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Medicare Part D and discount programs - Why cannot seniors have both
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Medicare & Insurance
Medicare Part D and discount programs - Why cannot seniors have both
Share Medicare dos and don’ts, including eligibility and supplemental insurance.
I am trying to understand why a person on Medicare Part D with a prescription program may not also use discount programs. Several years ago my wife and I joined a discount program at a pharmacy since
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Cat:91a4afbf-9555-4e02-b9d3-9eef604476f6Forum:c79f53c3-fa71-4e76-b517-aef042efd7ffDiscussion:471cd54c-e788-4c98-b92c-0b700a30971e
Forums » Health » Medicare & Insurance » Medicare Part D and discount programs - Why cannot seniors have both
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Medicare Part D and discount programs - Why cannot seniors have both
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Medicare Part D and discount programs - Why cannot seniors have both
posted at January 5, 2012 2:24 PM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
I am trying to understand why a person on Medicare Part D with a prescription program may not also use discount programs. Several years ago my wife and I joined a discount program at a pharmacy since I was able to get a better price on my prescriptions by paying cash myself and using the discount program we joined than using my insurance program with their deductible and a $10 extra charge when I did not use mail order for the 3rd prescription. When we hit 65 we were told we could no longer use this program once we were medicare elegible even though we had not yeat picked up part B. Now more recently when I was in Costco and picked up a prescription where I paid cash, I was asked if I wanted to sign up for their program which would reduce their low prices on generics and it would not cost me anything since I was already a Costco member. I asked if they were sure I could sign up since I was now on Medicare. After she checked she said she did not think I could. I might also mention the Lipitor ads on television where you may be able to apply for their $4 copay for Lipitor, but again there is an exclusion for those on medicare. If you are not aware, Lipitor generics may now be available since they have passed the time period where they are protected. I might understand where Medicare may not want me to be on a program where I get a discount on a prescription paid through medicare part D so I do not get extra money after medicare pays for the prescription, but even here with proper controls to avoid abuse where the discount is made where I would receive extra. However it makes no sense to prevent me from joining a discount program where I would pay cash myself for the prescription and receive a discount from the pharmacy when Medicare would not be involved. Even with Medicare and deductibles, it is possible to buy some prescriptions and pay cash myself and receive a discount on my purchase from the discount club and Medicare pay nothing. This makes no sense to me since both I and Medicare are saved money. Going bback to the other case where Medicare is involved it should be permissable there also as long as the benefit does not have me being paid twice - from medicare and the discount club. Is it the way Congress wrote the law that causes this problem? If it is, AARP should get involved because we seniors are many times paying more than we need at the time. Anyone that has insight into this issue, please comment, since it makes absolutely no sense to me. As seniors it would be benficial to have access to both Medicare Part D and discount programs even if there is a fee. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 5, 2012 4:27 PM EST
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Posts: 1923
First: November 27, 2011 Last: May 18, 2013 |
Haven't you ever seen those fast food, grocery store, product specific or retail store coupon that says "Only one coupon per customer." The reasoning is about the same. However, if I am understanding your post correctly, you could use both but it would be your choice when to use it and it would NOT be at the same time but rather more drug specific. Example: Say, if you take (4) different low cost drugs that your discount program gives you a good deal on or the meds are cheap on some of the generic pharmacy programs (even if this is a little higher than what the Med D would charge you) AND You take some rather expensive medication too. In essence you could opt to pay cash for some of the low cost or covered by discount drugs - leaving your Med D coverage for the higher cost medicine - thus giving you a longer period to stay out of the donut hole. That is why when you look up your meds on the Medicare D Insurance website, you need to pay close attention to the prices that will be charged for each medication & their tier number in addition to the monthly premium or applicable deductible, if the plan has one, and figure out the best way for you buy your meds. It is all about the math when you are picking the best Med D for your benefit. Also remember that Med D plans also have their "in-network" pharmacies where you get the insured discounts on the Rx. Pharmacies have a mark up on their meds too but to be "in-network" they have to agree to sell it at a certain price. Costco Pharmacies may still participate in both plans - member discount and Med D (use to be Atena plan) - but you cannot have both on the same Rx because of the Pharmacy rules on the Costco Member Prescription Program: Per their website on the CMPP: Costco Member Prescription Program The Costco Member Prescription Program (CMPP) provides qualified Costco members lower costs on a number of prescription medications. By enrolling in the Program, Costco members who have no available insurance coverage for medications or whose insurance does not cover all of their prescription medications, may pay less for certain prescriptions than what they would otherwise pay at a Costco pharmacy for the same drug or a therapeutically equivalent alternative drug. Enrollment in the Program is open to Costco members (and their dependents) who have no prescription drug coverage available. Anyone receiving benefits from a publicly funded health care program, such as Medicare or Medicaid, is not eligible. