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Medicare Part D
Publ.Date : Fri, 29 Aug 2008 17:03:51 GMT
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Making Sense of Medicare Part D -
Out-of-Pocket Expenses
By: Jeremy Cockerill
A complete understanding of Medicare Part D Out-of-pocket expenses is critical
for all Medicare eligible individuals in order for them to maximize their
savings and get the most out of the program.
What are the Out-of-Pocket expenses associated with Medicare Part D?
On the Medicare.gov website “Out of Pocket costs” are defined as “health care
costs that you must pay on your own because they are not covered by Medicare or
other insurance.”
The Out-of-Pocket (OOP) expenses associated with Medicare Part D are basically
any costs for an enrollee’s medications that Medicare will not cover and that
they must pay for on their own. These OOP expenses include the annual
deductible, which ranges from $0 - $250 depending on the individuals chosen
plan, and any other portion of their medication cost that they are required to
pay such as the drug cost co-payments. It is important to note that an
enrollee’s monthly premium is not counted as an Out-of-pocket expense. These
premium payments are an additional expense on top of the out-of-pocket expenses.
The majority of Medicare drug plans have a $250 annual deductible and a 25%
co-payment for all enrollee’s drugs until they have reached $2250 in drug
expenditures. Under this scenario, at the $2250 expenditure point, enrollee’s
will have $750 in Out-of-Pocket expenditures. How do we come up with the figure
of $750? This is calculated as such:
The $250 annual deductible + $500 (25% co-payment x $2000 of drug expenditures)
= $750
Individuals who have close to or exactly $2250 in annual drug expenditures in
2006 will be the biggest winners of the Medicare Prescription Drug plan. Based
on the individual paying only $750 in OOP expenses and assuming that the
individual payed the national average monthly premium of $32.20, these
individuals save approximately 49% on their drug purchases. However, not
surprisingly, the majority of seniors do not fall in this category and the
savings drop off sharply when you spend more than or less than the $2250.
For the millions of American seniors who will spend more than $2250 on their
drugs in 2006, this is where the Out-of-Pocket expenses start to add up. Beyond
the $2250 expenditure amount you are responsible for paying for 100% of your
drug cost until you have spent $3600 out-of-pocket (called the Out of Pocket
Threshold). This means that between the annual drug expenditure range of $2250
and $5100 you are 100% responsible for paying for the cost of your medications.
How do we come up with the drug expenditure range of $2250 and $5100? Here is
the explanation:
When the Medicare Modernization Act was passed in 2003 it was decided at that
time that once people had spent $2250 on drug expenditures they would then be
100% responsible for paying for their drugs until they his a threshold of $3600
in drug expenditures.
So between from $0 to $2250 there are $750 in out-of-pocket expenses as we
calculated earlier in this article.
$3600 OOP Threshold - $750 in OOP expenses at $2250 = $2850 remaining to reach
the OOP Threshold.
Since after $2250 in expenditures enrollees are 100% responsible for their drug
costs we can simply add the $2850 remaining to reach the OOP Threshold to the
$2250 in drug expenditures to get:
$2250 + $2850 = $5100
That is how we get the drug expenditure range of $2250 to $5100 in which
enrollees are 100% responsible for their drug expenditures.
This expenditure range is often called the “doughnut hole”. It is very important
that Medicare eligible individuals are aware of the doughnut hole because for
the first few months of 2006 they may be budgeting based on only having to pay
for 25% of their drug purchases and then all of a sudden when they reach $2250
in drug expenditures they are hit with responsibility of paying for 100% of the
drug cost. That is a huge and sudden change in monthly expenditures.
It is also important that Medicare Part D enrollees are aware that not all
purchases are necessarily counted towards their Out-of-Pocket expenditures. The
following are examples of purchases that will not be counted towards OOP
expenses:
1. If a drug that an enrollee requires is not on the formulary of covered drugs
for their chosen drug plan (or if their plan removes that drug from its
formulary of covered drugs) that drug purchase will not be counted towards their
out of pocket expenses and you are 100% responsible to pay for it. Purchasing
these non-formulary drugs, that the enrollee must pay full price for, from
Canada is an excellent alternative to paying high prices at the local pharmacy.
