Discussion in 'General Health & Wellness' started by oatmeal601, Feb 21, 2011.

  1. oatmeal601

    oatmeal601 New Member

    Monthly premium in Michigan for part D with no deductible is $88. That's $1056/year just to have the minimal coverage it offers. On top of that, you have copays that can be costly:
    Tier 1 Copay is $4; Tier 2 Copay is $35; Tier 3 Copay is $70; Tier 4/5 Coinsurance is 25% of retail cost of med. If most of your meds are Tier 1 you can afford the $4 and don't need insurance. Keep in mind if any drug you take isn't in their Formulary, they cover nothing. Also, note that some meds have quantity limits and some require pre-authorization.
    Now for the donut hole: Once the total cost (what you and the insurance paid) of your meds reaches $2,840 in any given year, it pays nothing (you pay 100%) until you reach $4,550 and then you still have a copay of $2.50 for generic and $6.30 or 5% coinsurance for non-generic. In certain situations one might save money compared to not having insurance but compared to employer sponsored prescription coverage (no donut hole there) it's a joke, especially since people on Medicare are old and take much more medicine than they did earlier in life.
  2. TwoCatDoctors

    TwoCatDoctors New Member

    Oatmeal you stated: "Now for the donut hole: Once the total cost (what you and the insurance paid) of your meds reaches $2,840 in any given year, it pays nothing (you pay 100%) until you reach $4,550 and then you still have a copay of $2.50 for generic and $6.30 or 5% coinsurance for non-generic." THAT IS INCORRECT

    It is important for people to start researching the internet to find information on the Medicare Donut Hole for 2011 or call Medicare directly, otherwise you are going under incorrect assumptions. Read the "MEDICARE AND YOU" booklet that comes each year for info and also read the booklets from your insurance carrer. My insurance carrier booklets are where I found that for 2011, once I reach the donut hole, I still pay the generic cost of $5.00 set by my Medicare Advantage HMO carrier and they cover most generics during the donut hole. Check with your carrier as to what they offer. Below is part of an article from the U.S. Secretary of Health and Human Services on the Medicare Donut Holes for 2010 and 2011.

    Posted September 23, 2010
    By Kathleen Sebelius, Secretary of Health and Human Services

    New Help for Seniors Who Fall Into the Medicare Donut Hole: 50% Discount Starts in 2011

    The Affordable Care Act has started to close the Medicare “donut hole,” a coverage gap in Medicare’s prescription drug program, by issuing $250 rebate checks to people who fell into it in 2010. Today, on a phone call with seniors, Vice President Biden and I are announcing another important step forward.

    Starting in 2011, people with Medicare will receive a 50% discount on covered brand-name drugs they need while in the donut hole, and will start to pay less and less for generic drugs. My Department has signed agreements with many of the nation’s pharmaceutical manufacturers to provide discounts on the cost of covered brand name prescription drugs for people with Medicare.

    The “Donut Hole” is the coverage gap that people with Medicare hit after a certain amount is spent on their drugs, presents serious financial challenges---making some people choose between their rent and groceries or their medicine. You can read more about it here.

    Today’s announcement about the 50% discount will make a huge difference in the wallets of people who find themselves in the donut hole.

    More than 1.2 million people with Medicare who have hit the donut hole so far this year have received the rebate checks, and now, with the new agreements from the nation’s drug manufacturers, they will see even more savings off their drug costs next year. These savings will continue even after the coverage gap is closed in 2020.

    <br><br>[<i>This Message was Edited on 02/23/2011</i>]
    [This Message was Edited on 02/23/2011]
  3. TwoCatDoctors

    TwoCatDoctors New Member

    If you receive "Medicare Extra Help" you will not receive the 2010 donut hole check if you went into the donut hole and will not be eligible for help this year.

    If you don't receive the Extra Help and went into the Donut Hole and didn't get your check for last year, then towards the bottom of this post are the places to contact. Below is part of info from the government to help you understand the 2010 Donut Hole checks that were sent out.

    The Affordable Care Act passed by Congress and
    signed by President Obama this year contains some
    important benefits for Medicare recipients.

    If you have Medicare prescription drug coverage, and
    aren’t already getting Medicare Extra Help, Medicare
    will automatically send you a tax free, one-time $250
    rebate check after you reach the coverage gap (also
    called the “donut hole”) in 2010. This rebate is the
    first step toward closing the Medicare prescription
    drug coverage gap.

    What is the coverage gap and how will I
    know if I’ve reached it?

    Most Medicare drug plans have a coverage gap. This
    means that after you and your plan have spent a certain
    amount of money for covered drugs, you have to pay
    all costs out-of-pocket for your drugs (up to a limit).

    The Explanation of Benefits notice, which your
    drug plan mails to you each month when you fill a
    prescription, will tell you how much you’ve spent
    on covered drugs and whether you’ve entered the
    coverage gap.

    Will I need to do anything to get this rebate

    No. There are no forms to fill out. Medicare will
    automatically send a check that’s made out to you.
    You don’t need to provide any personal information
    like your Medicare, Social Security, or bank account
    numbers to get the rebate check. Don’t give your
    personal information to anyone who calls you
    about the $250 rebate check. Call 1-800-MEDICARE
    (1-800-633-4227) to report anyone who does this.
    TTY users should call 1-877-486-2048.

    When will I get the rebate check?

    If you reach the coverage gap this year and enter the
    Part D “donut hole”, you will receive a one-time $250
    rebate check if you are not already receiving Medicare
    Extra Help. These checks will begin to get mailed to
    beneficiaries starting in mid-June.

    Checks will be mailed monthly throughout the year
    as beneficiaries enter the coverage gap. However, this
    is a one-time benefit and if you qualify, you will only
    receive one check after you reach the coverage gap.

    Will I have to pay taxes on this rebate check?

    No. You don’t have to pay taxes on your $250 rebate
    check. It is tax free.

    What if I don’t get the rebate check when I

    If you hit the donut hole after the program has begun,
    you should expect to receive your check within 45 days.
    Your rebate may be delayed if Medicare doesn’t have
    information from your Medicare drug plan showing that
    you reached the coverage gap in time to include you in
    the next mailing. You should call your Medicare drug
    plan to make sure all of your information has been sent
    to Medicare.

    If you don’t get your rebate check, contact Medicare
    at 1-800-MEDICARE. Individuals receiving Medicare
    Extra Help will not receive a rebate check.

    You can also check to make sure Social Security has
    your correct home address. Call 1-800-772-1213 or
    your local Social Security office. TTY users should call


    [This Message was Edited on 02/23/2011]
  4. mbofov

    mbofov Active Member

    In California there are many different Part D plans to choose from, from cheap to expensive. The cheapest is $14.30 a month, which is what I have. It will never pay a dime for medication I need because I take few meds, and the ones I do mainly are the $4 generic ones. So right now it's money down the drain.

    But I pay for this plan anyways on the off-chance that I will need a pricey medicine someday. Also, if you don't have a Medicare part D plan when you are eligible to have one, and then say 5 years later decide you do want one, you will be charged an added cost to your premium for the time you went without a plan. The longer you go without part D insurance, the more you will be charged. The Medicare booklet explains what this will be.


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