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 5, 2012 6:03 PM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both: Haven't you ever seen those fast food, grocery store, product specific or retail store coupon that says "Only one coupon per customer." The reasoning is about the same. However, if I am understanding your post correctly, you could use both but it would be your choice when to use it and it would NOT be at the same time but rather more drug specific. Example: Say, if you take (4) different low cost drugs that your discount program gives you a good deal on or the meds are cheap on some of the generic pharmacy programs (even if this is a little higher than what the Med D would charge you) AND You take some rather expensive medication too. In essence you could opt to pay cash for some of the low cost or covered by discount drugs - leaving your Med D coverage for the higher cost medicine - thus giving you a longer period to stay out of the donut hole. That is why when you look up your meds on the Medicare D Insurance website, you need to pay close attention to the prices that will be charged for each medication & their tier number in addition to the monthly premium or applicable deductible, if the plan has one, and figure out the best way for you buy your meds. It is all about the math when you are picking the best Med D for your benefit. Also remember that Med D plans also have their "in-network" pharmacies where you get the insured discounts on the Rx. Pharmacies have a mark up on their meds too but to be "in-network" they have to agree to sell it at a certain price. Costco Pharmacies may still participate in both plans - member discount and Med D (use to be Atena plan) - but you cannot have both on the same Rx because of the Pharmacy rules on the Costco Member Prescription Program: Per their website on the CMPP: Costco Member Prescription Program Enroll at any participating Costco Pharmacy and save on prescription medications! The Costco Member Prescription Program (CMPP) provides qualified Costco members lower costs on a number of prescription medications. By enrolling in the Program, Costco members who have no available insurance coverage for medications or whose insurance does not cover all of their prescription medications, may pay less for certain prescriptions than what they would otherwise pay at a Costco pharmacy for the same drug or a therapeutically equivalent alternative drug. Enrollment in the Program is open to Costco members (and their dependents) who have no prescription drug coverage available. Anyone receiving benefits from a publicly funded health care program, such as Medicare or Medicaid, is not eligible. Posted by GailL1 Gail, you are missing my major point, since I am not asking to get 2 discounts as in the case of 2 coupons for the same item. I am first saying I should have the ability to pay cash out of my own pocket while using the benefits of the discount club instead of using my Part D Medicare prescription if the former is cheaper.Here Medicare pays nothing and if the generic was 10 and the discount saves me another 2 so I only pay 8. I benefit and so does Medicare since my medicare coverage may have had a 10 copay. This is not using two discounts like your example, but I have used the discount program and Medicare has not paid anything. I took it a step further though I would be at least a bit more content if the other were possible. Taking it one step further if my prescription plan has a 10 copay, why should I not be able to use the discount card which would reduce my copay since I have paid for both medicare and a prescription club. The latter is not at all like the use of 2 coupons since coupons are to get you to purchase a product allowing a discount for incentive. If a pharmacy wants to offer an incentive to get my prescriptions there why should I not be able to join the club and let the reduced price benefit both medicare with lower expenses and the medicare recipient. We still have the case of Lipitor where we are automatically excluded just because we are on Medicare. Would it not makes sense for medicare recipients to get the $4 copay instead of using their insurance. My understanding it is something with the government that does not allow you to even join some of these clubs and use them if you are on medicare. At Costco there is no charge for the prescription discount if you have a membership and my feeling is that at a minimum you should be able to use the discount club or medicare depending on what is cheaper. All because you are on medicare you should not be restricted from this selection which is also partially to avoid the donut hole which is a nonsensical item also. |
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Re: You are FREE to choose what plan to use or no plan at all.
