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Discussion Starter · #1 ·
Since I am on disability due to my SAD, I get both Medicaid & Medicare, so Ive been getting the letters about the change to the new drug coverage & have gone on the internet & have read over all the Wellcare pamphlets I got this week. I still dont get how its supposed to work. :stu

I am wondering if anyone here knows anything about this, or might be in the same boat, if you get Medicaid/care as well, or maybe your helping your parents or grandparents (My grandparents will be getting this too). My mom's asked around at work & she says NOBODY really seems to understand it! :um

What confuses me the most is how the payments & co-payments work. On one page (in most of their literature actually) it says that you pay 0 for generics or 3 bucks for brands, with no other fees or bills premiums or deductibles. Ok great! but then when you read the formulary(the list of drugs they cover) they tell you when you reach a certain period you will have a "gap" after your total drug costs reach $2,250 (it varies on whether the drug is Complete, Premier or Signature covered) where you'll have to pay the full amount out of your own pocket. Uh and just how long is this gap? After you pay $3,600 out of pocket you pay 2-5 bucks or 5% coinsurance for your meds...what happened to no other fees bills etc.?

It was so much easier when Medicaid just paid for everything... :fall

Oh & they automatically enrolled me in the plan called Wellcare(everyone who has Medicaid or doesn't choose a plan by Dec 31 is enrolled in this plan, hmmm, how convenient), but I can choose to join a different plan, but... I dont even get how the one they placed me in works. I feel bad for all the elderly people who have to figure all this on their own... :|
 

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Yeah I have heard there are over 70 new plans being introduced. I know some people that are pharmacists and they are having the toughest time trying to figure it all out. So you are not alone in your confusion.
 

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Exactly.............In Michigan, there are people that have studied the plans.........Non profit, that will sit down with a group and help them chose..........You might want to check your paper.........Call the council on aging............See if they know of anyone that is explaining this............All volunteers.........
 

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Discussion Starter · #5 ·
thanks for moving this for me mods! :thanks


I know bon, that you can get counseling, I think Medicare even has their own counseling they can provide for you, im not sure on that, but I have to check in one of the tons of letters they have been mailing me since Sept. But Ive been lazy this month(especially these months were we been going nuts with the roof damage/contractors/insurance due to the hurricanes). The last thing i want is to have to take public transportation(no car) to some gov. office, blah blah blah...I feel like just staying with Wellcare & seeing what happens...

maybe I can call them & have them explain that "gap- pay out of your pocket" thing...at least i can get cleared up on that. :stu
 

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Ask your pharmacy if they know of any work shops that are happening soon to explain the new system. Various pharmacies and churches in my area have been holding work shops to explain the new system to people because yes it is very complex.
 
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