What You Need To Know About Prescription Drug Plans (Part D)

By B. Loughead

  

Medicare Part D was created by the passage of the Medicare Modernization Act and went into

effect as of the 1st of January, 2006. If you are eligible for Medicare Parts A and B or already have that coverage, you are also eligible to receive the Prescription drug plans (Part D). If you currently have Medicare, you are eligible to receive this benefit provided you enroll in a Medicare Advantage (MA-PD) plan or a stand-alone PDP (prescription drug plan). The Medicare program approves and regulates these types of plans.

What You Should Be Aware Of With Part D Coverage

You need to be aware that these plans are designed and administered by private healthcare insurers. However, Prescription drug plans (Part D) coverage is not standardized unlike Parts A and B. Each plan selects which medications or classes of medications they are going to cover as well as the level at which they are covered. They also have the right to select those drugs that they do not want to cover. The primary exception would be those medications that are excluded by Medicare coverage.
These include barbiturates, benzodiazepines, and narcotic cough suppressants but are not exclusive to these. Additionally, those plans that cover drugs which have been excluded by Medicare cannot pass the costs of them on to Medicare. If by chance Medicare is billed for these medications, they will refuse payment on them or back-charge the insurer that sent those costs onto them. If you are a Medicaid and Medicare beneficiary, Medicaid will occasionally pay for medications such as benzodiazepines or other types of restricted controlled substances.

The "Donut Hole"

You may or may not have heard the terminology "the donut hole" when researching Prescription drug plans (Part D). This is a gap in insurance coverage that oftentimes occurs once the pre-set prescription medication spending limit has been reached by you and your plan. Not only will your plan quit paying for any further medication expenses once that limit has been reached, there will be a period of time where you will be 100% responsible for payment of your prescriptions.
In closing, you need to keep in mind that there will be a donut hole found in every type of coverage plan. However, the reality is that many individuals never reach the donut hole of their coverage. In addition to this, you may be eligible for discounts on both brand name or generic medications when reaching the donut hole. Fortunately, the donut hole should be phased out completely in 2020.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit http://www.SummitMedigap.com/ or call us at 1-888-40-Summit (888-407-8664). **We will provide a Free Part D report specific to your prescriptions to anyone who get's a Medicare supplement plan through us. It will show every plan available in your area and if it covers your prescriptions. It will save you hours of research.

How The $700 Billion Cuts From Obamacare Will Impact Medicare

By B. Loughead

 

In August of 2012, then presidential candidate Governor Mitt Romney went on the offensive regarding President Obama's proposed $700 billion Medicare spending cuts. Although Vice-Presidential running mate Senator Paul Ryan of Wisconsin has stated that Medicare should be transformed and plans to cut $700 billion in future Medicare expenditures, Obamacare would cut roughly $716 billion over a period of 10 years. So there is now a great deal of speculation as to how the $700 billion in cuts under Obamacare is going to impact Medicare.
In order to get Obamacare to pass, President Obama proposed $700 billion in across-the-board cuts that were extremely arbitrary in nature. Medicare patients will see reduced reimbursement rates for services provided them regardless of how poorly or well these patients are treated by healthcare and medical services. Nearly $160 billion in cuts to Medicare Advantage plans will also be incurred over the next decade as well. This means that by 2017, seniors will be paying nearly $4,000 more for healthcare.
Even worse is the fact that it has been estimated that this increase in healthcare costs will eliminate roughly 4 million seniors from all Medicare Advantage plans over the 6-year period beginning in 2012 and ending in 2018. Hospital payment rates would also be slashed drastically as a result of these Obamacare cuts. According to the program's Chief Actuary, these cuts could jeopardize any senior's access to healthcare.
In addition to the above, it has been estimated that 15% of all assisted living facilities and hospitals will no longer take Medicare patients in the future in order to prevent potentially huge financial losses resulting from payment of Medicare premium rates. Additionally, it is speculated that 25% of these institutions will no longer be a part of the Medicare program as of 2030.
According to Charles Blahous, a Stanford University fellow who specializes in domestic economic policy research, the Medicare cuts involved with Obamacare won't be used as replenishment for Medicare benefit trust funds. The reality is that the money from these cuts will pay for a huge entitlement spending expansion. So another question arises. Where will this $700 billion plus in Medicare cuts actually come from?
A portion of them will come from the harsh, restrictive control over medical billing procedures. However, the worse part regarding this entire scenario is how seniors are going to suffer from these cuts. With so many of them now living on fixed incomes, it could be financially disastrous in the long run.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit http://www.SummitMedigap.com/ or call us at 1-888-40-Summit (888-407-8664).

