Medicare Part D Explained | (And How To Avoid The Donut Hole)
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- เผยแพร่เมื่อ 9 มิ.ย. 2024
- www.abtinsuranceagency.com | (888) 465-9728 | stephanie@abtinsuranceagency.com
Confused by Medicare Part D? You're not alone. In this video, I'm breaking down exactly how Medicare Part D Prescription Drug Plans work, including the 4 Phases of Part D coverage, the "Donut Hole" or Coverage Gap and how you may be able to avoid it, and how to find the best Part D Plan to cover YOUR specific medications.
As an independent Medicare broker, we do Part D searches and annual policy reviews for all of our Medicare Supplement and Medicare Advantage Clients. If you have any questions, give me a call - our service is always 100% FREE of charge. (888) 465-9728
Find the Best Part D Plan on the Medicare.gov Plan Finder Tool - • Find a Part D Rx Plan ...
Using Abt Insurance Agency's Part D Enrollment Tool (with the Part D carriers we've chosen to represent for 2020) - www.FindingPartD.com
Find the Best Medicare Supplement Plan - • Best Medicare Suppleme...
Your Costs in the Coverage Gap (Medicare.gov) - www.medicare.gov/drug-coverag...
www.goodrx.com
www.blinkhealth.com
My wife and I will be new to Medicare, in 2021. Both of us are active and healthy, and neither of us take medication. She’s of the mind to NOT sign up for Part D, where I believe we should sign up for the cheapest plan available, as a placeholder for the future. Thoughts? Thanks, dave
This is a popular question. Although you don't have to enroll in Part D, you should be aware that there is a penalty if you do decide to enroll in Part D later on down the road - This video explains more: th-cam.com/video/EgTmRW8-ay4/w-d-xo.html I hope this helps!
Thanks! I'll watch the video, but already knew about the penalty. That's why I think signing up for the lowest priced plan (as a place holder) might be the best option. I was just wondering if you had any insight (rule of thumb) as to when you might not want to sign up for Part D. dave
@@km-bo3zx Some folks who are not taking any medications and are subject to IRMAA (which makes their Part D premiums much higher) decide to go without Part D. For them, it can make financial sense to do so, even when factoring in a potential penalty down the road.
@@km-bo3zx I did the same thing as a new Medicare recipient in Sept 2019. I was on no medications and decided to take the cheapest Part D to avoid the penalty. How could I know that I would get an upper respiratory virus in November 2019 that put me in the hospital for five days and threw me into A Fib! I am now on blood thinners and a medication that regulates my heart rate. I am improving, but will be on the meds for a while longer. I am so glad I bought the Part D, United Healthcare AARP it cost me $16.00 per month. My meds are mostly tier 1, so no copay.
@@jenniferlee7167 I'm glad it worked out for you and thanks for your input!
those lawmakers should have to wade thru this obstacle course and deal with it every year as we have to. they should also have same coverage deductibles etc as we do.
You're right!
It's better than nothing. It's not that hard to figure out unless you take a lot of drugs, in which case, I'd go and sit down with someone in the business.
You are very right, but a dreamer!
They should, but they don’t Republicans & Manchin spare no expense in getting themselves the best medical coverage in the country, but they won’t spend a penny to make life easier for Seniors!
Those scum get $0 deductible, no donut hole, etc.
Good informative video, thank you! Having been on Medicare for a few years now, the most important message you’ve given is that WE HAVE TO REVIEW OUR PLAN(S) EVERY YEAR.
In the beginning, I did a thorough research of Part D plans and picked one. Good split what I paid and what insurance did. And so I kept the plan year in and year out. What I didn’t notice was that the next year, they raised the copayment limit. Now the market price of my copayment was all within that copayment. So, in 2021 I will have spent $1,600 of my money on my medications, while the insurance will have paid $0. And the premium will still have cost me over $400 for the year.
So clearly, yearly review is a must. I am doing it now - and what I am finding is that ALL PLANS ACTUALLY SUCK. So much information (for insurers, it’s a game) and so many variations of the same: YOU (patient) pay as much as spossible and WE (insurer) pay as little as possible, preferably nothing.
Like all health insurance in America, it’s a scam!
Pointless if you do not know which medications you will be on. I have NO IDEA WHICH EXPERIMENT THE DOCTOR WILL TRY NEXT.
The big thing to me is other people have gone through and just shrug their shoulders and accept it- No one ever told me. And I listen to everyone that wants to talk. I am very grateful of your videos and the easy to understand materials you present. It is really alot to take it but you have a real skill to teach people. May the force be with you.
