by Leah deRoulet, MSW

After covering the highlights of Medicare parts A, B, and C in the last post, we’ll now move to Part D, the plan that provides outpatient prescription drug coverage. If one can afford it, it is usually best to purchase the plan that covers most of the medications you are taking, and this might be available through the Medigap supplemental plan you choose. Then you have one plan that covers both Parts B and D. In cases where this is not affordable, and you do not have prescriptions for many oral drugs, you might be able to get by with an inexpensive Part D supplement plan. I have one patient who pays $25.50 per month for her plan, as well as the co-pays and the deductibles required for the plan. But this is a very reasonable plan. I have other patients who are paying $95.00 or more for their plans, but some of these more expensive plans also covered the dreaded “donut hole“, or coverage gap that occurs after a certain amount of money is spent by Medicare to cover the cost of the drugs. Although there may be some differences in charges relative as to how much money should be spent, for the most part there are 4 areas of Part D that must be traversed. The first one is the initial deductible. The second one is the area where Medicare pays its share of the costs except for the co-pay, which is 25% of the cost of the drugs. The third area is the coverage gap or donut hole, where Medicare pays absolutely nothing until the patient accrues a total amount of out of pocket spending, which can be as low as $3,800.00, including the deductibles and the co-pays and cost of the drugs while the patient is in the donut hole. At the point at which the out of pocket spending meets the necessary monetary criteria (in 2008, that figure is $4,050.00), Medicare then picks up all of the cost of the drugs at a 95% payment rate, and the patient pays a minimal co-pay, usually no greater than $5-10. This is returned to zero again at the beginning of every year, when the plan starts fresh for the next year, and the deductible (and donut hole) kicks in again. Read the rest of this entry »

by Leah deRoulet, MSW

Recently I’ve had a few patients who wanted to come in and discuss their confusion about all of the Medicare plans since they had to make decisions whether or not to actually accept Medicare as their health insurance plan or stay on the plan they currently had. Patients who have been granted Social Security Disability and are on it for 24 months receive a letter from the Social Security Administration informing them that will be eligible for Medicare on a certain date, and that they have approximately 30 days from the date of the letter to let the government know if they plan to accept Medicare, and what parts of Medicare they wish to enroll in. So, although the Prescription Drug coverage, Part D is the one that confuses people the most, all of the other plans except Part A are still confusing. Here’s a quick run through of Medicare, and then we will talk primarily about Part D in the next post Read the rest of this entry »