Sunday, December 16, 2012

What You Need To Know About Prescription Drug Plans (Part D)

By B. Loughead
Medicare Part D was created by the passage of the Medicare Modernization Act and went into
effect as of the 1st of January, 2006. If you are eligible for Medicare Parts A and B or already have that coverage, you are also eligible to receive the Prescription drug plans (Part D). If you currently have Medicare, you are eligible to receive this benefit provided you enroll in a Medicare Advantage (MA-PD) plan or a stand-alone PDP (prescription drug plan). The Medicare program approves and regulates these types of plans.

What You Should Be Aware Of With Part D Coverage

You need to be aware that these plans are designed and administered by private healthcare insurers. However, Prescription drug plans (Part D) coverage is not standardized unlike Parts A and B. Each plan selects which medications or classes of medications they are going to cover as well as the level at which they are covered. They also have the right to select those drugs that they do not want to cover. The primary exception would be those medications that are excluded by Medicare coverage.
These include barbiturates, benzodiazepines, and narcotic cough suppressants but are not exclusive to these. Additionally, those plans that cover drugs which have been excluded by Medicare cannot pass the costs of them on to Medicare. If by chance Medicare is billed for these medications, they will refuse payment on them or back-charge the insurer that sent those costs onto them. If you are a Medicaid and Medicare beneficiary, Medicaid will occasionally pay for medications such as benzodiazepines or other types of restricted controlled substances.

The "Donut Hole"

You may or may not have heard the terminology "the donut hole" when researching Prescription drug plans (Part D). This is a gap in insurance coverage that oftentimes occurs once the pre-set prescription medication spending limit has been reached by you and your plan. Not only will your plan quit paying for any further medication expenses once that limit has been reached, there will be a period of time where you will be 100% responsible for payment of your prescriptions.
In closing, you need to keep in mind that there will be a donut hole found in every type of coverage plan. However, the reality is that many individuals never reach the donut hole of their coverage. In addition to this, you may be eligible for discounts on both brand name or generic medications when reaching the donut hole. Fortunately, the donut hole should be phased out completely in 2020.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit or call us at 1-888-40-Summit (888-407-8664). **We will provide a Free Part D report specific to your prescriptions to anyone who get's a Medicare supplement plan through us. It will show every plan available in your area and if it covers your prescriptions. It will save you hours of research.

How The $700 Billion Cuts From Obamacare Will Impact Medicare

By B. Loughead
In August of 2012, then presidential candidate Governor Mitt Romney went on the offensive regarding President Obama's proposed $700 billion Medicare spending cuts. Although Vice-Presidential running mate Senator Paul Ryan of Wisconsin has stated that Medicare should be transformed and plans to cut $700 billion in future Medicare expenditures, Obamacare would cut roughly $716 billion over a period of 10 years. So there is now a great deal of speculation as to how the $700 billion in cuts under Obamacare is going to impact Medicare.
In order to get Obamacare to pass, President Obama proposed $700 billion in across-the-board cuts that were extremely arbitrary in nature. Medicare patients will see reduced reimbursement rates for services provided them regardless of how poorly or well these patients are treated by healthcare and medical services. Nearly $160 billion in cuts to Medicare Advantage plans will also be incurred over the next decade as well. This means that by 2017, seniors will be paying nearly $4,000 more for healthcare.
Even worse is the fact that it has been estimated that this increase in healthcare costs will eliminate roughly 4 million seniors from all Medicare Advantage plans over the 6-year period beginning in 2012 and ending in 2018. Hospital payment rates would also be slashed drastically as a result of these Obamacare cuts. According to the program's Chief Actuary, these cuts could jeopardize any senior's access to healthcare.
In addition to the above, it has been estimated that 15% of all assisted living facilities and hospitals will no longer take Medicare patients in the future in order to prevent potentially huge financial losses resulting from payment of Medicare premium rates. Additionally, it is speculated that 25% of these institutions will no longer be a part of the Medicare program as of 2030.
According to Charles Blahous, a Stanford University fellow who specializes in domestic economic policy research, the Medicare cuts involved with Obamacare won't be used as replenishment for Medicare benefit trust funds. The reality is that the money from these cuts will pay for a huge entitlement spending expansion. So another question arises. Where will this $700 billion plus in Medicare cuts actually come from?
A portion of them will come from the harsh, restrictive control over medical billing procedures. However, the worse part regarding this entire scenario is how seniors are going to suffer from these cuts. With so many of them now living on fixed incomes, it could be financially disastrous in the long run.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit or call us at 1-888-40-Summit (888-407-8664).

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