Why is this whole insurance thing so complicated. Is it done on purpose? To confuse. I think so.
Because insurance companies are in the business of making money; understanding that one fact makes the confusion, clearer. Brokers such as Stephanie and others who provide these services are the representation you want because they’re giving you all the options. An agent representing one specific company won’t do that.
It’s also used to avoid paying necessary healthcare needs.
yes it is
It’s mostly government regulated. Part D just means prescriptions. That coverage gap is not something most beneficiary’s hit. If you’re on a very expensive drug then after you hit $4,430. Basically the insurance company takes a break and you pay 25% instead of copays.
Then if you hit $7,050 you are saved by the plan again and you just pay 5% or a small copay.
@@kd8199 yes; as do ADVANTAGE plans that are actually NOT medicare but are private and can throw you off anytime. Try that when you are in your 80s, have no advocates and need serious medical attention
You are delightfully easy to listen to!
Why thank you! 😊
I take 2 inhalers, Symbicort and Spiriva. After a $400 deductible, I am in the do-nut hole by June. I get my name brand inhalers from a Canadian pharmacy and pay less than my cost from my insurance before the do-nut hole. They come from foreign countries but are made by the same companies as the original but will have a foreign language on them.
Isn’t Symbicort a preventive medication, so it’s fully covered? I also take symbicort, but not under Medicare, but under an employer medical plan.
@@jacobkowski7705 Before I went on Medicare and Part D I was under an employer medical plan. This was before Symbicort and Spiriva were available (before the chloro-fluorocarbon ban). I don't remember the names but there was a small yearly deductible, no co-pay and no do-nut hole. I have never had a preventive/non-preventive drug issue with either drug plan with any prescribed drug. I searched my current Part d drug list and there was no mention of "preventive". On the other hand, I must mention that I have been having cancer treatments from the end of 2020 through 2021 and now into 2022. My costs each year have been roughly $200+/- supplemental medical plan deductible, $200+/- Part D prescription deductible and a couple of bucks for incidental cancer meds, anti-nausea med etc. And that's it other than the normal plan premiums ($2200-$2500).
@@jacobkowski7705 Depends on the insurer, that is the real problem with part D, some companies will cover what other companies do not, it is a crap shoot unless you know every drug you will take this year. I never do. What really stinks is of you pay for it yourself it does NOT count towards you deductible, only IF is part of a co-pay. Total SCAM !!
I too have to use those inhalers which controls my COPD very well!!!!!! No issues at all in years! However I tried to sign up for PART D and they charged me $ 331.70 a month because the drug companies take advantage and charge that much! So I cancelled my United Health care insurance and shopping around for a new one! I get my inhalers from a different source now. I do not need Part D however I would like any suggestions on insurance that is for catastrophic Part B expansion. Not too fond of united health care!
I fell into the donut hole abyss after three 90 day prescriptions for Eliquis. I switched that prescription from my Medicare Advantage Plan to my VA benefits before ordering the 4th 90 day refill. Now my copay is ZERO for Eliquis. My remaining prescriptions are still with my Medicare Advantage insurance provider. If you're a military veteran, and have VA benefits, you should be able to get a much lower co-pay at the VA. If you're receiving 70% or higher disability benefits, your copay should be zero. Even for the "designer" medicine that's heavily advertised on TV.
and then you get diabetes and you are denied coverage. Supplemental plans do not make medical decision like your scummy HMO.
You are a Godsend Stephanie! Deeply appreciate all the "gaps" 🤗of knowledge that I have been missing in the process of signing up for Medicare B, D, G....etc. Our situation was and still is complicated, but your many teaching-based videos that I have been watching for a few hours now have alleviated a lot of stress I have every day as to when to apply for the Medicare Part B, D, G...etc.. An Insurance agent is someone I would love to have working with us. At least now I can approach this process head on now.
Thanks for the feedback! We would love the opportunity to assist, call us anytime. 888-465-9728.
Medicare Part D questions? Leave them below!
Deductible amount doesnt count to the initial level coverage amount right?
I have a question I’m sure I have Medicare and united healthcare plan K. and I need to have injections because I have psoriatic arthritis I can’t get an answer how I could get the deductible which is like $1500 for the year paid not necessarily by me do I have to change my plan I do have Medicare part D please advise me because I definitely need these injections
@@helenfischer2002 depending on your location, you will likely need to pass through medical underwriting in order to obtain a new Medicare supplement plan that covers that deductible. Feel free to give us a call at 888-465-9728 🙂
I’m only 43 years old and all of this is so overwhelming. It breaks my for the senior citizens . So I called Medicare and I’ve spent a weeks trying to figure all of this out. Remember I’m clueless about all of this . So they entered all my meds in the system & they said the system would chose which tri advantage plan . You need to be President of Medicare . I’m so thankful you have explained everything to us .
why are you wasting ssa staff time when you when not be eligible for medicare for more than 20 years?
