Tag: medicare prescription drug plan

Prescription Drug Assistance: Where to Get Help

Posted on August 10, 2015 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

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.

Resources

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)

Attention Seniors…Beware of Sharks!

Posted on October 1, 2012 by - Medicare Advantage, Medicare Drug Plan

A feeding frenzy is about to begin.  No, I am not talking about real sharks.  I am referring to the Medicare Annual Enrollment Period (AEP).  The Annual Enrollment Period is the time of year, set aside by Medicare, during which Medicare beneficiaries can enroll in or change their Medicare Advantage or Prescription drug plans.  The AEP runs from October 15 to December 7, although insurance companies and agents can begin marketing to you beginning October 1st.

The problem arises due to the fact that this is the only time of the year that insurance companies and agents can market their Medicare Advantage and Prescription Drug plans to you – unless you are new to Medicare.  In my opinion, this leads to very aggressive marketing behavior.  Now don’t get me wrong, just like every shark in the ocean is not out to bite you, not every agent and insurance company is out to take advantage of you, but you do need to be aware.

So what steps can you take to protect yourself?

Know what you have.  It is extremely important to know what type of plan you have.  Do you have Traditional Medicare Parts A&B paired with a Medicare Supplement policy, or do you have Part C of Medicare which is a Medicare Advantage plan?  If you have a Medicare Supplement policy, what plan do you have (A – N)?  If you have a Medicare Advantage plan, do you have a HMO, PPO or PFFS plan?  Do you have a stand-alone Part D prescription drug plan or is it part of your Medicare Advantage plan?  These are all important questions to ask yourself.

Know what you should do.  The first thing you should know is that you don’t have to do anything, unless your plan is terminated for some reason.  If that is not the case, and you are completely happy with your plan, you can just leave everything “as is.”  With that said, it is important to review any benefit, premium or formulary changes to your plan.  If you have a Medicare Advantage or Prescription Drug plan, your plan will send you an “Annual Notice of Change” packet explaining any changes to your plan for 2013.  Don’t assume that because your medication was covered this year that it will automatically be covered next year.  Finally, don’t let any agent or insurance company lead you to believe that you have to make any changes.

Know what you can/can’t do.  There are a lot of rules surrounding Medicare, so be careful when you do make any changes.  Some changes could get you disenrolled from a plan you didn’t intend to get disenrolled from.  Don’t assume all agents know these rules.

Know what agents can/can’t do.  It is important to know that agents cannot cold call you in any way, meaning that if you didn’t invite them, they can’t contact you – except by mail.  Be careful when requesting free information whether by mail or on the internet.  Many times when you request this free information, you have just given an agent permission to contact you.  If you have made this mistake in the past, you know how many phone calls you can get.  The Ohio Department of Insurance put out an excellent flyer called, “Medicare & You: Understanding & Protecting Yourself from Predatory Sales practices.”  You can view this form on their website.

Work with a trusted advisor.  When you do have questions or need to make changes to your plan, make sure you work with a trusted advisor.  An advisor is someone who listens to you and helps you find a plan that is right for you based on all the options available.  A salesperson is someone who will tell you what you want to hear so they can sell you a product.  Sometimes it’s hard to tell the difference, so do your homework on this one.  How long have they been in the business?  Are they a jack of all trades or do they focus on senior insurance?  Do they have a local office?  Do they have a website to help you research your options?  Do they work with someone you know who can vouch for them?  Are they available during working hours to help you, or do you just get their voicemail?

If you will do your homework and become knowledgeable in these five areas, you will have come a long way in protecting yourself and making sure you don’t get bitten when the feeding frenzy begins October 1st.

Donut Holes Aren’t Always Tasty!

Posted on February 2, 2012 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Social Security

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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