The Consumer Reports article published in the Aug. 18 Health & Science section, “Poll shows drug prices moving higher,” stated “when people covered by Medicare Part D plans reach the ‘doughnut hole’ — the situation where, after you and the plan pay $2,960 together, you have to pay fully for medications until the total reaches $3,310.” This is inaccurate for several reasons.
This year, once a Medicare beneficiary who is enrolled in a Medicare Part D Plan reaches the doughnut hole ($2,960), he does not pay full price for medications. Rather, he pays 45 percent of the plan’s cost for his covered brand-name prescription drugs and 65 percent of the plan’s cost for generic drugs. Once the beneficiary has spent $4,700 out of pocket for the year, his coverage gap ends, and he will pay a small coinsurance or co-payment for each covered drug until the end of the year.
WHAT IS THE DIFFERENCE BETWEEN MEDICARE SUPPLEMENTAL INSURANCE AND MEDIGAP INSURANCEThe two terms are synonymous. Medicare Supplemental Insurance is also called Medigap Insurance. It got this nickname because the insurance fills the gaps left by Medicare alone.HOW CAN I APPLY FOR MEDICARE SUPPLEMENTAL INSURANCE?The application process for Medicare Supplemental Insurance is very easy and can be done over the phone or in person. The process takes about 30 minutes and most times the policy can be issued within a week. You can call my office today at (239) 288 – 0880 , fill out the form on this webpage and I will be in contact shortly or send me an email at V.Reed.Speas@gmail.comDO I HAVE TO QUALIFY AND ANSWER HEALTH RELATED QUESTIONS FOR MEDICARE SUPPLEMENTAL INSURANCE?If you are turning 65 you are in a Guaranteed Issue period for the 7 months surrounding your 65 birthday. This means you will not have to answer any health questions and cannot be denied coverage for health reasons. There are other Guaranteed issue periods for Medicare Supplemental insurance some of them are: leaving a employer sponsored health plan, being dropped by a Medicare Advantage Plan or a Medicare Advantage plan you are enrolled in going out of business, or leaving a Medicare Advantage Plan after your first year.
Switching Your Medicare Advantage PlanUnder certain circumstances, you can change Medicare Advantage plans mid-year. Otherwise, you’ll have to wait for the open enrollment period for the year ahead.By Kimberly Lankford, September 4, 2015I haven’t been too happy with my Medicare Advantage plan this year—I started taking a drug with expensive out-of-pocket costs, and some of the doctors I want to see aren’t included in the plan’s network. Is it too late to switch plans?SEE OUR SLIDE SHOW: 11 Common Medicare Mistakes to AvoidProbably. In most cases, you can only switch plans during open enrollment in the fall, which runs from October 15 to December 7, 2015, for coverage to begin on January 1. But there are a few exceptions. For instance, you can switch into a Medicare Advantage plan with a five-star quality rating anytime during the year—if you have access to one. Only 11 Medicare Advantage plans with prescription-drug coverage earned five-star ratings for 2015. These plans are in certain counties in California, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, New Hampshire, Ohio, Oregon, Virginia, Washington and Wisconsin, and in Washington, D.C. Five-star Medicare Advantage plans without prescription-drug coverage are in certain counties in Illinois, Iowa and Wisconsin. Use the Medicare Plan Finder tool to see if there are any five-star plans in your zip code. See this fact sheet from Medicare Interactive for more information about the star ratings.You can also switch plans outside of open enrollment if you move to an address that isn’t in your plan’s service area. There are a few other, less likely situations in which you can switch plans throughout the year; for details, see the Special Circumstances fact sheet at Medicare.gov for more information about situations where you can switch plans outside of open enrollment.
Q: I have a retiree medical plan sponsored by my former employer. It is a PPO with a $400 deductible per person and 20% co-insurance. The plan’s costs are reasonable, and it covers a wide range of drugs. There’s a $1,000 annual out-of-pocket maximum and one month of free maintenance drugs when you buy a 90-day supply from the preferred pharmacy. I will be Medicare eligible in 2016, and I do not think that my former employer will continue to offer a retiree health plan. Is there any insurer that will offer similar drug coverage to what I have now with no penalty for pre-existing conditions? How can I find such a plan, regardless of annual cost? Is there any way to avoid the $5,000 per year out-of-pocket cost that I hear is standard with Medicare Part D plans? Thank you. — Gary, N.Y.A: Gary’s question is a great opportunity to talk about the challenges that more and more retirees face as they shift from employer-sponsored group health plans to Medicare.As retiree health benefits have become increasingly expensive, many companies are dropping this coverage. In the best case scenario, the employer gives these retirees a lump sum, which is deposited into a health reimbursement account (HRA). The retiree can use the HRA funds to help buy an individual Medicare policy. But all too often, the employer may simply end the retiree health plan and provide no further support.Still, there is some good news. Gary won’t face pre-existing condition limitations as long as he signs up for Medicare on a timely basis. If he meets the enrollment deadlines, any pre-existing conditions he has will not affect him when purchasing Part D, or when signing up for Original Medicare (Parts A and B) or Medicare Advantage (Part C).If Gary chooses Original Medicare, he may want to buy a Medicare supplement policy, which also is called Medigap. Original Medicare pays only 80% of insured expenses, after beneficiaries pay annual deductibles and co-pays; policyholders must pay the other 20%. Medigap policies will pay that 20% plus other services that Medicare does not cover. If you purchase Medigap coverage at the time you become eligible for Medicare, you have guaranteed issue rights—you cannot be penalized for pre-existing conditions.