@@christopherallen9580 Because that's how long it takes to understand it.
@@christopherallen9580 He is an idiot, unless he is disabled it does not natter. Not everyone on SSA is 65 yet.
@@audreyboag7670 LOL! Of course it will be completely different by the time he gets there!
@@christopherallen9580 no questions are a waste of time
As a new agent, this is very clear to me. Thank you so much Stephanie. Bless your heart for sharing your knowledge.
Yup, I retired after 40+ years in HR & Benefits/ Mgt., I was confused by Part D reg's when I retired w/Medicare years ago. There were very few resources like on the internet or TH-cam to help at the time.
THANK u for detailed explanation about tier 1 ,2 3 and 4 ,when deductible starts in easy ,simple words which we understand properly..
We’ve been on medicare and plan d for 10 months now. I’m appalled at how expensive my costs are.
You income is probably to high to qualify for low co-pays.
Depends on your plan. Pay higher premiums and lower copays/more drugs are covered, or pay lower premiums and higher copays/fewer drugs covered. They are insurance companies, not charitable organizations. One way or the other, they are going to get their money out of you.
@@toriless my hubs is still working so no assistance
This helped a lot of my understanding about part d phases in general, just started working as a benefit adviser so really appreciate your efforts enlightening us....,
Someone please explain this to me: I am retired Military (served 24 years). I had Tricare coverage supposedly for Life. I also have VA coverage because I'm rated 90% disabled. At 58 or so I had to quit working and go on SSA disability. I did NOT take the Part D at the time because I had (I thought) Tricare and the VA who provided what Med's I needed. Even the Social Security rep told me I didn't need it. But then about a year ago I discovered that my Tricare coverage had been DROPPED!!! After MANY hours on phone calls to every Guberment agency I could reach I was told that I HAD to have Part D to keep my Tricare!!! By LAW supposedly. SO I had to wait until this past January to get the Part D reinstated. And they are penalizing me at like $178 a month. Even though SSA told me I didn't need it. And I'm also paying a fee to Tricare to keep the Family coverage I served 24 years for! I was blown up twice, shot once, ribs broken multiple times, crushed hands, shrapnel wounds, collapsed lung, lots and lots of stitches, some other broken bones, thermal burns in both eyes, and Guano Virus! Whew! I've also been told that when I turn 65 I will get Tricare For Life and I can drop the Part D. Just doesn't make any sense to me. Maybe the Guberment just wants me to die...............
From my experience with government apply for everything you can, except EBT. That is only for the poor. By poor I mean $500 a month, not $1000. If you do not qualify they will let you know. Get whatever you can and between them all you will finally get enough.
I can't say enough for your clear and decisive presentation: Because most people take the same medicines, the finances also continue, predictably year to year!! Yes? You are really good at this.
I found out "today" (I am always the last to know) my own MOM takes six different meds every single day!! Of course, she has to be medically underwritten if she changes her coverage!! Six!! Just a doctor knowing the possible interactions of those drugs is a professional determination!! Thanks again for YOUR very professional presentations. This isn't "rocket science" but it has alot of important decisions to be made.
Great presentation: You convinced me that Part D is something I will need. My wife will as well. I turn 65 in March. Retired Military which provides free medical and prescription coverage for $50.00 per month no matter how many family members I have. I don't plan on taking Social Security until FR (66.4). When does Part A have to be paid? I understand Part B will start @65? I get medication at Military Treatment Facilities and the Veterans Hospital. Will that all stop? Please send a quote for D that provides service in Hawaii.
Daniel - I thought Hawaii had social medical. Just go to the county hospital and wait in line until all the more serious injuries and illnesses are treated, then it's your turn. I'm guessing that most doctors in those hospitals are just out of school, and graduated in the bottom 20% of their class.
The cost of part D is cheap compared to the $144 for part A & B, something like $3, SSA messed up and was not paying so I had to pay myself to get it going. It was never explained why they were not paying but without admitting a mistake they covered what I have paid later on. This is why I know how cheap it is. I do not know why anyone would not get Part D.
