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Any Way to Avoid Part D *Penalty*?

Posted by chisue (My Page) on
Mon, Dec 13, 10 at 9:51

DH has never been prescribed any expensive drugs, so did not take a Part D plan when they were instituted in 2006. This year he has been prescribed two expensive drugs: One Tier Two and one Tier Three totaling $4500/yr. retail. He needs to take a Part D policy for 2011.

His penalty for not having the coverage since 2006 will add $17.60 a month ($212/year) to his Part D premium *forever*. I'm trying to find a way to avoid this.

DH's former employer offers a Medicare Supplement Plus Pharmacy Plan that would provide *credible* drug coverage. If he took that plan for 2011, would he avoid the penalty for 2012 and beyond?


Follow-Up Postings:

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RE: Any Way to Avoid Part D *Penalty*?

You cannot avoid it by the definitions outlined by Medicare, but you can contest it.

Once you've been notified in writing by the Part D insurer that your husband will be penalized, you should receive a "Late Enrollment Penalty Reconsideration Request Form" along with that notification. Fill it out as defined within the form itself and return it immediately to the address provided within the form.

There are no guarantees that Medicare will waive the penalty, but it's worth the effort to complete the form and submit it. They'll notify you within 90 days whether they will waive the penalty.

HTH

Anne


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RE: Any Way to Avoid Part D *Penalty*?

Anne -- Thanks for that!

Today I remembered that DH had creditable drug coverage folded into his former employer's group policy for a while. I called them; they verified he had it through 12/31/08. They are mailing me 'proof'. This would drop his penalty to $7.76/month -- but of course he'll still be paying the penalty forever.

How does a company offering Part D for 2011 know whether you had prior coverage or not? My Part D for 2010 was paid via deduction from my Soc.Sec. payment, so Medicare would know that. However, in 2009 I paid for my Part D by check.

I'm glad to have whittled the penalty down a bit. Should I feel a guilty trying to eliminate it? I just don't want to be naive or stupid about how this works.

Sue


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RE: Any Way to Avoid Part D *Penalty*?

The insurer has access to all insurance records. All companies offering Part D coverage had to register/qualify with Medicare when this program first began...thereby creating reams of records. Your company records are available through IRS/SS [all Federal services] records and as long as you have a SS# and/or file a tax return each year...you, your husband...all of us can be traced.

No...do not feel guilty. Many of us citizens...including me...had no idea we would be penalized for not subscribing to meds coverage we did not need.

I lost my husband and all medical benefits 3 years ago. I knew I had to replace the supplemental health policy [and did so immediately] but had no idea of a Part D plan...let alone a need to replace it. Nor did any of the insurers advised me that I was required to do so. I didn't take prescriptive meds then and still don't now. If an ailing neighbor hadn't informed me about the need for this coverage...and my making an inquiry through AARP...I would never have known.

Consequently...I, too, am being penalized for the lapse in coverage. I still have no need for the coverage but have expensively acquired it under duress. I am going to contest the penalty to my last breath and have spoken at length with Medicare as well as my insurer about this issue. I have been encouraged by both agencies to complete the form and submit it. I consider that a good sign...but never do any dancing in the street 'til I see the proof of my quests with my own eyes.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

I'm so sorry for your loss. I see you have come about your extensive knowledge on this topic the hard way. Thanks for sharing.

I assume my health coverage would evaporate too should my DH die before me. I know we opted for the larger, non-survivor pension when he retired and the health plans are deducted from the pension. He has always been more physically robust than I and will probably outlive me, but your is a remnder I needed to get.

Short of moving to Canada -- or discovering that I've had amnesia about serving in the US Army and am eligible for some great deals from the VA -- I'll be scrounging for plans too.

Did you find a low-cost Part D plan? The best I've found in our Chicagoland area is United HealthCare's at about $350/year pp. My only expensive med is Advair, which will run me $444 a year under the plan. There's another whole story there about the manufacturer's endless grip on the patent and their profit on the product ($2500/yr. retail).

I hope to read here one day that you've won your penalty battle! Good Luck!

Sue


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RE: Any Way to Avoid Part D *Penalty*?

I went through AARP, Sue, and elected their MedicareRX Plan...for $32.90/mo...which is through United Health Care.
There are all sorts of plans out there...but my supplemental health policy is through AARP/United Health Care and I've been very satisfied with their coverage.

I opted for the broadest Part D coverage I could afford...after educating myself about tier coverages...because chances are...if I ever need to use the coverage...it will be for some expensive drug. I simply can't afford high out-of-pocket drug expenses now or in the future. There were several plans for less than $32.90/mo available in my CT area...but after reading the small print, the actual coverage wasn't as good as what United Health Care offered.