Individuals can save an average of 42% by purchasing these medications in
Canada.
2. If an enrollee travels and buys their prescription drug at a pharmacy that is
not included in their drug plan’s network of pharmacies they are 100%
responsible for the cost of the medication and it will not be counted towards
their OOP expenses.
3. If an enrollee currently has an insurance plan and they utilize their
insurance coverage to pay for their drug purchase, the purchase will not be
counted towards their OOP expenses.
4. If an enrollee purchases their medications from another country that has
low-cost, high-quality medications, such as Canada, these purchases,
unfortunately, will not be counted towards their OOP expenses. However, these
individuals may want to explore this option when they reach the doughnut hole to
help them save even more money. In fact, if an individual spends more than $2250
a year on medicines but less than $7050 a year, buying their medicines from
Canada once they hit the doughnut hole is an excellent option for them.
Medicare eligible individuals’ knowledge of Out-of-Pocket expenses and what
these expenses entail is crucial for them to save as much as they possibly can
with the Medicare Prescription Drug plan.
Avoid The Donut Hole of
Medicare Part D
by Darwin Corby
Did you know that more and more people who have Medicare coverage are turning
to Canadian Pharmacy Online services? Do you realize that even with Medicare
Part D, most of the people covered by Medicare will still save lots of money by
continuing to use a reputable Canadian pharmacy.
By now, you have probably heard about the very large shortfall in Medicare
Part D, called the donut hole. Donut holes are supposed to be small; however
this shortfall is not small in any way and will probably cause many people much
worry and stress. The amount between $2150 and $5100 must be paid as
out-of-pocket expenses by those covered by Medicare Part D. Your goal should be
to try and avoid hitting the doughnut hole if at all possible.
Extend Your Savings
Canadian pharmacy online services can stretch your Medicare Part D coverage
by saving on each and every prescription medication you have mail ordered to
you. With savings of more than 30% or 40% on each Canadian pharmacy online
prescription filled, the time before hitting the so-called donut hole can be
significantly longer if ever.
Another problem with Medicare Part D is that whichever program you choose,
you may very well obtain prescriptions during the year that offer absolutely
nothing as far as savings on that particular medication. The good news is the
Canadian Pharmacy companies offer savings on almost every medication. The
savings are not tied to a "program", so no strings attached!
Freedom of Choice
It is a good idea to choose a Canadian pharmacy to assist your medication
costs. Because the medications you receive will be exactly the same as those
sold in the U.S. in both content and dosage, you will simply be putting money
back into your pocket. The medications are exactly equal in every way. The
difference is simply this: Canadian pharmacy services offer these medications at
much lower prices than U.S. pharmacy services.
Find a Reliable Service
To make certain your Canadian pharmacy is ethical and reliable, select a
Canadian pharmacy that requires verification of your prescription and validation
by a Canadian doctor before the prescription is filled. Be sure to confirm the
Canadian pharmacy service you are interested in insists on proper paperwork
before your meds are processed.
Any of the services that claim "no prescription required" should not be
trusted. Anyone obtaining prescription medication at home or abroad must have a
doctors prescription. It doesnt matter if you are doing business with a Canadian
pharmacy or a U.S. pharmacy; no one can legally mail you medications without a
doctors order. Also, avoid any service that charges a membership fee. Any
website that asks for a membership fee is not doing business ethically.
***Save Money With a Canadian Pharmacy Service*** Stretch your saving with
Medicare part d by using a reliable Canadian Pharmacy. Avoid the Donught hole!
Canadian
Pharmacy Online
Professional Services Canada has been helping Americans save money on
prescriptions for over five years. They offer a medicare supplement plan free of
monthly premiums
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