On SSD and just received my Medicare welcome package

[exit4]

I am on SSD and just received my Medicare welcome package. I am on my wife’s health insurance from her employer; it’s from Aetna and pays for 80% of medical until the deductable is met, then pays 100%. Prescriptions are also covered, but co pay is a lot – some meds costs me $60 for a month supply. I am on Humira also and so far this past year I only had to pay $5 per order with Humira assist program. Can going on Medicate decrease my prescription co pay? Is it even worth going on Medicate for prescriptions only?

 

[momto2teens]

We are in Pa. We used to pay 10$ & 15$ for scripts. Since my sons md insisted on getting the medical card for his future, now we pay 0. They pick up what our insurance does not pay. That goes for office visit copays as well.
I don't know if it will work the same for you in NJ

 

[lookame]

Medicaid will pick up the cost of whatever the insurance won't cover. So insurance covers 80%, medicaid will cover the 20% not covered. Under the manged care plans(Molina and/or Caresource) they will sometimes have a small copay for meds, I had to pay $2 for Lialda for awhile then they moved me over to state medicaid.

 

[exit4]

Thanks all for your response. So, If I use Medicare as my secondary insurance, I can submit to Medicare my $40 co pay I currently pay when I see my doctors, then Medicare will reimburse me the $40? Do I have to choose Medicare plan D for the reimbursement for my $60 co pay for my prescriptions?

 

[lookame]

Im not 100 percent sure exactly how it works but the next time you go to the doctor let them know you have 2to insurances now. The first and primary being your wifes then add the Medicaid. The doctors know how to handle it and you don't have ti pay the copay at all. They'll bill out your wifes insurance first then whatever isn't covered(copay, vaccines ect) is then sent to Medicaid and is billed to Medicaid. Same when going to pick up your scripts. Let them know there are 2 insurances to be billed. Again they'll bill your wifes insurance first then bill Medicaid. There is little to no copay for the scripts. As for what madicaid you need(part d ect)is im nit sure. Im not really on ssd so im not sure about that

 

[Miss Underestimated]

I don't think it works like that - once you are on medicare, Aetna is not going to pay like they did before - they will limit your coverage. Call Aetna and ask them.

Again, I would NOT take Medicare part D - you will be better off using your Aetna prescription coverage, and getting the manufacturer's coupon.

You cannot use the coupon if you have Part D.

I was an insurance agent for 25 years. Call Aetna and explain your situation to them, ask what they're going to cover.

They cannot tell you what's going to happen if you take the Part D coverage. They are not allowed to.