Healthcare Solutions for Seniors

Donut Hole Explained

JimSoucy — Mon, 13 Jun 2011 02:13:40 +0000

The Donut Hole is a moving target with respect to prescription coverage for people with Medicare Part D plans.

As of plan year 2011, here is how it works…

You must pay your co-pays (“X”) and the Medicare Part D provider (the insurance company) must pay the balance of the cost of your drugs (“Y”). When X + Y > $2,840, you enter the “donut hole.” Once in the donut hole, also known as the “coverage gap,” you are responsible for about 50% of the retail cost of most brand name drugs and 93% of the cost of generic drugs until your yearly True Out-of-Pocket (“TROOP”) costs (not including any plan premiums) equal $4,550.

Once your “TROOP” costs have reached $4,550, your plan pays the majority of the drug costs until the end of the year.

What is a Formulary?

JimSoucy — Mon, 06 Jun 2011 00:05:08 +0000

A formulary is a list of prescription drugs available by discount from an insurance company. Some insurance companies have multiple formularies at various plan price levels.

It is important to make sure that you make sure your list of prescription drugs is included in a plan formulary BEFORE enrolling in a plan.

Advantages of a Medicare Supplement Plan

JimSoucy — Sat, 04 Jun 2011 18:00:05 +0000

Although they may not be suitable for every Medicare customer based on price, Medicare Supplement plans offer some distinct advantages over some of the other Medicare alternatives. Here are a few of pluses to going with a Medicare Supplement plan:

No Surprises - Many Medicare Supplement plans have no co-pays or deductibles. This means that when you visit the doctor or enter the hospital for either in-patient or out-patient surgeries you will not have to pay anything.

No Network - Many Medicare Supplement plans do not restrict customers by network, which means that customers can travel throughout the United States and as long as they are utilizing a healthcare facility that accepts Medicare, they are covered the same as when they are in their home state. When you travel outside of the United States you are covered for emergency services only.

Plan Consistency – Unlike Medicare Advantage plans, Medicare Supplement plans do not change very often and aside from price, the plans are fairly consistent from company to company.

Flexibility with Part D Coverage – Most people see Part D as the weakest part of Medicare. While many Medicare Advantage plans have Part D included in their plans, customers have to abide by the formulary (drug list) for that built-in Part D plan. When you have a Medicare Supplement plan, you have the option of choosing any Medicare Part D plan available in your area, which gives you the flexibility to choose a plan that best suits your needs based upon the prescriptions that you might be taking.

These are just some of the benefits of choosing a Medicare Supplement plan for your healthcare needs. For more information about the plans available in your area, complete our contact form or call 1-800-515-9081.

Credible Coverage for VA Members

JimSoucy — Tue, 10 May 2011 00:40:02 +0000

Eligible veterans and their spouses who received prescription drug coverage through the VA are considered to have credible coverage whether or not they have had a Medicare Part D plan in place.

This is important to know because sometimes the company sponsoring a Part D plan might not automatically recognize VA benefits as providing the required credibile coverage and charge plan participants a penalty for having a lapse in their prescription drug coverage of 63 days or greater.

If you are Medicare eligible and over the age of 65, having a lapse of credible coverage longer than 63 days exposes you to a penalty charge which increase each month and will be assessed for the duration of your participation in a Medicare Part D plan.

For more information about understand Medicare prescription credible coverage, or for a FREE, no-obligation consultantion about your healthcare options with Medicare, please click here or call 1-800-515-9081.