Need To Change Our Drug Plan!

Discussion in 'Health & Wellness' started by Cody Fousnaugh, Jun 13, 2018.

  1. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    We currently have Humana Walmart as our drug plan. It really seems that they don't pay much for any prescription we might get. A number of months ago, my wife needed a prescription nasal spray for some type of infection. Her doctor gave her a prescription, but it was a "name brand" that Humana wouldn't pay anything for. The generic one, Humana would only pay $10/ The pharmacist told us the name brand spray was much better, so we got that one. We ended up paying $80 for a small bottle of nasal spray, but it sure worked.

    For my future cataract surgery, I will need three different eye drops to use after the surgery. Humana will pay nearly nothing, which will leave us with paying around $400 or so for each. The drops are a requirement for the post-surgery care.

    So, we are really considering changing our drug plan and I've read some about Medicare D. Both of us already have regular Medicare A and B (Hospital (A) and Medical (B). Our Humana Walmart costs us each $17.50 per month. But, all of my prescriptions come from the VA and my wife's only prescription comes from a local grocery store pharmacy and it's free. But, if I have to see a doctor outside the VA, which could definitely happen, I'd have to get any prescription thru the Humana Drug Plan.

    Any suggestions would be greatly appreciated.
     
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  2. Babs Hunt

    Babs Hunt Veteran Member
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    You might want to check out the plans they offer in the places you are thinking about moving to @Cody Fousnaugh as they usually have different plans in different States. I don't know much about the Supplement plans that are supposed to help cover what Medicare, etc. doesn't pay for...but I think they help take up the extra cost of prescriptions your current plans don't cover.

    There is free help to find the best coverage Plan for you and your wife. The Medicare.gov site might have where you can find that free help in Jacksonville. I don't have time right now to look it up for you.
     
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  3. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    Problem is, Babs, our current income is too high for any financial help with anything. Now, once we move, there's an excellent chance that I will have to drop my Medicare, supplement and drug coverage due to the change in our income. We will only be able to afford the coverage my wife will be on, Medicare A/B and a drug plan, and I will continue using my VA, but only my VA.

    We are just trying to find a better drug plan that will help pay for the eye drops I will need after my cataract surgery.
     
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  4. Babs Hunt

    Babs Hunt Veteran Member
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    On Medicare. gov there is a place to put where you live currently, etc. that will show you every plan available to you and those plans will be the choices you have to pick from Cody.
     
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  5. Holly Saunders

    Holly Saunders Veteran Member
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    I can't help you in any way @Cody Fousnaugh because I know nothing of your medical system except that you all have to have insurance and or pay huge costs for medical care....but I'm stunned...that a nasal spray would cost $80... here in the Uk it would cost you nothing after 60 years old... aboslutely zilch, zero..nada...for any medical procedure unless it was cosmetic surgery..or prescriptions ...and everyone under 60 gets free medical treatment, doctors , operations, hospital treatment..but they pay around £9 per item for any prescription...


    If it was legal I'd send you the meds from here ...but unfortunately I can't!!
     
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  6. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    Is this why, if it’s indeed true, so many Seniors are moving to the UK to live?
    There sure were a lot of American flags being held down the Wedding route.
     
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  7. Holly Saunders

    Holly Saunders Veteran Member
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    Yes it's completely True!!!!! ...and yes there's many thousands of Americans and Canadians living here...

    I know an American couple , who moved here about 5 years ago, the husband has Cancer and has had to have many procedures.. It's cost them not one penny for the treatment, and she told me that for all the treatment and procedures he's had here they would have had to have sold their house in the USA to pay the medical bills...

    I'm not saying the NHS (national health service ) is perfect, there are long waiting lists for consultant appointments sometimes , but we pay for the NHS out of our salaries while we're working in national Insurance contributions.. ( nowhere nearly as much as private medical insurance in the USA) the average total of tax and National insurance in the Uk is approximately 1/3rd of our salaries but that covers everything.., and it means that children, the unemployed, seniors over 60 get free prescriptions, and those in between pay just around $9 per prescription ...and all medical and surgeries are Free to everyone...whether you've ever paid into the system, or not..in other words Cody..even if someone has never worked a day in their lives, and always been on benefits they are still entitled to free prescriptions and medical treatment the same as everyone who has paid all their lives..

