Posted on Thursday, 22nd July 2021 by

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A number of our newsletter subscribers commented on my article titled, “Unexpected Medical Expenses.”  Several stand out and need further clarifications. One of particular interest was from Richard, he will turn 65 later this year and wanted to know if the drug manufacturer’s “savings card” that he now uses would be accepted after signing up for Medicare A & B.

Prescription Drug Discount Cards, available from various providers, may be able to find you a lower price than your insurance co-pay. Anyone can use them regardless of whether they have commercial insurance, Medicare, Medicaid, or any other type of insurance. They list the cost of your prescription at most of the pharmacies in your area so you can compare prices. If your FEHB plan’s cost for a certain drug seems high, compare them to one of the following discount card issuers:

I’ve used these when a drug I needed wasn’t on my plans formulary list and I wanted a specific drug, not a generic alternative.

Manufacturer’s coupons offer significant savings but often have stringent acceptance criteria. I ran into this issue several times since signing up for Medicare. Many of the manufacturer’s coupons can only be used when your prescription drugs are covered by a private insurer, not government programs like Medicare.

After signing up for Medicare I tried to refill my prescription for Asmanex Twisthaler, a medication I use to control asthma. The prescription was a covered formulary drug at the time and my copay without the discount was $120, with coupon, $60. The manufacturer disapproved the discount. The pharmacist ran it through twice without success and because it was the weekend, they couldn’t call their customer service department for clarification. The pharmacist said the coupons could only be used for private insurance. I had to explain to them that I had private FEHB insurance through GEHA for prescription drugs, not Medicare D. The pharmacist called the manufacturer on Monday and it was approved by phone.

If you run into a similar situation, let them know your prescriptions are covered by a private FEHB insurer, not by Medicare Part D and have them call the customer service department for assistance. Apparently, whenever the pharmacist logs in to the coupon site and selects Medicare as primary, the online system rejects the request.

As long as the drug is on your FEHB’s approved formulary list the manufacturer’s coupon should be accepted. Check with your pharmacist just to be certain. GEHA dropped Asmanex from their approved formulary awhile back. After this happened the manufacturer’s coupons were rejected and my FEHB plan offered alternatives. Proceed with caution when first using other medications. The side effects could be pronounced. One of the alternatives I tired caused an angioedema incident. If the approved alternatives aren’t effective, file an appeal with your provider to allow the use of the original prescription.  Now that Asmanex is not on my provider’s approved formulary list the coupons don’t apply and I would have to pay the full cost for the prescription, $324 in this case, if the substitutes don’t work and an appeal is rejected.

Another hidden Medicare cost is their income adjusted Part B premiums. I covered this in a recent article titled What is Medicare’s IRMAA Premium Adjustment?” The cost for Part B increases dramatically when your total income exceeds certain limits. Monthly premiums range from a low of $148.50 to as high as $504.90 per month! Many aren’t aware that the Modified Adjusted Gross Income (MAGI) that is used to determine what premiums you pay includes capital gains, taxable interest, tax-exempt interest, dividends, annuity income, wages, business income, and IRA distributions. If your income is close to one of the higher premium thresholds take care when taking capital gains, etc.

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Disclaimer: The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, and benefit information are subject to change. To ensure the accuracy of this information, contact relevant parties for assistance including OPM’s retirement center. Over time, various dynamic economic factors relied upon as a basis for this article may change. The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Last 5 posts by Dennis Damp

Posted in ANNUITIES / ELIGIBILITY, BENEFITS / INSURANCE, FINANCE / TIP, RETIREMENT CONCERNS, SOCIAL SECURITY / MEDICARE, SURVIVOR INFORMATION | Comments (0)


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