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Medicare Part D Explained | (And How To Avoid The Donut Hole)

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Medicare Specialist - Abt Insurance Agency

Medicare Specialist - Abt Insurance Agency

Күн бұрын

Пікірлер: 504
@km-bo3zx
@km-bo3zx 4 жыл бұрын
My wife and I will be new to Medicare, in 2021. Both of us are active and healthy, and neither of us take medication. She’s of the mind to NOT sign up for Part D, where I believe we should sign up for the cheapest plan available, as a placeholder for the future. Thoughts? Thanks, dave
@AbtInsuranceAgency
@AbtInsuranceAgency 4 жыл бұрын
This is a popular question. Although you don't have to enroll in Part D, you should be aware that there is a penalty if you do decide to enroll in Part D later on down the road - This video explains more: kzfaq.info/get/bejne/e82EoLWInZPFqWg.html I hope this helps!
@km-bo3zx
@km-bo3zx 4 жыл бұрын
Thanks! I'll watch the video, but already knew about the penalty. That's why I think signing up for the lowest priced plan (as a place holder) might be the best option. I was just wondering if you had any insight (rule of thumb) as to when you might not want to sign up for Part D. dave
@AbtInsuranceAgency
@AbtInsuranceAgency 4 жыл бұрын
@@km-bo3zx Some folks who are not taking any medications and are subject to IRMAA (which makes their Part D premiums much higher) decide to go without Part D. For them, it can make financial sense to do so, even when factoring in a potential penalty down the road.
@jenniferlee7167
@jenniferlee7167 3 жыл бұрын
@@km-bo3zx I did the same thing as a new Medicare recipient in Sept 2019. I was on no medications and decided to take the cheapest Part D to avoid the penalty. How could I know that I would get an upper respiratory virus in November 2019 that put me in the hospital for five days and threw me into A Fib! I am now on blood thinners and a medication that regulates my heart rate. I am improving, but will be on the meds for a while longer. I am so glad I bought the Part D, United Healthcare AARP it cost me $16.00 per month. My meds are mostly tier 1, so no copay.
@km-bo3zx
@km-bo3zx 3 жыл бұрын
@@jenniferlee7167 I'm glad it worked out for you and thanks for your input!
@majorpayne4098
@majorpayne4098 3 жыл бұрын
those lawmakers should have to wade thru this obstacle course and deal with it every year as we have to. they should also have same coverage deductibles etc as we do.
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
You're right!
@johnz8843
@johnz8843 3 жыл бұрын
It's better than nothing. It's not that hard to figure out unless you take a lot of drugs, in which case, I'd go and sit down with someone in the business.
@keko7098
@keko7098 2 жыл бұрын
You are very right, but a dreamer!
@cherylmcnutt9905
@cherylmcnutt9905 2 жыл бұрын
They should, but they don’t Republicans & Manchin spare no expense in getting themselves the best medical coverage in the country, but they won’t spend a penny to make life easier for Seniors!
@toriless
@toriless 2 жыл бұрын
Those scum get $0 deductible, no donut hole, etc.
@padellina9596
@padellina9596 2 жыл бұрын
Good informative video, thank you! Having been on Medicare for a few years now, the most important message you’ve given is that WE HAVE TO REVIEW OUR PLAN(S) EVERY YEAR. In the beginning, I did a thorough research of Part D plans and picked one. Good split what I paid and what insurance did. And so I kept the plan year in and year out. What I didn’t notice was that the next year, they raised the copayment limit. Now the market price of my copayment was all within that copayment. So, in 2021 I will have spent $1,600 of my money on my medications, while the insurance will have paid $0. And the premium will still have cost me over $400 for the year. So clearly, yearly review is a must. I am doing it now - and what I am finding is that ALL PLANS ACTUALLY SUCK. So much information (for insurers, it’s a game) and so many variations of the same: YOU (patient) pay as much as spossible and WE (insurer) pay as little as possible, preferably nothing. Like all health insurance in America, it’s a scam!
@toriless
@toriless 2 жыл бұрын
Pointless if you do not know which medications you will be on. I have NO IDEA WHICH EXPERIMENT THE DOCTOR WILL TRY NEXT.