posted at January 5, 2012 7:50 PM EST
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Posts: 1923
First: November 27, 2011 Last: May 18, 2013 |
>>>>>I should have the ability to pay cash out of my own pocket while using the benefits of the discount club instead of using my Part D Medicare prescription if the former is cheaper.<<<<< I do that all the time when purchasing my mother's medications if the discount is cheaper, I buy it that way - actually the pharmacy clerk gives me the lowest price be that a special retailer generic cost or the Med D plan price. />>>>>> I have used the discount program and Medicare has not paid anything. <<<<<<< That is the way that it has to work because when they aren't putting it through the Medicare D system (whomever your plan is with), your plan D will not pay. My mother has one Rx that Med D does not cover at all but I get a discounted price for it under her Medicare supplemental insurance. This one never shows up on the Med D plan because it is put through under another insurer. >>>>>>Taking it one step further if my prescription plan has a 10 copay, why should I not be able to use the discount card which would reduce my copay since I have paid for both medicare and a prescription club. If a pharmacy wants to offer an incentive to get my prescriptions there why should I not be able to join the club and let the reduced price benefit both medicare with lower expenses and the medicare recipient.>>>>>>>>>>>>>>> Because of the above reason - the pharmacy can only process your medication under one program or another, not both. >>>>>We still have the case of Lipitor where we are automatically excluded just because we are on Medicare. Would it not makes sense for medicare recipients to get the $4 copay instead of using their insurance. My understanding it is something with the government that does not allow you to even join some of these clubs and use them if you are on medicare. The Lipitor program says this about the Lipitor for You Program: Lipitor For You $4 Card Program FAQ "This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico ([formerly known as "La Reforma de Salud"]). The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs." The term "eligible to be reimbursed" is the key since the insurance companies in Med D have already set a price for the drug, know the estimated usage and this is part of their business plan to work within the Medicare D framework.However, if you wanted to buy the Lipitor at whatever the pharmacy price out of your own pocket and not have it filed through Medicare D, it seems you could get the card - there are other terms and conditions on the Pfizer website: "To qualify for this offer, your out-of-pocket expense must be greater than $4 per prescription. If your out-of-pocket expenses for a 1-month supply (30 tablets) are $54 or less, you will pay $4 for a 1-month supply. If your out-of-pocket expenses for a 1-month supply (30 tablets) exceed $54, you qualify for up to $50 in savings for a 1-month supply. In either case, you can only qualify for up to $600 of savings per calendar year. After maximum of $600, you will pay usual monthly out-of-pocket costs. You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. The Card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third-party insurance, or where otherwise prohibited by law. This Card cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. The Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer good only in the U.S. and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable. Offer limited to 1 use per month. Pfizer reserves the right to rescind, revoke or amend the program without notice at any time. Card and Program expires 12/31/2012. No membership fees." >>>>>At Costco there is no charge for the prescription discount if you have a membership and my feeling is that at a minimum you should be able to use the discount club or medicare depending on what is cheaper. All because you are on medicare you should not be restricted from this selection which is also partially to avoid the donut hole which is a nonsensical item also.>>>>>>All these companies - insurance, retailers - deal with their suppliers/maufacturers on a pricing basis - they buy so much/ they get it wholesale for so much - not too much different than any other business. If you buy at pure retail, you pay higher. If you go with this insurance, you pay their pricing. If you go with another insurer, you pay their pricing. If you go with a pharmacy discount card, you pay tbheir pricing. The only decision that you have to make is IF you want to participate and receive the cost break that they are providing you via their business plan. If you want to buy a Rx through some other program and not have it go through their system of reimbursement - you are free to do it. They only set the rules when you are using their system be that Med D, regular health insurance with a prescription drug plan, a pharmacy chain discount program, etc. The decision of how you want to get the best price is yours - but if you participate in their reimbursement plan by putting the Rx that you got through their system, that is the choice that you have made. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 5, 2012 9:26 PM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
>>>>>I should have the ability to pay cash out of my own pocket while using the benefits of the discount club instead of using my Part D Medicare prescription if the former is cheaper.<<<<< |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 6, 2012 8:39 AM EST
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Posts: 1923
First: November 27, 2011 Last: May 18, 2013 |
In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both: /> />>>>I should have the ability to pay cash out of my own pocket while using the benefits of the discount club instead of using my Part D Medicare prescription if the former is cheaper.<<<<< I do that all the time when purchasing my mother's medications if the discount is cheaper, I buy it that way - actually the pharmacy clerk gives me the lowest price be that a special retailer generic cost or the Med D plan price. ------------------------------------------------------------------------------------------------------ The above is where there is a problem since at one pharmacy I was told that once I was Medicare eligible I could not use the discount program any longer. Notice the Lipitor excludes those that are Medicare eligible though it would work with others. The latter is why I think something is in the Medicare laws which disallows us from using some discount programs like the one at Costco when I want to pay cash instead of using Part D for an inexpensive generic. Congress has not done the seniors a favor, and I do not think AARP has done much for us either. Posted by JimR45 ONLY IF you USE your medicare benefit - in this case Part D. - the term, "eligible to be reimbursed" is ONLY in play if you are using the benefit. If you ARE NOT using the benefit - in