Barry, my nephew lived in Hawaii for several years. They have some of the best healthcare in the country. Just check out Best Places to Live on the internet. Very highly rated healthcare in Hawaii. Also, not Socialized Medicine, but don't knock it. Countries that have it generally are happier with their healthcare, and in many cases, have better outcomes than in the money hungry US. Just imagine if your healthcare insurance premiums didn't have to support big bonuses for fat cat CEOs, and profits for investors! Your premiums just covered the actual cost of healthcare. That's what your extra taxes would look like with Socialized Medicine, in lieu of premiums.
@@toriless I think A and B are now close to $165-$170 month
Part A is free, unless you have not worked 10 years or more then you pay a prorated premium. Part B is what you pay for, and it is around 165-175 per month. If you do not have creditable coverage (insurance equal to or better than Medicare) elsewhere like on your job or your spouse's job after reaching age 65 there will be a penalty after 12 months of non-coverage if and when you sign up for Part B.
Another excellent presentation/explanation and Stephanie is pretty easy on the eyes!
Exceptionally and clearly presented. Thanks very much for posting.
Dear Stephanie, thank you very much for your videos. Your explanation is very informative and easy to absorb. I wish that I could find a video which explains in what situation, one person may be declined by either a Medicare Supplement Insurance Carrier or a Part D plan, when they apply for switching.
Wonderfully detailed information and great visuals. Thank you🦋
Thank you Stephanie take care stay safe and stay healthy
A BIG hint if you use one primary pharmacy for all your Part D, AND you occasionally use a discount club like GoodRX because of a substantial cash saving on a particular drug- use the GoodRX at a different pharmacy. Do not commingle. Reason- the customer database profile often, if not probably, at your main Part D pharmacy gets confused (corrupted) by your different plan and BIN IDs resulting in nightmares at checkout. These days pharmacies are running at sprint speeds and are slaves to their computer spit-outs, thus sorting out conflicts are not a priority. Don’t mix insurance coverage at the same pharmacy.
Thank you so! My Mom need this! Thanks
Your videos are so helpful. Thank you!
Hello, Please continue to post such an informative and creative videos. Therefore, people like us will be motivated and learn in real life.
Due to having diabetes Type II, high blood pressure, cardiac arrhythmias, and other stuff, I usually hit my "donut hole" around March or April. But, I usually come out around August. But still those months in the "donut hole" are financially painful. It is why I am still working at 71.
Diabetes can be especially expensive, I hear. It was used as an example in another video. The problem is even if you qualify for a $8 co-pay they might be paying $300 and then maybe another $150, so boom $4K can go quickly even if you did not pay most of it since it was a generic tier 1 or tier 2 drug. Apparently Eloquis costs $500 even if you only pay $50. Real easy to hit the donut hole.
Shop around. Try generic variants.
Stupidest thing, the donut hole. Seniors can't afford that kind of financial hit.
Some drug companies have programs to help pay for drug costs. Also, Medicaid may also be helpful. There are programs that can help, just inquire through Social Services.
Can you do an updated video of the new 2021 information ?! Love your explanations!!
Only the amounts change each year, $425 to $435 to $442 to $447 to $454, etc. It is like anything in government. SSA payments creep up a few bucks each year too. It is never significant except when it come it estate taxes but I doubt you have to worry about that or you would probably have a retirement advisor and various types of trusts.
Stephanie,
Thanks so much for explaining Medicare.
I’m turning 65 in Jan 2021 and received my Medicare card in the mail today.
Currently I’m not taking any prescriptions so I’m wondering would I need plan D coverage?
That's a questions I get a lot! In fact, I make this video to answer it -- th-cam.com/video/EgTmRW8-ay4/w-d-xo.html . Basically, you don't have to get a Part D Plan, but if you don't get one when you're first eligible then you may get penalized down the road. Let me know if I can be of any assistance! (888) 465-9728
Abt Insurance Agency
Stephanie, you are definitely a blessing....I reviewed the recommended video regarding partD, logged into Medicare.gov, located an affordable option available in my zip code area and have successfully enrolled (yippee 😂)!
Thanks again for your wonderful help❤️
Why is that damn thing made of flimsy paper and not a plastic card. I am always ordering a replacement one.
Same situation when I turned 65. I just got the cheapest plan I could find, just to say I did. You can always change it later, but if you don't get anything you have to a penalty every month for the rest of your life when you do sign up. I hate paying penalties, even if it's small. Premiums for everything are high enough!! With part d, though, there are some pretty cheap plans out there.
Best explanation I've seen.
Thank you!
