Tag: donut holes

Prescription Drug Assistance: Where to Get Help

Here is a Helpful article that was recently in the Dayton Daily News.

By Marci Vandersluis

Contributing Writer

I recently visited with a couple that shared that they were having difficulty paying for some of their prescription medications. One spouse stated that some of their medications had very high out of pocket costs. These co-pays were affecting their ability to pay for some needed home repairs along with food purchases. While this article has no magic solutions on how to eliminate prescription drug costs, it should be of some relief to know that with a little perseverance, along with some web “surfing”, there are programs and services available directed towards providing prescription assistance to lower income older adults.

Since 2006, those eligible for Medicare have been encouraged to enroll in a Medicare Part D plan, which provides prescription drug coverage. The two ways to get coverage are either through adding drug coverage to original Medicare, or to enroll in a Medicare advantage plan that offers Medicare prescription drug coverage. Beneficiaries must first have Medicare A and/or B to enroll in a drug plan and must have Medicare A and B to qualify for enrollment in a Medicare Advantage Prescription Drug plan. It is important to note that while enrolling in a Medicare D plan, is voluntary, not signing soon after eligible or when other medical coverage (such as an employer sponsored plan) ceaseD-resized-600s will result in a monthly financial penalty that will continue through the duration of coverage.

Most have found that while the implementation Part “D” has provided significant cost saving, it continues to present some challenges for beneficiaries. One such frustration is the feared coverage gap or “doughnut hole.” In 2015, once the beneficiary and drug plan have spent $2960, the person is responsible for much higher of pocket costs for prescriptions. Once these costs reach $4,700 the beneficiary is only responsible for 5 percemt of prescription costs, for the remainder of the year. While Medicare is working on more discounts for those in the coverage gap with the ultimate goal of closing the gap in 2020, there are still significant costs while in the “ doughnut hole.” Monthly statements from your drug plan will outline explanation how much has been spent on medication and if you have reached the coverage gap.

Co-pays for some medications can be very expensive even when not in the coverage gap. Fortunately, for those who meet certain financial guidelines there are some programs to help with prescription drug costs. One such program is the Chubby Checker, Patty Duke, endorsed Medicare Extra-Help program. Individuals with income of approximately $17,655 yearly income ($23,895 for married couples), with resources of approximately $13,640 ($27,250 for married couples) should consider applying for this program as it can offer considerable savings. See below for the link to apply online. If there are additional circumstances, if only marginally above these guidelines, or even if in doubt regarding eligibility, it is encouraged to apply. The Medicare website also advises contacting and your specific drug plan to see if eligible for any type of extra help.


Ohio Benefit Bank-Consumer Hotline: 800-648-1176 or www.ohiobenefits.org

United Health Solutions: 937 220-6600 or www.uhs-dayton.org

Partnership for Prescription Assistance: 888-477-2669 or https://www.pparx.org

Needymeds: Helpline 800-503-6897 or http://www.needymeds.org/newuser

Ohio’s Best Rx: 866-923-7879 or http://www.ohiobestrx.org/en/index.aspx

Good RX-drug discount card: 888-799-2553 or https://www.goodrx.com

Drug companies that offer assistance:http://www.needhelppayingbills.com/html/get_free_prescription_drugs.html

Medicare information on lowering drug costs: 800-633-4227 or https://www.medicare.gov/part-d/costs/coverage-gap/ways-to-lower-drug-costs.html

Ohio Senior Health Insurance Information Program (OSHIIP): 800-686-1578 orhttp://www.insurance.ohio.gov/Consumer/OSHIIP/Documents/whatisoshiip.pdf

Medicare Extra Help: 800-772-1213 or www.socialsecurity.gov/extrahelp (Online application)

Which Saturday Night Live cast member turns 65 in March? Find out here!

William Macy March 13-
William Macy may be best known for his lead role in Fargo (1996), for which he was nominated for an Academy Award. His film career has been built mostly on his appearances in small, independent films, Macy has described himself as “sort of a Middle American, WASPy, Lutheran kind of guy . . . Everyman.” He got his start in theater and had roles in more than 50 Off-Broadway and Broadway plays in New York. Later, he appeared in numerous films that David Mamet wrote and/or directed, including House of Games, Homicide and Spartan. Other Macy roles of the 1990s and 2000s included Boogie Nights, Pleasantville, Magnolia, Jurassic Park III and Seabiscut. Macy has also had a number of roles on television. In 2003, he won two Emmy Awards, one for starring in the lead role and one as co-writer of TNT’s Door to Door, based on the true story of a door-to-door salesman born with cerebral palsy. His work on ER and Sports Night has also been recognized with Emmy nominations. In 2007, Macy starred in Wild Hogs, a film about middle-aged men, which was a financial success. In 2010, Macy received high critical acclaim for his performance in Showtime’s Shameless, eventually getting an Emmy nomination for Outstanding Lead Actor in a Comedy Series in 2014. Macy made his directorial debut with the independent drama Rudderless (2014) and serves as director-in-residence at the Atlantic Theater Company in New York. He and actress Felicity Huffman have been married since 1997.