How does Medicare & Medigap insurance work?

Understanding the basics to Medicare:

• Medicare Part A, Hospital Insurance;
• Medicare Part B, Medical Insurance;
• Medicare Part C (Medicare Advantage), or
• Medigap Insurance (Medicare supplement insurance)  and
• Medicare Part D, prescription drug coverage.

Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B.  Some people with certain disabilities also may qualify for Medicare that are under the age of 65. 

Medicare Part Ais paid for by a portion of Social Security tax.  It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.  Part A has coinsurance and a deductible of $1,156 unless you have a Medicare supplement that covers that amount.  This is not an annual deductible and can be every 60 days in some cases.

Medicare Part Bis paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury.  It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.  Part B has a deductible and coinsurance unless you have a Medigap (Medicare supplement plan) that covers it.  It is important to get a Medicare supplement policy within 6 months of your Part B effective date.  This period is referred to as open enrollment and you are not required to qualify with health questions.

Medigap Insurance (Medicare supplement insurance).  Medicare Part A & B covers about 80% of the costs.  A lot of people decide to get Medicare supplement insurance (Medigap Insurance) to cover the gaps that Part A & B does not cover.  These plans tend to cover deductibles, coinsurance and sometimes copays.  There is no network so any doctor or hospital that accepts Medicare will accept a Medigap plan because it’s the law.  Also, the benefits can’t change from year to year.  The plans are designated with a corresponding letter and currently are Plan A through D, Plan F, Plan G and Plans K through N.

One of our Licensed Benefit Advisors can help make Medicare seem much easier to understand than it appears.  Click the link if you would like to Compare Medicare Supplement Plans Instantly Online.

Part C (Medicare Advantage) is optional if you decide not to get Medicare supplement insurance (Medigap Insurance).  Typically this type of plan has a network and requires you to get a referral to see a specialist.  The benefits to this plan can change from year to year and if you move you may need to change plans.  If you decide you want one of these plans it is very important to understand the “max out of pocket” expense section of the plan.  These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee.  You must have both Parts A and B to enroll in Part C.  You can’t get Medigap Insurance (Medicare supplement insurance) if you have Part C.

Part D(prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare.  Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.

Bill Loughead

SummitMedigap.com

We make Medicare seem easy!

1-888-40-Summit (888-407-8664)

info@summitmedigap.com

Medicare Premiums- The cost of Part B

Medicare Premiums- What does Medicare Part B cost?

You pay a premium each month for Medicare Part B (Medical Insurance). Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

How much does Medicare Part B cost?

Most people pay the Part B premium of $99.90 each month. You pay $140 per year for your Part B deductible and also co-insurance unless you have Medicare supplement insurance.  Some people automatically get Part B.  If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.  If you’re modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more. 

Social Security will contact some people who have to pay more depending on their income. The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree (for example, if your income goes down), you should contact Social Security.

Part B premiums by income

If your yearly income in from 2 years ago was:

File Individual tax return                       File joint tax return               You pay


$85,000 or less                                       $170,000 or less                   $99.90
$85,000 to $107,000                              $170,000 to $214,000            $139.90
$107,000 to $160,000                            $214,000 to $320,000            $199.80
$160,000 to $214,000                            $320,000 to $428,000            $259.70

In contrast, Medicare Part Ais paid for by a portion of Social Security tax.  It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.  Part A has coinsurance and a deductible of $1,156 unless you have a Medicare supplement that covers that amount.  This is not an annual deductible and can be every 60 days in some cases.

Medicare part A & B does not cover everything.  It is recommended to get a Medicare Supplement Insurance (Medigap Insurance) in order to make sure deductibles, co-insurance and co-pays are covered.  You can click the link if you would like to Compare Medicare supplement insurance instantly online.

Bill Loughead

SummitMedigap.com

We make Medicare seem easy

1-888-40-Summit (888-407-8664)

info@summitmedigap.com