in the same way since we have coverage under VA for drugs. In other words you could just hold off on signing up for the plan without penalty.

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Posted

Using the VA is penalty enough. My HMO is making us use the plan. It sort of stinks but who knows?

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Posted

I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

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Posted

I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

If you have TRICARE or CHAMPVA stay with that. If you join Medicare you will have to pay the premium each month if you use it or not! I was told the premium is $45.00 per month. When you are on Medicare you can join any Medical Insurance Company of your choose. Some Medicare Insurance Companies Premium's are FREE. I have Health America Advantra with is free, I pay for part-B, I get my FREE meds by mail from ChampVA. You know the Medicare prescripton program is just another way for the goverment to help the rich and Drug Companies get richer. Don't you remember how much the Drug Co. spent the first six months, last year to pay the Lobbiest? I read that in ARAP, I think it was around $1,000,000.00. Any senior on medicare and has a limited income could apply for Healthy Herizon, this is a federal program, it passed Congress and became Law around the 1900's. This program provides payment of Medicare Part B premium for persons with limited resources whose incoome is more that 100% but less than 120% of the Federal Poverty Income Guidelines. There are other programs where the income is much higher! In the State of Pennsylvsnia the County Assistance Office is where you apply or you can go to the Area Agency on Aging.

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Posted

09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

The medical industry will make alot of money on a questionable benefit.

B)

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How about a plan that actually guarantees affordable drugs and health care for our senior citizens and not another bureaucracy that just buries our elderly in paper work, quite literally, to death.

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