@timisaac8121
@timisaac8121 2 жыл бұрын
The big thing to me is other people have gone through and just shrug their shoulders and accept it- No one ever told me. And I listen to everyone that wants to talk. I am very grateful of your videos and the easy to understand materials you present. It is really alot to take it but you have a real skill to teach people. May the force be with you.
@pinchermartyn3959
@pinchermartyn3959 2 жыл бұрын
Why is this whole insurance thing so complicated. Is it done on purpose? To confuse. I think so.
@Crymeariver227
@Crymeariver227 2 жыл бұрын
Because insurance companies are in the business of making money; understanding that one fact makes the confusion, clearer. Brokers such as Stephanie and others who provide these services are the representation you want because they’re giving you all the options. An agent representing one specific company won’t do that.
@kd8199
@kd8199 2 жыл бұрын
It’s also used to avoid paying necessary healthcare needs.
@toriless
@toriless 2 жыл бұрын
yes it is
@Dexion845
@Dexion845 2 жыл бұрын
It’s mostly government regulated. Part D just means prescriptions. That coverage gap is not something most beneficiary’s hit. If you’re on a very expensive drug then after you hit $4,430. Basically the insurance company takes a break and you pay 25% instead of copays. Then if you hit $7,050 you are saved by the plan again and you just pay 5% or a small copay.
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
@@kd8199 yes; as do ADVANTAGE plans that are actually NOT medicare but are private and can throw you off anytime. Try that when you are in your 80s, have no advocates and need serious medical attention
@randyc5650
@randyc5650 2 жыл бұрын
I take 2 inhalers, Symbicort and Spiriva. After a $400 deductible, I am in the do-nut hole by June. I get my name brand inhalers from a Canadian pharmacy and pay less than my cost from my insurance before the do-nut hole. They come from foreign countries but are made by the same companies as the original but will have a foreign language on them.
@jacobkowski7705
@jacobkowski7705 2 жыл бұрын
Isn’t Symbicort a preventive medication, so it’s fully covered? I also take symbicort, but not under Medicare, but under an employer medical plan.
@randyc5650
@randyc5650 2 жыл бұрын
@@jacobkowski7705 Before I went on Medicare and Part D I was under an employer medical plan. This was before Symbicort and Spiriva were available (before the chloro-fluorocarbon ban). I don't remember the names but there was a small yearly deductible, no co-pay and no do-nut hole. I have never had a preventive/non-preventive drug issue with either drug plan with any prescribed drug. I searched my current Part d drug list and there was no mention of "preventive". On the other hand, I must mention that I have been having cancer treatments from the end of 2020 through 2021 and now into 2022. My costs each year have been roughly $200+/- supplemental medical plan deductible, $200+/- Part D prescription deductible and a couple of bucks for incidental cancer meds, anti-nausea med etc. And that's it other than the normal plan premiums ($2200-$2500).
@toriless
@toriless 2 жыл бұрын
@@jacobkowski7705 Depends on the insurer, that is the real problem with part D, some companies will cover what other companies do not, it is a crap shoot unless you know every drug you will take this year. I never do. What really stinks is of you pay for it yourself it does NOT count towards you deductible, only IF is part of a co-pay. Total SCAM !!
@MsLindaWhite
@MsLindaWhite Жыл бұрын
I too have to use those inhalers which controls my COPD very well!!!!!! No issues at all in years! However I tried to sign up for PART D and they charged me $ 331.70 a month because the drug companies take advantage and charge that much! So I cancelled my United Health care insurance and shopping around for a new one! I get my inhalers from a different source now. I do not need Part D however I would like any suggestions on insurance that is for catastrophic Part B expansion. Not too fond of united health care!
@lcg5067
@lcg5067 Жыл бұрын
You are a Godsend Stephanie! Deeply appreciate all the "gaps" 🤗of knowledge that I have been missing in the process of signing up for Medicare B, D, G....etc. Our situation was and still is complicated, but your many teaching-based videos that I have been watching for a few hours now have alleviated a lot of stress I have every day as to when to apply for the Medicare Part B, D, G...etc.. An Insurance agent is someone I would love to have working with us. At least now I can approach this process head on now.
@AbtInsuranceAgency
@AbtInsuranceAgency Жыл бұрын
Thanks for the feedback! We would love the opportunity to assist, call us anytime. 888-465-9728.
