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[M376]Medicare And Part D
by Ray La Foy, Ray
As of Jan. 1, 2006, the federal government expanded Medicare coverage with the launch of the Medicare Part D program. This program enables seniors to get the prescriptions they need, when they need them with the benefit of an insurance program that can really help lessen the annual costs for drugs. To take advantage of the program, however, Medicare recipients have to navigate a system that seems a little confusing on the surface.

To begin to understand how the new Medicare program works, it's important to first understand a few basic facts. Part D is available to everyone on Medicare. Period. There are no other eligibility requirements. A Medicare recipient cannot be denied Part D coverage for medical reasons or income level. If you're enrolled in Medicare, the prescription coverage is available. The choice to participate, however, is up to the individual.

The caveat here, however, is the coverage is voluntary. You have to enroll to get it, but don't worry about denials, because they won't be forthcoming. For those who already have solid prescription coverage from other sources, it's important to carefully weigh the benefits of both. A private policy might in fact cover more for a lesser financial impact on the individual Medicare recipient, but it may not. Look to see which plan works better for your particular situation.

When enrolling in Medicare prescription coverage, the first thing recipients will notice is there are several options to choose from. There is no single drug plan and what's even better is that Medicare doesn't administer them - private drug plan companies do. For those on very limited incomes, the new coverage will allow Medicare to cover most of the drug costs. For those with very high drug expenses, there's even a Medicare plan that will cover about 95 percent of the costs beyond a deductible each year.

To review the different plans available, it's a good idea to speak directly to Medicare or check out the agency's web site. The plans are diverse and are meant to assist as many different people and situations as possible. Ideally, the best way to approach studying the different plans is to look at each of the options while keeping your personal circumstances in mind.

For those who decide to use the Part D coverage, it's important to note that the discount cards issued in the past are not the same thing. Those cards only provided discounts, not insurance. The new Part D coverage replaces those on a permanent basis.

Since Part D is new and it is a little confusing for Medicare clients to understand coming out of the gate, it's important for interested seniors to get informed advice on choosing plans, benefits and so on. Medicare has promised to provide information to its clients each year prior to the annual open enrollment period, which will include a list of plans available and their benefits.

For other help, Medicare Part D recipients or those who want to enroll in coverage should visit the Medicare web site or call 1-800-633-4227. State agencies and the Social Security Administration may also be able to provide informed advice. Visit the Medicare web site here http://www.medicare.gov/medicarereform/drugbenefit.asp.

Here are some facts that may help answer the concerns and make the issue a little clearer.

The Government is enforcing Medicare Part D. Proof of this is evident if considering the penalties individuals will incur by not joining Medicare Part D by May15th. The accumulative 1% penalty (per month) can become expensive over time and looks counter productive. It seems more likely the Government agenda is geared towards herding the public into a central plan and closing the doors for international prescription imports.

Medicare Part D is great if individual retail expenses are exactly $2250 each year. The further away annual costs are from that perfect amount, the less effective the plan is.

Medicare Part D is deceptive because it is presented as a 75% savings when in reality the savings are at best 60% when the perfect amount of $2250 is spent.

Medications that are not insured obviously reduce the savings. If you spend xactly $2250 retail on insured medications then your savings will be significant, probably between 50% and 60%. So who will hit that perfect amount?

Here are some scenarios to consider: (Based on $250 deductible and monthly premiums of $35)

  • Spend $1200 on insured medications - Savings will be about 16%
  • Spend $3000 on insured medications - Savings will be about 36%
  • Spend $4000 on insured medications - Savings will be about 27%

The Perfect Situation:

  • Spend $2250 on insured medications - Savings will be 52%

Anyone who is spending more than $2250 on prescriptions each year will be unhappy paying full retail after spending beyond the $2250 mark, and possibly angry when they realize the monthly premiums are still due.

Spokesman for Professional Services Canada Darwin Corby, has this advice:

"Sit down and calculate all your prescription expenses at full retail by phoning a local Pharmacy. Get familiar with your Medicare Part D costs. Add the $250 deductible and monthly premiums together with the %25 not covered in the first $2250. Then add the full retail you will be paying in the doughnut hole on top of your costs. (The doughnut hole is the gap between $2250 and $5100) Subtract the deductible, monthly premiums, doughnut hole expenses and 25% from the savings to find your approximate savings for the year. You also need to understand that reaching the ideal savings is highly unlikely."


A simple webpage chart is provided to help understand Medicare Part D on this page


Recommendations:

Use a Canadian Prescription service to help avoid the Doughnut hole if expenses are high. Join a low cost Medicare Part D plan to avoid the penalties if expenses are low. Enquire about Canadian prescription prices to maximize savings.

Article Source : Health Care In The Us

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Both Ray La Foy & Darwin Corby are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Ray La Foy has sinced written about articles on various topics from Home Improvement, Software and Parenting. #1 Resource
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