William HurtMarch 20- William Hurt made his film debut as a troubled scientist in the science-fiction feature Altered States (1980), for which he received a Golden Globe nomination for New Star of the Year. He subsequently played a leading role, as a lawyer who succumbs to the temptations of Kathleen Turner, in the well-received neo-noir Body Heat (1981). The step-grandson of Henry Luce, founder of Time magazine and actress-writer Clare Boothe Luce, Hurt co-starred in The Big Chill. In 1985, Hurt garnered substantial critical acclaim and multiple acting awards, including an Academy Award and a BAFTA Award (British Academy of Film and Television) for Best Actor, for portraying an effeminate gay man in Kiss of the Spider Woman. He received another two Academy Award nominations for his lead performances in Children of a Lesser God (1986) and Broadcast News (1987) and for Best Supporting Actor in A History Of Violence (2005). Throughout the 1980s, Hurt remained an active stage actor, appearing in Off-Broadway productions, including Henry V, Fifth of July, Richard II and A Midsummer Night’s Dream. In 1985, he received his first Tony Award nomination for the Broadway production of Hurlyburly.Hurt appeared in the cast of Vanya, an adaptation of Chekhov’s Uncle Vanya, at the Artists Repertory Theatre in Portland, Oregon. In 2006, he was in the TNT mini-series adaptation of Stephen King’s Nightmares and Dreamscapes. In 2008, Hurt starred as General Thunderbolt Ross in The Incredible Hulk. He appeared as President Henry Ashton in the 2008 action-thriller Vantage Point. In 2009, Hurt became a series regular on the FX series Damages, playing a corporate whistleblower, for which Hurt earned a 2009 Primetime Emmy Award nomination in the “Outstanding Supporting Actor in a Drama Series” category. In September 2010, Hurt played U.S. Secretary of the Treasury Henry Paulson in the HBO film Too Big to Fail and starred as Captain Ahab in the 2011 television adaptation of Herman Melville’s novel Moby-Dick.

Martin ShortMarch 26 – Martin Short is best known for his comedy work, particularly on the TV programs SCTV and Saturday Night Live. Originally intending to pursue a career in social work, in 1977 he came to public notice in Second City Television, or SCTV, which ran for several years in Canada, then the United States. At SCTV Short developed several characters before moving on to Saturday Night Live for the 1984–1985 season, including oddball man-child Ed Grimley. In addition to his work on SCTV and SNL, Short has starred in several television specials and series of his own, including The Martin Short Show (1994-2000), as TV interviewer Jiminy Glick on Comedy Central’s Primetime Glick (2001–03) and I, Martin Short, Goes Home (2011), which follows Short’s return to his native Hamilton, Ontario. Beginning in October 2014, Short has been starring in the Fox sitcom, Mulaney, playing the boss of the show’s central character.In film, Short appeared ¡Three Amigos!, (1989), the 1991 remake of Father of the Bride and Tim Burton’s sci-fi comedy Mars Attacks! (1996); and wrote and starred in Jiminy Glick in Lalawood (2004). Short also provided the voices of several animated film characters, including in We’re Back! A Dinosaur’s Story (1993) and in Madagascar 3: Europe’s Most Wanted (2012). In theater, Short played a lead role in the 1993 musical version of the Neil Simon film The Goodbye Girl, on Broadway, receiving a Tony Award nomination and an Outer Critics Circle Award. He had the lead role in the 1999 Broadway revival of the musical Little Me, for which he received a Tony Award and another Outer Critics Circle Award. In 2003, Short took to the stage once again in the critically acclaimed Los Angeles run of The Producers. Short performed in his satirical one-man show, with a cast of six, Martin Short: Fame Becomes Me, on Broadway and has continued to tour in his one-man show, which features many of his best-loved characters and sketches.

Next “Solving the Medicare Puzzle” Workshop

Announcing our next “Solving the Medicare Puzzle” Workshop!  Monday, March 16 at 5:30 pm in our Troy office at 1385 Stonycreek Road in Troy.

Are you, or someone you know, feeling overwhelmed about signing up for a Medicare Supplement? Is your mailbox overflowing with flyers and invitations? Are you more confused now than you were a couple of months ago? What do all of the letters of the alphabet have to do with healthcare? Well, look no further. Sign up today so you can be in the know!

Call our office at 937-492-8800 to reserve a seat (or two!), or simply complete the form below:

[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’I would love to come! There will be a total of __ people in our group:’ type=’radio’ options=’1,2,3,4’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Website’ type=’url’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]

Medicare Supplement policyholders are paying too much for their coverage!