-If you are an inpatient do the drugs you receive in the hospital come out of your part D or out of your hospitalization
Great question. This comes from a CMS document about drug coverage under different parts of Medicare -- "People with Medicare may get drugs as part of their inpatient treatment during a covered stay in a hospital or skilled nursing facility (SNF). Generally, Part A payments made to the hospital, SNF, or other inpatient setting cover all drugs provided during a covered stay." --
Here is a link to the referenced document: www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf
informative, clear, and good recommendations. Thank you.
Wow, what a complicated deal. Thanks Stephanie!!😊
great job wish I could find her to talk too. Really good information
You can call us anytime, 888-465-9728
Thanks Stephanie I am from NJ and have gained substantial value from your videos. I have been with AARP UHC Plan F since retirement in 2007 but I am shopping this year. Thanks again you are very informative.
Warren thanks so much for taking the time to leave a comment! I am so glad we've provided value to you. Please don't hesitate to call or email us with questions, I am licensed in NJ and would be happy o run you some comparison quotes (888-465-9728). Have a great day!
@@AbtInsuranceAgency hi Stephanie do you currently have clients in NJ?
@@davidson_oldbull_sectionhiker yes, I do!
Thanks Stephanie, Now I have to add adderal for my upcoming depression.
That is for ADHD not depression, it has some nasty side effects unlike some other drugs for ADHD.
Thank you a lot for this video. This is very interesting and informative. Keep posting like those amazing videos, this is awesome.
WHAT perverted, damaged brain conceived the intricacies of Part D?? Doughnut hole? This is THE most convoluted policy I've ever seen.... was any rational for this type of logic ever explained? Again, though, thank you for making it as clear as possible under the circumstances. Your videos are awesome!
Congress. I always thought Medicare was to blame, but it was explained to me that Congress makes the rules and Medicare follows their sick, perverted rules. Especially for those who have Medicare instead of MediCAID. Medicare recipients pay a lot of money for the higher tiered medications.
@@jenmidwest2432 Not only do we spend our working lives paying for our own Medicare coverage for our retirement years, we also have to pay for every person on Medicaid through taxes we are required to pay.
Polititians! They are scum.
@@jgjg3848 And many on Medicaid have also paid into Medicare.
@@jenmidwest2432 GWB was in charge when the bill was written and passed. Repubes held majorities in both the House and Senate at that time. The big takeaway about the whole program: The federal government is not permitted to negotiate Part D drug prices with drug companies, as federal agencies do in other programs. Basically, a handout to big Pharma.
Very good info...thank you!
Generally, I find that the included Part D plans with most Part C plans are superior to that of any any stand alone plan offerings, in particular, that only included Part D plans will not have the initial deductible stage!
I haven't seen any Part D included in my PartC...
@@kayleeguy5471 Some Medical Advantage plans have a drug plan included.
For people with VA drug benefits , would you advice them to enroll in a Part D plan perhaps for expediency?
They, of course, do not have to as they are considered to have creditable coverage. If they are not close to a Va facility or a med is not covered by the VA or they frequent a civilian doctor may be some reasons veterans would choose a PDP.
If it's you, thank you for your service!
I would, it does not hurt. All VA service MUST be done through them and not a civilian doctor.
I’m 70 and my wife is 67. My plan is going up to almost $400.00 per month. I need a new plan.
That's what we're here to help with! Please give us a call at 888-465-9728.
Probably!!
Thank you!
Thank you for making such helpful videos, but it's quite sad that we have to go through so much rubbish just to get our basic human right of healthcare.
how does Wellcare do with insulin plans and other drugs, thanks
I love listening to you and This year I need to speak to you because with Medicare and my Humana Insurance I’m paying over 500 a month and I only use for mostly My annual Wellness test. I take a little BP med other than that they say I’m ok.
Thank you looking forward to your Guidance! I have watch lots of your videos and very impressed. I’m 73 and a widow so hopefully to talk soon
@@mikedavis7733 Humana Medicare Past D?
@@christopherallen9580 I have them, they stink.
@@toriless good to know
The best explanation ever
Thank you!
Why does medicare make it so complicated for seniors when it should be simple and straight forward?
profits
Very informative, thank you.
I would add an explanation of the penalty aspect of Part D if one does not take Part D when they are eligible. In searching for a plan it’s hard if you are initially not taking any medications. I asked my pharmacist for 13 common drugs often prescribed and used this as at least something to help compare plans.
That is BS, I never used Part D for the years after I had medicare coverage. You must be going to a bad web site and are being fed lies!