this case, Med D plan, there is no law to prevent you from paying another way. The only thing you have to remember is that the price of the Rx will be different under each type of payer - and you have to select which option you want for that particular medicine. If you don't put it through your Medicare D plan You don't get their pricing. If you sit down with a list of your medications and research the price of each one under different payers, only then will you see which way is the best - but just remember prices can change under some of your discounted methods. I came back to edit this post to add an important factor - The definition of "Insurance" of any type is for the benefit of protecting ones self from the unknown. There could be seniors who are eligible for Medicare D but who take NO medications or perhaps they take very low cost medications and could easily afford them monthly without any Med D plan or could use other programs for discounted medications and not have to pay the Med D monthly premiums or consider this benefit in their Medicare Advantage choice. However, who knows, what might happen in the future - they could be put on a medication of astronomical price - so they pick up the Medicare Prescription Drug coverage as "insurance" against some future happening, pay their monthly premium or consider it in their choice of Med. Advantage plan (and also not have to pay the Medicare assigned penalty for late enrollment) to protect themselves from some future event, in this case an expensive medication. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 7, 2012 9:03 AM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both: If you ARE NOT using the benefit - in this case, Med D plan, there is no law to prevent you from paying another way. The only thing you have to remember is that the price of the Rx will be different under each type of payer - and you have to select which option you want for that particular medicine. If you don't put it through your Medicare D plan You don't get their pricing. It was on this specific issue that I contacted the corporate headquarters of a major pharmacy inquiring about using the discount program. I was told that I would be excluded by fact of my having Medicare. I did not have the choice of using one versus the other. I had previously inquired with local management about using my prescription plan when I was medicare eligible even before I applied for Medicare Part D. It is simply a fact of being eligible for Medicare Part D not whether you use it or not. This is what irritates me. Even when I hit 65 I was excluded because of my Medicare eligibilty and I had not even signed up for Medicare other than the Medicar Part A, since I was receiving a plan from my employer which met the law where I did not have to apply for Medicare Part D. There is something wrong with Medicare that excludes seniors from taking advantage of some of these discounts, since they might come in handy if they provide cheaper costs than Medicare Part D or help those when they reach the donut hole.
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at January 23, 2012 6:06 PM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both: [QUOTE]In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both : ONLY IF you USE your medicare benefit - in this case Part D. - the term, "eligible to be reimbursed" is ONLY in play if you are using the benefit . If you ARE NOT using the benefit - in this case, Med D plan, there is no law to prevent you from paying another way . " For all of my prescriptions except one I pay cash now at Costco since their cost is less than my Medicare RX copay from my insurer. SInce they offer free to me a membership to accept a further discount, I think I should be able to use that but I can't since I am on Medicare. If I had other insurance I could.This is why I must assume it is again reflecting the incompetence of Congress when they wrote insurance coverages for those on Medicare. But this is the same government that gives people a tax break by decreasing the Social Secutiy tax. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at February 6, 2012 11:19 AM EST
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Posts: 373
First: October 22, 2011 Last: May 3, 2013 |
In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both: In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both : In Response to Re: Medicare Part D and discount programs - Why cannot seniors have both : ONLY IF you USE your medicare benefit - in this case Part D. - the term, "eligible to be reimbursed" is ONLY in play if you are using the benefit . If you ARE NOT using the benefit - in this case, Med D plan, there is no law to prevent you from paying another way . " For all of my prescriptions except one I pay cash now at Costco since their cost is less than my Medicare RX copay from my insurer. SInce they offer free to me a membership to accept a further discount, I think I should be able to use that but I can't since I am on Medicare. If I had other insurance I could.This is why I must assume it is again reflecting the incompetence of Congress when they wrote insurance coverages for those on Medicare. But this is the same government that gives people a tax break by decreasing the Social Secutiy tax. Posted by JimR45 I was told by another that the restriction to use a club discount when you pay for a prescription goes against medicare rules. In this case I was paying cash and not using medicare at all. I only use medicare on one prescription and pay cash for all of my others since the cost is less than the $9 copay. However it could be even cheaper if I could use my discount since I have a membership in the store which would allow me to join the discount prescription plan for nothing more. Why doesn't AARP become involved in this instead of just promoting insurance programs which are not necessarily better than others. Is AARP representing us or their insurance carriers. |
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Re: Medicare Part D and discount programs - Why cannot seniors have both
posted at February 8, 2012 1:29 PM EST
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Posts: 14588
First: January 28, 2008 Last: May 22, 2013 |
I'm not sure ,but i think it's not a law. Insurers may insist you use certain pharmacies to get the best rates etc., but you can always buy with other means. Discounts may have their own rules,but again that's not a law. The VA allows you to have both Medicare and their co0verage if you're eligiblewhich I do for madicare B and a medigap ,but not Med. D because even with copay it's cheaper than D withj premiums. Lots of people used Canada or other cheaper sources while in the doughnut hole, but with the drop to half price recently it may not be worthwhile. Pharma accepted that change partly because so many didn't use the insurer during the "hole" I believe. karl |
Forums » Health » Medicare & Insurance » Medicare Part D and discount programs - Why cannot seniors have both