If your parents were like mine, they probably taught you to spend your money wisely. Let me use a story here to make a point. Suppose you are shopping for a new refridgerator. Your first stop is at Sears where you find the perfect Frigidaire XL2014, and at a great price, $2100. But because your parents told you to shop before you buy, you decide to check a few more places. The last stop you make is at Lowes, where you find the same Frigidaire XL2014. Same make, same model, same features…they are IDENTICAL! Only the one at Lowes costs $1500. Do you go back to Sears and buy the one for $2100? Unless you own stock in Sears, or your son is the sales rep, I hope your response is…Absolutely not! Why would you spend $600 more on the same thing. But Retirees are doing that very thing with their Medicare Supplement insurance.


But you may ask, “How do I know I’m getting the same benefits?” The answer is simple, our government did something right. Prior to 1992, Medicare Supplement insurance plans were not standardized. What this meant was that each insurance company’s Medicare supplement plans offered different benefits. This made it almost impossible for the Retiree to shop their coverage from company to company. Compare it to shopping for a car today. You can’t really compare cost from one dealer to another because the options are completely different. This one has leather seats, but the other one has On-Star. This one has a DVD player, but the other one has alloy wheels. It is impossible to truly compare cost because you are never comparing “apples to apples.” The same was true with Medicare Supplement insurance prior to 1992. But in 1992 the federal government stepped in and “standardized” Medicare Supplement insurance.


They did this because prior to 1992, unethical salespeople were taking coverage away from Retirees in order to save them money, and they weren’t disclosing the fact that they reduced their coverage. So the government stepped in and standardized the plans so this couldn’t happen anymore. They did this by offering 11 plans and giving them the letter names of A through N. In other words, it means you can compare a Plan F with one company to a Plan F with another company and know that the benefits are IDENTICAL. So you no longer have to say, “I know my supplement is expensive, but I don’t want to change it because it pays so well.” As long as you stick with the same Plan letter name, the new company is legally obligated to pay the same benefits as your old one.


So what does this mean for you? It means it would be a good idea to know what premium you pay compared to what others your age and in your area are paying for the same plan. This is important because you may be paying hundreds if not thousands of dollars more per year in premium and not be getting any better benefits. For example, the premiums for a Plan F for a 70 year old female range from $130/month on the low end up to $276/month on the high end. That’s a difference of $1,752 per year. And worse yet, the person paying $276/month is not getting any better benefits than the person paying $130. And don’t forget, you can change your medicare supplement policy any time of the year…you don’t have to wait for the Annual Enrollment Period at the end of the year.


If you would like to see how your premium compares, you can go to our website at www.seniormark.com and click on the “Supplement Rates” tab. And don’t worry, you will get instant numbers and we won’t collect your personal information. If you are not tech savvy just call us at 877-492-8803 and we will provide you with a free comparison report.


I bet your momma never thought shopping would be this easy!

Turning 65 and looking for some answers?

Are you turning 65 and wondering what the next step is? 

We will be holding our next Medicare Solving The Medicare Puzzle Workshop:

Wednesday, June 26 @ 5:30 pm – Location: Troy office — 1385 Stonycreek Road. 

This is an introductory session explaining the 4 parts of Medicare and what an individual’s options are when they turn 65 or retire and go on Medicare.  We have had an excellent response to these workshops, so if you know of someone who could benefit, please let them know.

Seating is limited, so please RSVP:  Toll Free – 877-492-8803, or comment on this post!

New and improved website~

Things are changing all over the place at Seniormark! We are so excited about these changes, because it means we will be able to provide the same excellent service our clients are used to, while being able to add even more ways of teaching and expanding the knowledge base of our clients.

Today’s exciting announcement is that our website has been completely redesigned and has a fresh new look! We hope you will head over there and take a peek. We will continually update it with new videos, keep our prices current, etc.  Bookmark it and visit often for changes!

Please check out the new website at https://www.seniormark.com and let us know what you think!

State Teachers Retirement…To Save or Not To Save

I am often asked about the health insurance coverage offered by the State Teachers Retirement System (STRS) of Ohio and whether a retired teacher should stay on the STRS coverage once they turn 65 and go on Medicare.  I will be assuming here that the retiree had 30+ years of service with STRS.

As with all situations there is never a hard fast rule for everyone, but in most cases for the employee it is what I call a “no brainer.”  The current premium in Ohio for the employee is $81/month.  The plan offered by STRS is the Aetna Medicare Plan (PPO) which is a group Medicare Advantage Plan.  The plan has a $500 deductible and a $1500 annual out of pocket maximum (which includes the deductible).  More importantly, the prescription drug plan does not have the infamous donut hole like Medicare Part D has.  So if you are a retired teacher, be very wary of “advisors” recommending you leave STRS to go on a Medicare Advantage plan on your own.  If you have already made this mistake, don’t worry because you may be able to get back on your STRS plan.  Just give them a call to find out what to do.  You may have to wait until the Annual Enrollment Period (AEP) before you can get out of your current plan.