I think the best plan, if you aren't currently taking any medication when you originally sign up, is to just find the cheapest plan. For me it was like 12 bucks a month. That way you have a plan and won't end up paying penalties later. It's impossible to try and guess what you MIGHT be prescribed at some later date. You can always switch plans during open enrollment later if you are put on a drug that isn't covered. Also, always ask the pharmacist what the cash price is, as sometimes it's cheaper that the copay!!
Hi ,
My name is William and I am 79 years old. I have had Medicare since 2008 and part D also. I take eight generic drugs and one higher tier drug, Eliquis. That is where my problem lies. I have hit the donut about June every year since 2008 and it has almost killed what little savings that my wife and I were able to save over the years. I have tried over and over to get help, but the instant that I admit that I am a responsible person and have insurance, I am always denied any help of any kind. I am at the end of the road and would love some advice from you, if you could please help. You seem to be one of the most sensible, down to earth person on the internet. Thank you in advance.
William
Yeah, those 8 probably cost you $28 a month and another $90 for medicare but Eliquis costs over $500.
what happens if I get Plan D then following enrollment period do nothing about Plan D, do I lose coverage for the following year or is my current Plan D automatically renew with no change to coverage?
Excellent explanation!
so confusing. as a person on MS drugs which cost 7K/month i have no idea what i'm supposed to do. all MS treatment is Tier 5 and the manufactures aren't allowed to step in for financial assistance.
Wonderful easy to understand expl
helga withem thank you!
Thank you🙏
Does Medicare A and B cover antibiotics and such rather than maintenance meds ? My husband isn't on any medications , not sure if he needs part D
Wow...THAT was a mouthful but, lucid and comprehensive. Thank you! I'm turning 65 in January so, I'll be a rookie. I wanted to know if a chart exists about the various Plan D's in comparison to each other? Is there a go between agency that I would sign up with or do I deal directly with Medicare? See? i don't even know the basic steps to brace for Medicare. If there is a link to a website you could recommend to find answers to my concern, that would be great! I noticed with info I've been getting in the physical mail and email about Medicare, they only ask, which plan do I want, Plan A or Plan B? No option for a Plan C or Plan D. I'd appreciate any help you could give me. Thank you
Please call my office! We can help answer all of these questions, and our service is completely free. 888-465-9728
Great out-of-pocket tip.
Many thanks for your video
Hello Abt Insurance Agency If I have Medicare A and B and Medicaid eventually the Medicaid will end! Will I be able to sign up for an insurance that is medical and support an RX and then I won't have to worry about Part D b/c D is prescriptions so if I purchase for a regular insurance with RX i will be fine right?
Hi Stephanie, I’m newly Medicare eligible turning 65. I’m choosing traditional Medicare and a supplement plan. Since I’m healthy and not on any meds at all I was wondering if i should just skip Part D insurance. My question is - are there any disadvantages like penalties that are timing related that I would confront later if I chose a Part D plan only after I needed meds?
There are some penalties to be aware of if you skip Part D now. This Video explains more! th-cam.com/video/EgTmRW8-ay4/w-d-xo.html
Do not skip part D, supplement plans only cover the 6 gaps in Part A & B. N cover 4, G cover 5.
Thanks for your presentation. Even healthy and no medication, I always approach insurance to protect against financial ruin by expensive drugs. Are
Are most if not all of those expensive cancer drugs administer in doctor's office which is covered by plan B but not plan D?
Awesome video.... Grt work
I don’t take any medications at this time. How does Plan D work for me?
Ha ha. How about 1470 my 25%for trulicity, now past gap about 170 now stage 4. Thanks good info.My 1st year on D.
I am a type 1 diabetic on an insulin pump and am in the donut hole every year by June. Would it be beneficial for me to get away from part d and have better luck with a different plan? Thanks.
You just need a different insurance company. Part D make NO determinations as to coverage, just co-pay amounts, coverage is all determined by which company you use unlike Plan A & B which are solely what you doctor determines unless you are moron and get an Advantage Plan, those are all HMOs and THEY decide what is covered unlike original Medicare or Supplement Medicare which cover the gaps ONLY.
Having an exiting Medicare plan D plan with insurance coverage, if I decide to switch coverage plan within the same company, can they deny the switch? Hope this is clear.
Big Cat no, you cannot be denied switching from one Part D Plan to another during the Annual Election Period (oct 15 - dec 7), even if those plans are within the same insurance carrier. I hope this helps!