    Also our primary care doctor is free too...

    America is a great country in many ways... but the medical bills and or insurance are just eye wateringly expensive..and I've heard that some people have to go without treatment due to being unable to afford it..
     
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  8. Holly Saunders

    Holly Saunders Veteran Member
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    Incidentally..I forgot to mention...it's only England where we have to pay the minimal amount for prescriptions...the rest of the UK..Scotland, Northern Ireland and Wales pay nothing at all...
     
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  9. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    Well, don't know about the UK, but in the U.S., money talks...……..without a doubt, even for healthcare.

    BTW, yes, the eye drops do cost that much, because they are specialized eye drops to stop any kind of infection that could happen in the eyes due to the surgery. Like most other things in the U.S., there are cheaper eye drops, but they aren't nearly as good to use for post-surgery for cataracts.

    We also have both regular cataract surgery, incision done with a scalpel and laser where incision is done with a laser. Of course the laser is more expensive, but very highly recommended due to the recovery time (a couple of weeks) compared to longer with regular surgery. There is also a specialized lens that replaces the cataract lens, which is much better, but costs more, than a normal lens. Again, the specialized lens is highly recommended as well.
     
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  10. Holly Saunders

    Holly Saunders Veteran Member
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    Those eye drops would still be free here Cody... we're not given Generic meds on our NHS... they are available in the pharmacy and supermarkets but not on prescription... we only get good quality drugs on prescription ...

    In fact just last week I had to see an Ophthalmologist at the hospital... after being referred by my optician. After extensive tests on my eyes, he gave me a prescription for eye drops to take 4 times a day and eye cream to take at night before bed... top quality stuff.. Cost to me?...Nothing!!!!
     
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  11. Holly Saunders

    Holly Saunders Veteran Member
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    Cody...I'm not here to knock the USA...I think it's probably a wonderful country in many ways and has it's problems like we do... but what I'm telling you is true..and to prove it..I'm going to post this example from Quora written by an American living and working in the UK...


    For the UK, taxes/National Insurance cover all NHS medical treatment barring prescriptions in England (nominal charges - free in Wales, Scotland, and Northern Ireland).

    In the case of US insurance, let's consider the figures here:

    http://www.ncsl.org/research/hea...

    This states at the top that the average cost of health insurance for a family in the United States was $18,142 in 2016, equivalent to £14,174 at the current exchange rate. Assuming that's two adults on roughly similar salaries, it's $9,071/£7,087 each.

    Here in the UK, I earned just under £32,100 last year (about $41,100), which is above the average UK salary of just under £28,000 ($35,800). My total combined income tax and National Insurance for that year was just under £6,750 ($8640). My wife is on a slightly higher salary than me, so she probably paid around £7,500 ($9,500). That means that between us we are paying in income tax/National Insurance a simlar amount to the average US health insurance bill only.

    Just let that sink in.

    Our total income tax/National insurance obviously covers a whole lot of government spending, including our own future state pensions, welfare payments, etc., as well as healthcare provision. The latter involves no top-up, no co-pays, and only nominal prescription charges (£8.60 per item - $11.00).
    Here's an illustration: In March my wife gave birth to our first child, but it was a difficult labour. We had 1:1 midwife care in a hospital delivery suite for about eight hours, but it became apparent a natural birth was not going to happen, so it was decided to investigate the possibility of an assisted delivery.

    The half-dozen strong surgical team was in the room within minutes, and we got to the operating theatre in less than ten. The lead obstetrician carried out an examination, said that even an assisted delivery was too risky, and recommended a c-section, but it was our choice. After clarifying with the obstetrician that the risks to the baby were significantly higher for an assisted delivery than the risks to my wife of the c-section, we agreed to the latter. Less than an hour after the leaving the delivery suite, our daughter was born.

    Obviously after the c-section my wife had to stay in hospital for a couple of days, but two days after the birth some issues arose with our daughter, so she went into Neonatal Intensive Care Unit (NICU) for the next eight days, before she's discharged home, fit and healthy.