For the spouse of a retired teacher the story is much different.  The current premium for the spouse is $290/month for the same Aetna Medicare Plan (PPO).  On the surface it may seem like the answer is cut and dry, but not so quick.  There is no doubt that you can get much better medical coverage for a much lower premium.  But like I tell all of my clients, premium doesn’t tell the whole story.  We can’t forget about the prescription drug coverage.  Like I said above, you have to deal with the donut hole when you leave STRS and go with the Medicare Drug Plan.  So whether it makes sense to leave STRS and go out on your own will depend on your medications.  This is where you would be wise to contact a professional who can analyze the costs for you.  Here are two clients I have worked with in the past, with two very different outcomes:


Client 1:

This gentleman was in good health and only on three generic medications.  We were able to put him on a Medicare Supplement Plan G for $106/month and a Part D prescription drug plan for $25/month for a total of $131/month.  He wasn’t even close to having to worry about his donut hole.  With Plan G his annual out of pocket maximum on medical expenses is $140.  So for this gentleman he saved $159/month and now has much better medical coverage.

Client 2:

This lady was in fair health but had a very long list of medications including several brand name meds.  We could have put her on the same Plan G for $106/month and given her better medical coverage, but the real story was her medications.  With her meds she was going to go WAY into her donut hole.  This seriously raised her cost.  The premium for her drug plan was only $25/month, but because of the donut hole her total cost was going to average $333/month.  This combined with his $106 for Plan G made it a total monthly cost of $439/month, which would be $149/month more than she was currently paying.  We obviously told her to stay on STRS.

As you can see, you can’t just look at premiums when you are making a decision on the best plan for you.  Looking at the two examples above, the premium was the same for both clients, $131/month.  But the expenses were VERY different.  So before you make a decision you may regret contact a professional (not a salesperson) who can help.

 If you know a retired teacher, please pass this article along (just click the SHARE button below).  I’m sure they would appreciate it!

Donut Holes Aren’t Always Tasty!

If your brain works like mine, it thinks about food a lot more than it should.  And it’s always food that’s not good for me, like donut holes.  Nothing beats a donut hole.  It’s like eating a whole donut in one bite…AWESOME!

But when it comes to the Medicare Prescription Drug Plan, donut holes lose their luster.  Don’t ask me why Medicare decided to give it the name donut hole, maybe it was to take the edge off its bite (no pun intended, unless you think it’s funny).  The Donut Hole, otherwise known as the coverage gap, is exactly what it sounds like.  It is a hole in your coverage.  Here’s how it works according to the Medicare guidelines:

Stage 1: The plans start off with a “Deductible Period.”  This is the amount you must pay for out of your pocket before the plan will pay anything.  Not all plans have a deductible.  The plans cannot have a deductible higher than $320.

Stage 2: After you have met your deductible (if you have one) you go into what is called the “Initial Coverage Level.”  During this stage you will pay approximately 25% of the cost of the medication.  Most drug plans set up copays during this stage based on the medication which they assign to a Tier.  For instance, you might pay a copay of $5 for generics (Tier 1), $25 for formulary brand names (Tier 2) and $45 for nonformulary brand names (Tier 3).

Stage 3:  Once you have had $2930 in total drug costs, you will go into the “Donut Hole.”  Notice I said “total drug costs.”  This means what you paid for the medications plus what the plan paid.  For example, if the total cost of a medication is $100 and you only had to pay a copay of $25, it’s the entire $100 that goes toward the donut hole number.  Once in the donut hole you will pay 50% of the full cost of any brand name medications and 86% of the full cost of any generics.  Due to the new healthcare reform, these percentages will continue to decrease each year until they reach 25% in the year 2020.

Stage 4:  Once you have paid a total of $4700 in out-of-pocket costs (not including the premium for the plan), you enter the “Catastrophic Coverage Level.”  Notice that this amount is out-of-pocket meaning that you would have to pay a total of $4700 before you entered this next level.  Once you hit this level you would only pay approximately 5% of the cost of the medication for the rest of the calendar year.

Once you reach the end of the calendar year, all plans start back at Stage 1 on January 1st.

According to a report from the Kaiser Family Foundation, approximately 19% of Medicare beneficiaries reach the donut hole at some point during the year.  So not everyone has to worry about hitting the donut hole, but if you do your expenses can add up in a hurry.  For those of you who are in this situation, maybe you can ease the pain with a box of donut holes (the good kind from the local bakery).

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