She misread, Big Cat. Reach out to her, again. You're talking about medigap Plan D but she thought you were speaking of Part D (PDP).
Yes you will, in most cases, have to go through underwriting, again, even if you stay with the same carrier. 🙂
All Supplement plans require acceptance.
Tier 1 and Tier 2 medications are so cheap you don't need a D policy. The copay can actually be more than the discount price for the drug without using your insurance.
Depends on the drug, for instance, Benadyrl cost about 1/5 as much in a retail bottle off the shelf but a steroid can cost $200 instead of $3. I have seen a medication as high as $600 for one container. Size count a lot too, you could pay $200 for 60 22.5g pills but $8 for 90 15g pills. Those are actual prices I have seen and it get even more extreme for some other medications. Form matter too, an ointment may be $7 but a cream $200. Part D is the least problem with medications.
Funny how, in real life, they almost never prescribe a tier one or two drug, though!
My deductible is about 6,500$ as I take insulin and tragenta an diabetic oral meds plus 2 other meds that are in high tier thru Silverscript. But now I am " out " of the donut hole. .
Where I live there is no CVS which is part of Aetna. So is there something I can do ?
I do now have a a person to help me as come fall as I might switch..
Thank you.
It’s sad that Medicare does not allow coupons for seniors. We work so hard all of our lives, and what do we get in return!
Your explanation is very good “except” you don’t fully explain the “Almost” full retail cost while in the Donut Hole in getting to the Catastrophic phase. That is a grey area. Who determines the “Almost” portion? And how is it derived? Most insulin dependent diabetic seniors end up in the Catastrophic phase simply because of the high prices set by the pharmaceutical companies.
It is based upon the medicare negotiated price just like with services. I had a diabetic cat, we only paid $100 per bottle for the good stuff that lasts all day. Of course with a cat it would lasts months not weeks. I guess it is more now??
I was told if I get a different plan, such as add on dental, vision etc (I have regular Medicare and Medicaid.) I would lose my part d help
Clarissa it sounds like you may be referring to a Medicare Advantage Plan. If you enroll in a Medicare Advantage Plan then your stand alone Part D coverage would terminate. You can’t have both a stand alone Part D Plan and a Medicare Advantage plan. However most Advantage Plans include Part D Rx benefits. We’d be happy to help explain this in more depth - feel free to give us a call at 888-465-9728.
Do NOT get a Medicare Advantage plan, all medical rights are gone, the HMO decides, not your doctor like with original medicare or a supplemental plan.
WHEN CVS CHARGES $1,700 + FOR ONE RX....90 TABLETS OF FARXIGA 5 MG...YOU GET DONUT HOLED REALLY FAST.
Qestion: I am a employee, soon to retire, just turned 65 in July.. I have medical thru government. Now that I am looking at other medical insurance plans I have found I am paying a lot more than other seniors. I keep hearing how wonderful our medicare advantage plan is but I'm not so sure. It seems to me that a should suspend or drop my government plan and look for other more affordable medical insurance.
Medicare Advantage is a scam, HMO's are garbage compared to Medicare. If the doctor says you need a surgery you are covered under medicare but not under Medicare Advantage. Drop that garbage !!
I would stay away from any ADVANTAGE plans; they are NOT government plans (owned by YOU) they are private insurance that can kick you out any time they want to
Can you pick up a part D plan when you switch from MA to Medigap , when it is not open enrollment?
What do you think of silver script for part d?
Extremely popular plan.
Where does insulin fit into part D....do I have to pay full price.... ? TY....... of course insulin cost increased dramatically
Depends, it is actually determined by the insurer, generic tier 1 and 2, name brands tier 3 and 4. Tier 5, sell you car to pay for it.
What Dental and eye plans would you recommend that’s the best bang for our buck? If we’re on Medicare A,B
@@living2day617
America's alledged care plans are horrible, horrendously expensive, and the doctors and dentists nowadays are Allopathic pill 💊 pushing robots (not doctors).
Before the 4-profit predatory changes started in the late 90s, greed and incompetence wasn't so prevalent.
None, they all stink!
Hello, is the part d plan you pick now the one you half to stay with or can you pick a better one as you get older and are on more prescriptions ?
You can change your Part D drug plan every year during the Annual Election Period!
I am 65, but still working and have good prescription drug coverage. Do I need to sign up for Part D now or should I wait until I retire? Thanks!
Wait, but then get Part D, it will be a LOT cheaper once you switch to a retirement income. Unlike Part A & B which are directly handled by medicare, Part D is by insurers not the government. Medicare only negotiates prices not coverage.
