Avoid Falling into the Medicare Donut Hole - Costing You THOUSANDS! 💸
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- Опубликовано: 25 авг 2024
- Are you looking to save money on your medications? In this video from Medicare School, Marvin explains the importance of understanding Medicare Part D plans and the potential cost savings they offer for those who take multiple medications daily. With medication costs being one of the biggest expenses in healthcare today, it's essential to understand the differences between standalone drug plans and those embedded within a Medicare Advantage plan.
Marvin breaks down the six key features of Part D plans, including types of pharmacies, formularies, tiered copays, quantity limits, prior authorizations, and annual switching of plans. He also explains the four stages of coverage for Part D plans, including the deductible phase, initial coverage phase, coverage gap or "donut hole" phase, and catastrophic phase. This informative video is a must-watch for anyone seeking to navigate the complexities of Medicare and make informed decisions about their healthcare coverage. Watch the video now and discover how you can save money on your medications with Medicare Part D plans.
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I can't believe how complicated this all is. And these rules are applied to people who aren't as mentally sharp as they were when they were younger. All of this is just not right. I am thankful for the excellent explanation presented here.
Not only complicated for the insured but also for medical providers. (See my posting). Part B deductibles seem to be a major confusion for some medical providers. The problem word is "met".
from taxes, credited invester/investment, insurance, medicare , 401k, IRA, rothIRA, trust, revocable trust, irrevocable trust .... made complicated by design. Look up documentary " tax me if you can" on youtube. it will shock you.
This isn't complicated.
I am 60+ and understand it easily and quckly.
Get Part A B and D at 65.
Get a supplement Plan G high deductible.
Done.
$300 a month.
@@sammencia7945 Hi Sam, I wasn't really thinking about someone 60. My mom is 84, and I'll be there too some day.
@@sammencia7945 High deductible doesnt sound great to me but if it works for you thats cool. Dont think its quite as simple as you stated. Too many variables.
Only the government can make something this simple this complicated.
Ironically, my love for donuts is why I have to take all of these medications in the first place. 🍩
😂😂 Thanks for the laugh.
My glucose went way down when I stopped eating pastries.
Funny!
It is truly amazing that you seem to have all of this in your head. You don't even seem to be looking at notes. You also explain it very well. My wife is turning 65 next year so we are starting to look at Medicare and trying understand it. Your videos have been a great help.
Glad it was helpful!
If you have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
You would think that it would be simpler and less expense for seniors. A lot of seniors are living from check to check from SSA. God help us.
One of my most favorite rooms ever! Absolutely phenomenal! Cozy, comfy, charming!
The paint color makes all the difference! I love it and want to use it somewhere in our home! Your coffee table is stunning - perfect wood addition w the lighter upholstered furniture.
Thanks for the comment.
I learned a lot from your videos and helps me straightening my confused brain. You are really a Medicare professor. Thank you.
Thank you for the feedback.
This is a nightmare. I won't have enough money to pay for all the co-pays and part B and a plan G supplemental.
You have options. We can compare the most cost effective G and D plans and get a totals page. If your budget doesn't allow we help many people find a great Advantage plan option out there. There are ones that are much better than others. You can pair Advantage with a Hospital Indemnity plan that pays you cash if you're Hospitalized/lump sum check for Cancer to cover those bases. If you have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
You may qualify for Medicaid
Very interesting that a lot of people on Medicare D don't get into the donut hole. Almost every retiree that I speak to that takes drugs speak of it so I thought it was a given. I am on a drug that will put me into that hole as it is not generic yet. It's amazing that while I am working with private insurance I can get it for $10 for a 3 month supply but once part D kicks in I lose that. I plan on speaking to my doctor before getting medicare next year to put me on something else until it does go generic. We got to be up on everything!
Yes, the Group insurance rates can be much lower on certain high cost medications compared to an individual Medicare Part D plan. That sounds like a plan. We can help you find the most cost effective options! If have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
such helpful information, thank you.
Thank you for watching
Thank you for clarification! What a great explanation!!!!!!!!
Glad it was helpful! If you have questions or need help setting up your Medicare coverage correctly, give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Shouldn't the questions really be "Why are we all on so many medications? (Statins as a "prevention"?)
And why do these drugs cost exponentially more than in ANY other country??
Good questions. Thanks for the feedback.
The question is why do we keep voting in representatives that don’t have our best interests at heart ❤️
The most irritating thing about medicare is - for us seniors, our income can be limited and our insurance SHOULD be cheaper. Instead, our elected officials put all of these rules and regulations on medicare and seem to make it as confusing as possible, 4 phases of co-pays? Meanwhile, those same government officials and drug companies are making big $$$, and we keep tolerating it and voting for them. WHEN will they regulate the drug companies? WHY does someone's medication cost 23K a month?
I wish I had an answer regarding regulating drug companies. Thank you for the feedback.
Excellent overview of Medicare part d
Super helpful
You're very welcome, thank you for watching.
Thanks for all of the information you share.
You're welcome!
This is very helpful, thank you.
