I’ll be eligible for Medicare on September 1, and I’m trying to learn what my options are. I’ve got the Medicare web site and the “Medicare and You” booklet, and I can’t believe how complicated they’ve made this process. I’m a reasonably intelligent person, yet I’m at my wit’s end trying to comprehend things. I’m convinced that most people just get a recommendation from someone they trust, and go with that, without really understanding what they’re getting into. I’m having a hard time believing that my older relatives really understood any of this before making a decision.
Ok, end of rant. My immediate question that I don’t see answered anywhere is the “Spending limit.” I had thought it was the maximum amount you’d have to pay in any given year, yet it’s consistently less than the “Annual cost.” Or is it the maximum amount ***they ***will pay in any given year? I’m currently looking at six PPOs that have annual costs from $7050 to $7850, and have spending limits from $3850 to $6000. What do those numbers mean?
I just went to Medicare.gov and walked through their Medicare Plan Finder. The only “spending limits” I see are “out of pocket spending limits.” Those refer to the maximum amount you would spend out of pocket in a year. I believe that maximum is separate from the prescription drug part of the plan. They are sometimes called a stop-loss. If you are referring to some other type of spending limit, please clarify.
It looks like you can get PPOs with and without drug coverage.
I’m looking at specific PPOs that include drug coverage. In every single plan, the annual cost is greater than the spending limit. So are you saying that the annual cost includes drugs and the spending limit doesn’t?
And here’s something else that I’m discovering: I am currently taking 10 different medications, with an annual cost of over $3100. I have no insurance, so pay for them all out of pocket. If I get a plan with drug coverage, it turns out that, between the premiums and the copays, I’d be paying more with drug coverage than I’m paying now. No matter how I figure it, that turns out to be the case.
Not to discourage you from asking for help here or from anyone else contributing but why don’t you call your local dept. of aging and see if someone will meet with you and help pick the best plan and answer questions? I know in Pennsylvania they have trained volunteers during each open enrollment period (end of the year) to help, and a few paid professionals all year.
They even have software so they can enter all your prescriptions and identify the absolute best medicare part D program for your current medications. I know you want a medicare advantage program, but even if they don’t have any computer programs to mathematically figure out the best one like they do for prescription plans, they should be able to help significantly. In my dad’s case, after we looked at all the Medicare Part D plans we decided it would be best to stick with his Medicare Advantage plan. We didn`t have any computer program for that, we just figured it out by hand and having someone work with us who understood it all helped a lot.