Every big MN insurance company knows that I’m going to get Medicare benefits next year because my mailbox has been full with their enticements for months.  I am reading them because I don’t understand the Part D donut hole trap. My DH and I may pick different plans.  I’m considering a Medicare Medical Savings Account (Advantage) plans so I can use the account funds for a non-network dentist.  However, I’ve discovered that veterans enrolled in VHA cannot join Medicare Medical Savings Account (MSA) plans!   No explanation for this rule is offered on the MSA webpage–see “Who Can Join, right menu.”  My DH will have VA, original Medicare and maybe a stand-alone dental insurance.

Dental insurance?  It costs less to insure our Civic to the max than to buy a premium dental plan with a lousy $1,500 yearly spend limit. Dental insurance is a major rip-off for consumers but we may allow ourselves to be suckered into a basic plan if sanitary skillful local dentists are covered and accepting new patients.  That’s a big if.

(Veterans with dependent kids will be glad to know that when ACA kicks in, thousands of children (until 19) will get pediatric dental benefits through the exchanges.  I’ve only checked Vermont’s exchange.)

The Part D Donut hole.  I finally found a YouTube video that cleared up my confusion. The presenter, a medigap sales person, explains a smart tip to stay out of the blasted hole for as long as possible.  Once you see this video, you’ll see how tricky the no/low deductible and premium carrot plans like Humana’s cheapie Walmart Part D plan, isn’t necessarily a good deal.  His basic advice is to buy your $4 generics at Walmart, Target, etc. for cash and only your branded drugs with your part D plan card.  All I can say is, watch the video to understand why.  Be aware that different plans put the same drugs in different tiers and may have deductibles.  By design, the whole thing requires a lot of tedious study. The medical industry is counting on us to give up and go for the easy carrots and cheerful sales messages.

If you receive primary care at the VA, you don’t have to worry about this.  Based on your VA priority level, your meds will be cost-free or $9.00 per med.  Your VA primary doctor will also accept prescriptions from your non-VA doctor (last paragraph).

For those who might be taking the new pill form of HCV drugs next year, I expect the VA would be the least expensive route because even when one has passed through the donut hole into the covered catastrophic donut cake, you’ll still pay co-pays and/or co-insurance.   Over the next few years, the gaps may close and the discount percentages improve, but the drug companies can just raising their prices.  The insurance plans will increase their dispensing fees.  (I’ll try to find some good plan D calculators links to post later.)

The take-away is to stay away from Medicare’s donut hole if possible and donuts, even chocolate ones, in general.  And possibly self-insure and manage your own dental care in a health/medical saving health account plan or private bank account.