Tag: prescription drug plan

Medicare Supplement policyholders are paying too much for their coverage!

Posted on July 21, 2014 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Social Security, State Teachers Retirement

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!

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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