Medicare drug coverage

[poet1973]

I live in Mississippi I am 49 years old am on Medicare part A and part B however I need drug coverage for my meds. I have had a lot of people tell me not to get the advantage plans. Just wanting advice on what I needed to get?!

 

[Mary2]

If you stick with traditional Medicare then you can go to Medicare.gov and put in you zip code and see what drugs plans are available in your county. You probably also need a supplement/or Medigap policy as it is sometimes called. Medicare only pays 80% of your costs. The medigap policy pays the other 20%. This same website will show you the medigap policies that are available in your county.

 

[poet1973]

I thought about calling an insurance agent to see if they could help I'm on disability and my wife was working so I was trying not to be out of pocket alot of $. She is trying to get to where she can stay here with me. Just heard a lot of conflicting stories about the advantage and medigap coverages!

 

[Nikki J]

It is complicated. As Mary notes you need something to supplement the 20% that basic medicare doesn’t cover. I gather you can’t be on your wife’s work plan? Your choice then is either medicare advantage which often includes medications or a supplement plus a drug plan.

the issue with advantage plans is that they are often ( not always) set up like hmos and limit your providers.otherwise Technically they are supposed to cover everything that medicare would but some plans seem to try to gatekeep through approvals.
drug plans whether through advantage or free standing are not as generous as you are probably used to. I pay a lot more for riluzole than it was on my commercial plan. Coverage of the really expensive drugs radicava and relyvrio has been a challenge. If you want relyvriovand can stay on your wife’s plan it is worth it. Even if your insurance refuses amylyx will provide you with drug. They would also pay your copay. By law they can’t do that with medicare

every state has shine counselors. Trained volunteer insurance counselors. Thry may have a different name but I would consult them rather than a broker who may have an incentive to sell you a plan

 

[poet1973]

Yes thats what I'm struggling with is the relyvrio and radacava. I lost my insurance thru my employer last month. Amylyx has gotten me the relyvrio approved thru 2024. However the radacava was denied because of my insurance coverage. TThat's my dilemma trying to figure out what I need now! My wife is probably quitting her job because I am having trouble with my legs and getting around! I fell the other morning. Feeling kIndah useless at the moment!! She has been working because we're not wealthy was kinda lliving paycheck to paycheck!!

 

[Nikki J]

It might be worth exploring cobra it has never been worth it but the radicava / relyvrio thing changes the calculus if your resources are truly limited you might check if you qualify for medicaid. There probably isn perfect answer but I hope you can find the best

 

[poet1973]

Yeach medicaid denied me because she was still working although I don't know how long before I could re-apply!! It just so frustrating when you need these medications and can't get the help to get them. II have worked hard all my life and they make it so hard to get help . Just doesn't seem fair!!!

 

[Tomswife]

Did you contact the Healthwell foundation? They may be able to assist.

 

[poet1973]

Yes Still need some type of drug coverage. The amylyx care team has me approved thru next year but can't get radacava until I get some drug coverage. Just aabout at my wits end!!

 

[poet1973]

Been going through medicare in my area but the drug plans in my are only cover 1 of the 3 drugs from what I'm seeing. Driving me crazy supposed to start next round of radacava this week. Ready to pull .y hair out!!!

 

[lgelb]

Did you look at both Medicare Advantage and Part D plans in your zip for what drugs are covered? It is not the type of plan as much as which pharmacy benefit manager they use, and whether they have their own network formulary or not.

 

[Nikki J]

None of the plans in my zip cover either relyvrio or radicava. your neuro can appeal for a formulary exemption. No guarantees at all of course

 

[poet1973]

Yeah I understand it's just frustrating. It shouldn't be this hard!! Thank you all for your help and information!!!