You are welcome! If you have any other questions or need help getting your Medicare coverage set up correctly, give us a call to schedule an appointment: 800-864-8890.
Great presentation. Drug plans can be confusing! AVI MD MBA MHA
Very much so. Thank you for your feedback. If you have questions, or need help getting your Medicare coverage set up correctly, give us a call to schedule an appointment: 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
I really enjoy your informative videos. Ty. I do have one note. My current drug plan requires that I use a brand name drug even though I know there is a genetic available. The cost to me is small. However they use the retail amount to calculate the donut hole. This seems unfair. They are forcing me into the donut hole sooner. My only solution is to us GoodRx.
It seems they happened to have the brand name drug on their list of covered medications, keep in mind, the plans have a pre-established list/formulary of covered medications. I would also get that medication through goodrx and not run it through the plan and during AEP, review to see what better Part D options are available for your needs.
Thank you
Of course, I'm on Eliquis and I'm a little bit panicky.
Yes, but how do you avoid falling into the donut hole?
You can try to avoid it by taking less costly medications. Take a generic if available and talk with your Doctor about lower cost alternatives that treat the same condition.
@@MedicareSchool Seriously? Your advice is to take less costly medications? Gee, why didn't I think of that?
So, here it is May 2023. I had my first medical appointment of the year Jan. 03, 2023. At that time a good portion of my part B deductible was "met". Four months later I still have not been billed for this first appointment of the year amount. I have called the medical provider three times and Medicare twice. They both say my deductible has been " met". I say yes met but not paid. What am I missing here??? I just decided to go ahead and make a payment to my medical provider. It was posted as a credit and now pending. WTH? Medicare said nothing is pending for this Jan. 3 appointment. Why is everyone so confused about this? Am I the one missing something?? Medicare said its best to figure this out now so it doesnt go to collections down the road. Makes sense. How do I resolve this? Just pay it?
Di you have Medicare Supplement Plan G? You have to wait to receive a bill from your provider. Your provider would bill you for the $226 that Medicare & your Supplement plan doesn't pay. Do you have an online account set up on medicare.gov to manage your billing and view statements..etc?
@@MedicareSchool I have original Medicare amd medigap G. Thats the thing... my medical provider sent the bill ($185.26) to Medicare. It was processed. They kicked it back. I owe that $185.26 as my OOP part B deductible for 2023. Two other imaging places billed me for $12.90 and $27.84. Those three amounts add up exactly to part B $226.00. So for whatever reason I have not been billed for the $185.26 and here it is 4 months later. Total confusion on their part. I will check out an online Medicare account but all that would tell me is my deductible has been " met" no? Medicare told me it has no control over whether my medical provider does or does not bill me for the deductible. Its the medical providers responsibility to do that. And the medical provider has a deer in the headlights look. Its been met they say. By whom I say? lol.
That's correct. The provider is responsible for billing you for that, as part of your deductible.
Finally resolved this on the fifth call. I had to explain that I owed the Part D deductible.
I get to catastrophic EVERY year - this year the amount spent out of my own pocket to get there is right at $3,000.00, NOT $2.000.00.
Thank you for the input. If you have any other questions or need help getting your Medicare coverage set up correctly, give us a call to schedule an appointment: 800-864-8890.
Misleading title, good explanation of how it works. Did Not tell how to avoid donut hole!!!
Should include info for 2024 and 2025. $2,000 max for prescriptions
We'll have a new video when more information about that is released, this video is a bit outdated. Be on the lookout for that new information is released.
This video is amazing, it is really helpful
Glad to hear it!
If a medication isn’t covered but might cost 25k a year this is horrible
I checked mine this year. The 1700 month pain meds not covered. So my out of pocket doesn’t count for anything to get me into a higher tier?
I have been hitting the donut hole every year. It sucks.
Marvin, I'm a retired military man, eligible for both TFL and VA healthcare. I'm only 59 but when the time comes, my current plan is pick original medicare A&B w/TFL to cover my care, scripts, and the like. Comparing this to the MA only plan, which would you say has the lowest cost risk? My thinking is Original Medicare is the gold standard over MA, but am curious if there's an angle I'm not seeing.
We could review the current MA plans and do a comparison when you get close to 65. Since thr plans change each year it would be better to look at it then. We would be happy to assist!
Marvin. I am very happy using Medicare and TFL for almost all my medical needs. But, I also have a VA primary care provider, and have a yearly visit with that provider. Doing so allows me to get all medications through the VA at zero cost. I also have had custom hearing aids made by the VA.
I called an agency and talked to an agent in SD to ask about switching from an advantage plan to a medigap plan. Agent told me that any health condition could exempt that move such as diabetes, kidney problems, etc but if it occurred in the past from 2-5y , depending on the carrier, approval could happen. Also, moving to another county would give a clean slate to do a switch. I don't know the particulars with that.
True that underwriting questions can vary by carrier. Moving doesn't automatically give you an Open Enrollment in a Supplemental plan without health questions unless you move to State that doesn't require it.
Advantage plan is great till you need to see a doctor.
JeeeezusCrist😳!! You need a phd 😱😱😱😱
Thanks for the input. It can confusing. we're here to help.