Thanks for the good luck wishes. I'm praying I'll have success, too. A judge [can't remember his name] ruled within the last few days that the government forcing people to carry health coverage is not legal. It's going to be very interesting to see if his edict affects the system. If nothing else...his edict is going to make a lot of people do some serious thinking about all this penalty business...and that may have a positive influence on my waiver request. I'm keeping my fingers [and toes] crossed.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

I think you and we have selected the same UHC Part D plan. We were offered "Preferred" and "Enhanced" and chose the former -- at $30.60/month.

I'm glad to hear something good about UHC. We didn't like them much when we had them through 2008 (group plan via DH's former employer). They were impossible about sending us the Part D information in the mail now too. I requested information at the end of October. Nothing. Called again in November. Still nothing, then we received four sets of information on drug plans for people in long term care. Eventually what we'd requested arrived -- minus a formulary, which was the reason I wanted the stuff -- to have the numbers in print. Not a good start.

When we called to enroll, the recorded conversation was fine up to where the representative spoke about our costs within the gap. The canned talk only mentioned a 93% cost for generics. I had her reiterate for the record that brand name drugs would cost us 50% in the gap. (Their literature says 50% in one place and is silent about it in another.)

Well, we'll see how it goes in 2011. DH should fall into the gap about mid-May and emerge into the 'Catastrophic Coverage' in August. I don't quite hit the gap with just my Advair, but I could need antibiotics or some darn thing. I had pneumonia two years ago.

If our government controlled the cost of drugs as other First World Nations do, we wouldn't be having this conversation or going through this rigamarole. LOL


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RE: Any Way to Avoid Part D *Penalty*?

Perhaps I had less trouble with UHC, Sue, because I accessed them through AARP. However...I received nothing until the open enrollment date rolled around...Nov 15th. After that, I was barraged with info and forms. The formulary didn't arrive until I was actually signed up and then it came along with other data including my membership card.

The 50% coverage during the gap is now a mandatory percentage required under the new Obama health plan.

What all of these insurance carriers fail to tell us...including Medicare...is that there is quite a list of drugs already covered under Medicare Part B. You need no Part D for that list of drugs and although I don't remember every one of them...I do remember that the list included many of the cancer treatment drugs. Here's a link to their site that you might find helpful. Their list covers things like flu shots, the pneumonia vaccine and diabetic test strips [which I use]. Your Advair may be there. My husband used to use Advair and I remember how costly it was. Of course, we had to order a 90 day supply of it when we did order so that always made the bill higher.

Some days it seems like there's no winning at this "game". I'm thoroughly convinced that getting older is definitely not for the faint of heart...and there are times when I'd like to spend the day under my bed. ;-)

Anne

Here is a link that might be useful: Medicare Info site


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RE: Any Way to Avoid Part D *Penalty*?

It's good to see that many *serious* drugs are covered by Part B. Thanks for that tip. (Advair isn't on the list.)

My late father was on dialysis for ten years; who knows if that could be in my future too? My mother died of leukemia when she was only a little older than I am now. I felt then and I feel now that the medical machine spends far too much on last, desperate, *hopeless* causes -- sometimes in the name of 'research'. We'll see how I feel about that when it's *me*!

Advair retail via UHC is $209/month; $2508/yr. -- just under the gap. If I buy via Medco I'll pay $444 for a year's supply.

Ah-hah! You've explained why the 50% drug coverage in the gap wasn't in the older information. It was printed before the Obama bill became law. I don't know if the Medicare drug coverage is part of what's in the courts. I read that two courts have found the law constitutional and one (most recent one) has not. There were something like twenty suits filed. LONG ways to go...


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RE: Any Way to Avoid Part D *Penalty*?

I cautiously agree with you, Sue, when it comes to hopeless causes...but after caring for my husband 24/7 throughout his 20 month battle with pancreatic cancer I'm reserving any final decisions. Although I, personally, might not opt for all the research meds/treatments that are available for such terminal illnesses if I qualified...I watched my husband willingly apply for and accept anything that was available to him even though he knew it probably wouldn't help. To many...HOPE outweighs knowledge as well as common sense.

Yes...there's a long way to go and I doubt that mandatory insurance coverage will be reversed to any great extent. Amended...maybe. However...I do believe that this penalty act/requirement will be eliminated/overturned. To me, it's ludicrous to penalize someone for lack of information...or for lack of funds...to fulfill a governmental demand. It does nothing more than increase the poverty populace and add a fear factor to the lives of those who can least afford it. The next thing you know they'll be throwing people in jail for not subscribing to their mandatory insurance plans.