Stephanie, I plan on retiring in September at the age of 65, I plan on taking Social Security and signing up for Medicare. My wife is currently 63 and is on Social Security disability, she is currently on my health care plan at my work. When I sign up in September, will my wife be able to sign up as well?? I was told she would be eligible to sign up for Medicare under a "special enrollment" period. I want to make sure this is correct, since my wife will not be 65 until February of 2024. Thank you.
I have a question? Do you know if president trumps executive order will affect drug prescription?
no
I currently have medi-cal also known as Cal-Optima so my question is do I still need to enroll in Medicare as I’m turning 65 January 31 2022?
Beats me, is WA we have something called Apple Care, I'd hate to get sick in OH. They might not know it is Medicaid in disguise. I see CA does just as dumb things.
We are on SS and have part D.my husband has many co-morbities requiring so many medications .dr wanted my hubby to start a new medication Vesceba for his cholesterol and stop the script omega 3 .vesceba is 471.00 a month .kindly the Dr handed us a pharmaceutical prescription for 90 day supply for 9 dollars.went to fill it and the pharmacist said we could not use this coupon when we have government insurance .shouldn’t the dr be educated on these things?charlene
I would love to speak to you. You are very knowledgeable.
Give us a call anytime at 888-465-9728 🙂
Let’s say I have two tier 3 meds, now do I have to pay the deductible for each med before the plan kicks in?
The deductible is a once yearly deductible, not per medication.
@@AbtInsuranceAgency wonderful thank you so much! :)
It is the total, 1 med or 20 meds, but the co-pay is per prescription.
Thank you for your video. I have some questions.
How do I determine if the drug plan waives the deductible for Tier 1 & 2? Is it found in the details?
Are certain drug plans such as the Walmart plan only valid at Walmart or can I go to any pharmacy?
Are mail order usually cheaper?
And if I currently used another agent to enroll or is the agent of record, can I switch to you for your services?
When we do a Part D search for you (through us or through medicare.gov) we will tell you which Tiers your medications fall under, and if there is a $0 deductible for Tier 1 and/or 2 meds. The Humana WalMart Plan allows you to use several different network pharmacies, but WalMart is a "preferred network" pharmacy with this plan so your costs would be lowest at WalMart generally. Mail order is sometimes, but not always cheaper. Most of the time the agent you enrolled with remains your agent of record until you switch your plan. I hope this helps! Call us anytimes with questions - (888) 465-9728
Check your CMS paperwork. If you are lucky you may qualify for Extra Help which covers the $144 per month and lower your co-pays.
I'm sure I have no idea what I've been doing lol
Thanks Stephanie !!
I will seriously need to speak with you soon. You Rock 🤗🎸🎶🎶😘 now I want some jelly Donut Holes lol
Thank you so much for explaining all of this to us.
You are so welcome!
Great video thank you. I wonder is there any benefit to starting when new to medicare, a prescription benefit part D plan when you have no need of medications at the moment , but expect you will in the future. that is to say, is there any penalty to not enrolling out of the gate? thanks again.
Thank You
Can I not enroll in Part D and then when my costs go up in a few years, enroll in a Part D plan during open enrollment?
You can, but will face a penalty for every month you have gone without creditable drug coverage.
@@AbtInsuranceAgency Yeah, but if you take Part D immediately you do not. If fact, every few years SSA seems to change mine at random.
Just a quick question , is there a website that i can find a doctor in my area ( Rossford , Ohio ) ? . Thank you
Medicare.gov's provider finder tool will help you find providers in your area!
@@AbtInsuranceAgency Thank you very much , God Bless you all
Stephanie, are you licensed in Missouri? If not, how do we find a knowledgeable & reliable independent broker for Medicare?
Yes, we are licensed there! 888-475-9728 🙂
I just received a paad card and need a supplement for the 20% that medicare doesn't
pay can you advise me thanks
If I don't choose to enroll in Part D, do I still benefit from Medicare negotiated drug prices when I purchase prescriptions?
no
@@TK-cl1jm He said NOT enroll, you are wrong.
@@toriless Missed that important word. Glad you corrected me!
My wife is taking a tier 5 drug for Metastatic Breast Cancer-our current plan D initial monthly cost $3,000 followed by monthly co-pay of $750-once I reach the catastrophic limit will the cost automatically be calculated
Yes. And a search on Medicare.gov should show you your expected Rx costs during each coverage level.
Yes, they will calculate the percentage based upon their negotiate cost. It is not like GoodRX where the prices are random.