I wish that ‘they’ had some sort of guide that outlined which drug plan covered which drugs better or less…..so that depending on which drugs you require, you would know which plan would be the better one to go with at open enrollment time! Freak! Why do they keep this such a secret?!
As it is, I have found that going with the cheapest plan (Aetna), and using my SingleCare card MOST of the time, instead of Aetna, has been working out better financially so far. There have been a few RARE times when a prescription has been cheaper using Aetna than my SingleCare. I just always ask the pharmacist to always use whoever is cheaper!
I guess that’s one way to ‘avoid the donut hole’! Ha!
As part of being our Medicare client during our review we show you which plans are the most cost effective, show you how to use our Part D portal (client portal you have access to which has your medications and pharmacy preferences saved). The Part D plans are listed in order of least Cost annually with cost comparisons between pharmacies. This free portal you'll have access to as our client is similar to Medicare.gov but easier to navigate.
My doughnut hole this year was $2800 for one med, Creon. Without insurance it's $1300 a month. When in the hole it costs me $333 for 1 month. My insurance has told me it's going to cost $400 next year. My hole is going to $3400. I don't understand anything of what he is saying. I only know that without Creon I will get pancreatitis.
actual conversation about the donut hole is at 19 minutes. but you really need to watch the whole thing to UNDERSTAND it.
I injoy your website and the way you explain it, but when I received my Wellcare drug book it says Ozempic is a 6 tier drug and the cost is $35.00 so I called them and got the same explanation as last year. I thought insulin was changed to be no more than $35.00 a month. Can you explain why the Insurance Co. Is trying too over bill me and probably many more people who need the insulin? Thank you.
Insulin is capped at no more than thirty five dollars for a one month supply as of this year, however, ozempic is not considered insulin.
The title of this video was "Avoid Falling into the Medicare Donut Hole". The video very clearly explained the different stages of a Medicare Part D Plan but it did not provide guidance on how I could avoid falling into the Medicare Donut Hole. Did I miss something??
You didn't miss anything. The title was click bait.
Basically, high cost medications will get you to the donut hole phase sooner. If you can take generica and talk to your doctor about lower cost alternative medicine that treats the same condition.
@@MedicareSchoolit doesn't make a difference if there aren't any alternative meds that are more economical! So no the title on this video doesn't address what it claims it's just clickbait! Shame on you Marvin 🤬🤬👎👎
Love these videos what about using Amazon Pharmacy is there a donut hole if you get Xarelto from them? As long as have a cheapest drug D plan? Amazon told me they don’t have a donut hole. I tried to get in to your Monday sessions to no avail. Tx Jeff
The coverage gap, donut hole, phase is a factor with Medicare Part D plans. If you're able to find a medication for less through good rx or Amazon pharmacy etc and do not want to run it through your Part D plan, you're not required to.
I have a and b already.can i still get g added?
My team would be happy to assist you with setting up your Medicare coverage. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Thanks is there a way to find out which plan pays more for a expensive med?
Yes, you can see which Part D plan works be the most cost effective in order. We assist you with this when we review and help with your Medicare plan option. You can also go to Medicare.gov and input your medication, it will give you this information. If you have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
My biggest concern is how much is my long acting insulin going to cost me once I'm on Medicare.
$35.00 a month per prescription
If a plan covers an insulin on its formulary, it's capped at $35 for a 30 day supply.
@@MedicareSchool Thank you for letting me know. I'm kind of spoiled though. I'm hoping they will cover my Tresiba Flex pens. My insurance company is currently doing a pretty good job of that. Maybe I can find a supplemental plan with that as a formulary.
I’m wondering if a person should have cancer insurance just in case ?
It can definitely be a good thing. We have a recommended affordable option with with great coverage. If you have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
Works well Medicare Advantage -avoid Donut hole!
Currently the Donut Hole phase is a factor no matter if you have a Standalone Drug plan or a Mapd, Medicare Advantage with Prescription Drug.
I have noticed that you always refer to Medicare Advantage as Plan C. However, it is my understanding that in order to avoid confusion, only supplemental plans are referred to as “Plans”. As such, shouldn’t MA be correctly referred to as Part C and not Plan C?
Excuse me for the confusion...
How much of this applies to VA drug plan?
The phases of cost are part of Medicare Part D plans.
If have any questions please, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
Why have any stage 2-4? Just raise the Medicare tax to cover this. Simpler. Amazing, until recently Medicare wouldn't negotiate drug prices!
Disappointed. I thought you were going to give us some tips on HOW to avoid the donut hole.
Thanks for the input.
This only explains how the plan works. It does not give true advice on how to avoid the donut hole if you are on higher priced medication.
Thanks for the comment. If you need help getting your Medicare coverage set up correctly, feel free to give us a call at 800-864-8890 or schedule a free appointment here:
www.medicareschool.com/talk-to-a-guide?rc
If you use biologic injections, you hit the donut hole in the first month!!
thank you so much. you talk so well!!!!!!!!!!!!!!!!!!!!!!
Thank you for watching!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!