Wow! What a difference in price between UHC and Medco. That's positively scary!!! I had [just fired him] a Dr who thought I should use an inhaler for what he "guessed" might be an early case of COPD. Because he couldn't substantiate his diagnosis to my satisfaction...and because I have adverse effects to most meds...I refused his edict and concentrated on breathing exercises as well as keeping my home moister during this time of year. So far so good...but after seeing what Advair costs you...I'm sure that I'll avoid it at all costs.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

Just a last note about the Advair. If you need it, best take it! I'm grateful they invented it, but resentful that the company effectively forced an alternative off the market. You used to be able to buy the two active ingredients separately (and cheaply) and inhale them in sequence, to much the same effect.

GlaxoSmithKline still collects $2500 a year on my prescription. I'm paying $444 and my UHC Part D policy pays the rest. So...if you DO need Advair, you'd 'only' pay $444 for mail order under the UHC policy.

Advair didn't come along soon enough for me. There was only prednisone when my lungs were bad -- resulting in bone loss -- resulting in two nice, expensive hip replacements before I was 65. I developed asthma shortly after my mother died. I chalk it up to delayed stress.

I hope you are doing fine without meds, but I'd urge you to reconsider Advair if shortness of breath is adversely affecting your life. I have to pay close attention to my breathing -- learned my lesson after getting pneumonia!


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RE: Any Way to Avoid Part D *Penalty*?

My husband, too, used a steroidal asthma inhaler for years before Advair became available and I've often wonder to what detriment.

So far I'm surviving without the use of any meds. I'm not convinced that my problem is COPD. I'm more inclined to think that it may be stress induced asthma as I come from an asthma laden family. But I have noticed that cold, dry air...or on the opposite end of the scale...hot, dry heat cause distressed chest/lung pain. As long as I relax and breathe therapeutically...the problem subsides and/or goes away entirely. I use an in house humidifier during the winter to counteract the effects of my electric heat...cover my nose/mouth area when I go outside...breathing moist warm air through my mouth.

If my symptoms accelerate, I'll have no choice but to use an inhaler but, in the mean time, I'm going to do everything I can to strengthen my breathing capabilities so I can avoid such use as long as possible.

Can you get and/or tolerate the pneumonia vaccine, Sue? I used to contract viral pneumonia on average every other year for eons until the vaccine became available. I got the first shot and barely tolerated a booster shot 5 years later. But I'm protected. I haven't had a problem since the first shot. The vaccine works! Without it, I doubt I'd survive a bout of pneumonia today.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

We both had the pneumonia vaccine four years ago. I didn't have viral pneumonia; it was bacterial. We both got sick after we arrived on Maui. My cough went to pneumonia and DH's to bronchitis. I failed to recognize the seriousness until my temperature soared. That was a nasty bug. Thoracic MD did a biopsy of the material in my right lung and they did a PET scan as well. Nothing serious. It just took months to recover. I don't remember ever falling asleep sitting up before then! Weak.

I have about 70% breathing capacity now and would be in the soup without Advair. Within a few months of starting it I have not had to use my 'rescue' inhaler more than twice a year, and have only needed prednisone once in a great while.

We have a 10-year-old house with flow-through humidifiers and 6" thick pleated filters on the furnaces. One of my best weapons is my central vacuum, which takes any dust right out of the house. We have all hardwood and low-pile orientals. We also have a Westie, a breed that isn't supposed to shed much. However, Eliot is a puppy mill rescue, and he DOES shed! (Oil capsules help some.)

I don't do super-cold air well -- the air we've been having in abundance all month! I too mouth-breathe through a scarf outdoors. Yesterday we attended our DGS's Kindergarten Christmas Concert, starting at 8:30 a.m. The cold air set me coughing but at least I didn't need the rescue inhaler, and it soon stoped.

We leave for Maui mid-January. Maybe our plane will not be loaded with germs! There have been times out there when I forgot to use the Advair -- no symptoms. We'll see how I do this year. I've sometimes wondered if I wouldn't be better living near the ocean. My mom was from RI and I've always loved being near the water. Kihei/Wailea is rather different from Pt. Judith and the Cape!


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RE: Any Way to Avoid Part D *Penalty*?

