Some seniors enter their golden years with only one or two daily medications, while others find they need a daily chart to keep track of their pills, inhalers and vitamins. And, it's not unusual for prescriptions to range from a few dollars to staggering high sums. The increasing costs of medications may cause some residents in an assisted living community to worry about how they can keep up.
The typical Park Regency Thornton resident has several options for prescription care coverage, depending on their life circumstances and previous employment. You can also combine plans, billing one payor first as the primary and the other as secondary.
Retiree Insurance Benefits: Although this category is dwindling, many companies still provide medical insurance, including prescription benefits to retired personnel and their spouses.
Medicare: Government-sponsored prescription benefits are provided under Medicare Part D for a monthly premium. You may qualify for extra help if you have low income or resources.
Medicaid: Seniors whose income levels meet the state's requirements may be eligible for Health First Colorado, the state's Medicaid program.
Regardless of your insurance benefits, one of the most important ways to stay up on your current medications while keeping costs down is to have a good working relationship with your pharmacist. Your senior community may recommend a pharmacy, you may continue to use a local one in Thornton, Colorado, or your insurance plan may require you to use mail order. Either way, make sure you know how to contact them so you can take advantage of their expertise. Many of the tips below require the cooperation of your pharmacist and doctor.
Almost all insurance plans assign levels or tiers to their drug formulary. A drug formulary is a list of medications covered by that specific plan. Drugs listed as Tier 4 may have higher co-payments than drugs listed as Tier 1. It's typical to assign newer drugs or those that are more expensive to the higher tiers, although that isn't always the case.
Either way, if your drugs are showing up on a higher tier, talk to your doctor or pharmacist about alternative options. Many times, there are other choices, which is usually the reason the insurance companies have placed that medication on the higher tier. If your doctor feels this is the only suitable solution for you, he can submit a request for approval from your insurance company. Sometimes you can get a tier-reduction.
Sometimes after a lifetime of visiting different doctors and pharmacies, seniors may find they have duplications in their treatments. Make sure your doctor or doctors know about all your medications, even the ones they didn't prescribe. Scheduling a medication management overview with your pharmacist, either in person or over the phone at your assisted living apartment, can help make sure you aren't taking any drugs that are no longer necessary or that are duplicate treatments for the same condition.
Some pharmaceutical companies offer rebates on their products through cost-assistance programs. This money can be used to pay for drug costs, including deductibles and co-pays, although there are eligibility requirements. If you're prescribed a brand name medication that's new on the market, always check for company incentives.
Most discount cards available for prescription coverage don't require an upfront fee, although some may have a small transaction fee. In most cases, you can't combine a discount card with your Medicare or insurance co-pay, but it's a good option for when you're meeting your deductible or have reached a spending cap. It's also possible that you might find some prescriptions less expensive with the discount card instead of billing them through your insurance.
Insurance plans usually have a yearly deductible that must be met before they begin to pay. It's easy to forget all about this come the new year, which surprises many seniors when they receive their January statement.
Additionally, Medicare Part D plans have a period when coverage lapses, called the doughnut hole. Seniors may reach the doughnut hole at different times of the year depending upon how much they spend for medications, and some may never enter it.
Claims can be denied for many reasons, one of which is improper billing. Always check if you suddenly notice your co-pay has increased or a medication isn't covered that was previously. Anyone can make a mistake, and a little care on your part can save you money.
Also, some drugs may require prior authorization from your doctor; this is basically a statement of need. Most prior authorizations are only good for one year, so it helps to make a note in your calendar to remind your doctor before the prior authorization runs out.
You may find that going through your insurance isn't the best option, or you may be thrilled to see how much your insurance is saving you in healthcare dollars.
With a just a little preparation and research on your part, along with the help of your pharmacist and doctor, you may be surprised at what you can save.
Posted on Thu, April 9, 2020
by Shawn Deane