    Having worked in the NHS previously, I estimate that the total cost of the birth to be around £13,000 ($16,640) under the organisation's internal pricing structure. This is significantly cheaper than what it would cost in the United States.

    But how much did it cost us personally? Nothing. Zero. Nada. Zilch.

    OK, I had to buy a shedload of coffe and sandwiches while I was staying over at the hospital, and we bought some nappies (diapers), as we felt guilty using all the free ones in the NICU, but that's it, really. We didn't pay anything for the medication for our daughter after she was discharged, as being a child it's always free for her. My wife also gets free prescriptions up to a year after the birth.

    And no, our future taxes/National Insurance will not change by even a penny on account of the above treatment costs.

    https://www.quora.com/Whats-the-dif...s-and-an-American-paying-for-health-insurance

    This is just one of hundreds nay probably thousands who will confirm what I'm telling you is true...
     
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    Last edited: Jun 14, 2018
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  12. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    I looked up Medicare D and...….due to our yearly income, which isn't that high, but high enough, we'd have to pay an additional amount per month, besides the monthly premium.

    Anyone here know anything about those Discount Prescription Drug Cards that come in the mail? We have some and are going to ask our Pharmacists if one of these cards would be better to buy the eye drops with, instead of our current "lousy" drug plan. The cards may not work with the prescriptions, but we want to find out.
     
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  13. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    Holly, you don't have to "knock the USA", because there are plenty of people here that do, concerning the cost of healthcare. Now, if they a great retirement healthcare plan, have very little to worry about. One of the great retirement healthcare plans is Kaiser.

    Now, when I had my rotator cuff surgery, our Medicare took care of all but $600 of the $35,000 the surgery costs and all of my PT was free thru our Medicare. Medicare B, the age 65 medical plan from the government, is good-to-great, but our drug plan...……

    I really don't get it, because Humana Walmart gets so many good reviews. Perhaps people get the less expensive, and less affective, drugs using them. Don't know.
     
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  14. Bobby Cole

    Bobby Cole Veteran Member
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    Perhaps in the conversation, I might have missed something.
    It’s been my experience that if a civilian doctor gives a registered VA recipient a prescription, the VA will fill it. The exception is that if narcotics are involved, the VA will fill it with a non-narcotic near equal.

    My civilian primary health doctor has access to my VA records and visa versa and thus far, they have worked hand in hand very well.
    If your mean yearly income is over 12K, the VA “might” attach a small cost but it’s so small you can generally pay it with pocket change and if isn’t, (like non-military related VA hospitalization) you have 90 days to pay it or make the necessary arrangements which are extremely lenient.

    Like I wrote, I might have missed something .......
     
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  15. Cody Fousnaugh

    Cody Fousnaugh Veteran Member
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    First, Bobby, the VA doctor I had before the one I've got, signed an approval for me to get two VA prescriptions using my Humana Walmart Drug Plan at Walmart and they were cheaper than the VA Pharmacy charged me in a co-pay. Unfortunately, the VA doctor I have now absolutely wouldn't do that "approval" statement, so have to get all prescriptions thru the VA Pharmacy.

    We pay a co-pay for medical services and prescriptions, because we decided not to fill out a Means form indicating our yearly income. We knew, if we fill it our, we'd pay a co-pay anyway. Only things I get free from the VA is my lab work and Diabetic II supplies.

    I have Medicare B (medical insurance), but haven't had the need to get a doctor outside the VA to use it. And, since I'm not a "Service-Connected Injury" Veteran, I don't necessarily get the "top-notch" treatment.

    It really seems like the VA wonders why a Vet would seek any kind of treatment outside the VA. It was "ok" with my VA doctor that I got my rotator cuff surgery outside the VA, but she didn't seem thrilled about it.

    I used VA Medical strictly for a number of years, when companies started charging employees for medical insurance. I didn't make a good enough salary to pay into that. VA was good back then, but I lived fairly close to the Long Beach, California VA Hospital. The VA Hospital here is about an hour and a half from us. For certain things, I've had to go to the downtown Jacksonville VA, but for my lab work and lab consultation, the VA Clinic about 5 miles away takes care of that. The downtown VA doesn't do any kind of surgeries. It's like a large clinic, definitely not a hospital.
     
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