I've never lived on the ocean...but I do agree that the ocean air is extremely beneficial. I'm a New Englander by birth and despite living all over the world during my life time...I still prefer being home here. The Cape was my "stompin'" grounds as a youngster and young adult. These days...far from youth...I do well to walk the CT shore from time-to-time. If I had my druthers...I'd park myself there...permanently. The salt air does wonders for my breathing/sinus problems...and just the spectacular motion/vision of the ocean takes care of the rest of me.

I rarely, if ever, cough...so I must be doing something right. My only signal that some thing's amiss is the rare pain on/near my right lung and very occasional shortness of breath which I can "fix" with several short breaths. I've just had my yearly cardiology check up so although these symptoms sound more like heart problems...my EKG denies that.

If I were you, I'd wear a facial mask...as well as surgical type gloves...while flying. Airplanes and school buses are nothing more than fancy incubators for every germ/virus that's known to mankind...and then some. Wearing this type of protection isn't as rare as it once was and it sure beats spoiling a wonderful vacation. Maui in January sounds just delightful. Enjoy! I'm sure there'll be icicles hanging from my nose by then.

I'm a non-medicating diabetic [immuno challenged] and at this viral time of year...I don latex gloves when I do my marketing. I've had more people come up to me in the market and tell me they're going to follow my example the next time they shop. Every time I take a look at those shopping cart handles I shudder to think what lurks upon them.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

In a way I feel I have accumulated more immunities as I've aged, but I have thought about the mask for the plane!

DH and I wash our hands often; don't touch our mouths or eyes while out of the house; use the cart-handle wipes the grocery provides.

Our biggest germ-sources are our DS, DIL and DGS! DS is a paramedic. DIL teaches junior high math. DGS is in that mecca of germs, Kindergarten! We were in an ideal germ zone Thursday morning, the Christmas Concert at DGS's school. Three weeks ago DGS was sent home from school, along with his whole class -- head lice! (I was glad to see at the concert that some of the boys' hair has grown out since the shearing. The girls' moms took them to a beauty shop in the city that *specializes* in lice removal. Ugh.)

My mother was 'not quite' a Native New Englander. Despite having lived in RI from the time she was a tiny child, she'd been born in NYC. (You probably know how closely guarded is the title Native New Englander!) Her father's family were pre-Rev. War immigrants from Scotland to the Carolinas. My paternal grandmother's family, the Eliots, came even earler, to Stonington then on to upper NY and PA. I'm primarily Scots with some Swiss and French Protestants in the mix.

A Happy Christmas to you! Here's to Good Health for us both!

Sue


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RE: Any Way to Avoid Part D *Penalty*?

immunities ~ I wish I could say the same. I seem to be more sensitive to all sorts of airborne "things" that never bothered me before. But in all fairness...my genetic history is just terrible and I should probably count my blessings that these "sensitivities" waited this long to annoy me.

germ sources ~ Good grief! They've all ganged up on you, Sue. You don't stand a chance!

Native New Englander ~ LOL Oh my. Yes! That was pounded into me as a "youngin". I qualify for DAR on my father's side but my mother never being a "joiner"...it was not foisted upon me. By the time it really made any difference to me...I was living in an area that had absolutely no idea what "DAR" meant let alone its presumed importance.

A very Merry Christmas to you and yours, Sue...as well as Good Health. It looks like a previously predicted huge snow storm is going to miss us this weekend...but we may get snow on Christmas. Nothing would tickle me more as long as I can shovel out. ;-)

I'm assuming...from your sign-in name...that you reside in the Chicago area. One of the coldest Christmas's I ever spent was in the Chicago area...Glen Ridge to be exact...but I loved it. Being in down town Chicago during the winter is a real challenge to ones fortitude. It didn't matter how bundled up I was...I still froze when the winds whipped up.

Anne


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RE: Any Way to Avoid Part D *Penalty*?

Correction: PARK RIDGE...not Glen Ridge. Sigh. Brain overload...or maybe...brain drain. It was 35 years ago so I'll use that as part of my excuse. ;-)

Anne


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RE: Any Way to Avoid Part D *Penalty*?

Hah! My parents moved to Park Ridge before I was born. My mother was so homesick for the hills of New England that she used to drive back and forth over the railroad embankments. LOL That's how *I* got to Park Ridge; how about you?

I guess I am a 'reverse snob'; I never pursued the DAR thing either.

(I would have emailed this, but see no address for you. You can email me if you'd like.)


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RE: Any Way to Avoid Part D *Penalty*?

Afternoon, Sue.

Look for an email from me through your Garden Web page...giving my email address. Once I hear from you...I'll give you the history of my Park Ridge time. I truly loved that town and all its charm.

Anne


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