@nicholekennedy362
@nicholekennedy362 2 жыл бұрын
I’m only 43 years old and all of this is so overwhelming. It breaks my for the senior citizens . So I called Medicare and I’ve spent a weeks trying to figure all of this out. Remember I’m clueless about all of this . So they entered all my meds in the system & they said the system would chose which tri advantage plan . You need to be President of Medicare . I’m so thankful you have explained everything to us .
@christopherallen9580
@christopherallen9580 2 жыл бұрын
why are you wasting ssa staff time when you when not be eligible for medicare for more than 20 years?
@audreyboag7670
@audreyboag7670 2 жыл бұрын
@@christopherallen9580 Because that's how long it takes to understand it.
@toriless
@toriless 2 жыл бұрын
@@christopherallen9580 He is an idiot, unless he is disabled it does not natter. Not everyone on SSA is 65 yet.
@alansach8437
@alansach8437 2 жыл бұрын
@@audreyboag7670 LOL! Of course it will be completely different by the time he gets there!
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
@@christopherallen9580 no questions are a waste of time
@annalyncastro7557
@annalyncastro7557 Жыл бұрын
As a new agent, this is very clear to me. Thank you so much Stephanie. Bless your heart for sharing your knowledge.
@timisaac8121
@timisaac8121 2 жыл бұрын
I can't say enough for your clear and decisive presentation: Because most people take the same medicines, the finances also continue, predictably year to year!! Yes? You are really good at this.
@timisaac8121
@timisaac8121 Жыл бұрын
I found out "today" (I am always the last to know) my own MOM takes six different meds every single day!! Of course, she has to be medically underwritten if she changes her coverage!! Six!! Just a doctor knowing the possible interactions of those drugs is a professional determination!! Thanks again for YOUR very professional presentations. This isn't "rocket science" but it has alot of important decisions to be made.
@ler3968
@ler3968 2 жыл бұрын
Yup, I retired after 40+ years in HR & Benefits/ Mgt., I was confused by Part D reg's when I retired w/Medicare years ago. There were very few resources like on the internet or KZfaq to help at the time.
@barrylitchfield250
@barrylitchfield250 2 жыл бұрын
I fell into the donut hole abyss after three 90 day prescriptions for Eliquis. I switched that prescription from my Medicare Advantage Plan to my VA benefits before ordering the 4th 90 day refill. Now my copay is ZERO for Eliquis. My remaining prescriptions are still with my Medicare Advantage insurance provider. If you're a military veteran, and have VA benefits, you should be able to get a much lower co-pay at the VA. If you're receiving 70% or higher disability benefits, your copay should be zero. Even for the "designer" medicine that's heavily advertised on TV.
@toriless
@toriless 2 жыл бұрын
and then you get diabetes and you are denied coverage. Supplemental plans do not make medical decision like your scummy HMO.
@zuster6962
@zuster6962 2 жыл бұрын
We’ve been on medicare and plan d for 10 months now. I’m appalled at how expensive my costs are.
@toriless
@toriless 2 жыл бұрын
You income is probably to high to qualify for low co-pays.
@alansach8437
@alansach8437 2 жыл бұрын
Depends on your plan. Pay higher premiums and lower copays/more drugs are covered, or pay lower premiums and higher copays/fewer drugs covered. They are insurance companies, not charitable organizations. One way or the other, they are going to get their money out of you.
@kellyeastridge114
@kellyeastridge114 2 жыл бұрын
@@toriless my hubs is still working so no assistance
@kiritpatel8202
@kiritpatel8202 2 жыл бұрын
THANK u for detailed explanation about tier 1 ,2 3 and 4 ,when deductible starts in easy ,simple words which we understand properly..
@warrenphelps5342
@warrenphelps5342 2 жыл бұрын
I would add an explanation of the penalty aspect of Part D if one does not take Part D when they are eligible. In searching for a plan it’s hard if you are initially not taking any medications. I asked my pharmacist for 13 common drugs often prescribed and used this as at least something to help compare plans.
@toriless
@toriless 2 жыл бұрын
That is BS, I never used Part D for the years after I had medicare coverage. You must be going to a bad web site and are being fed lies!
@alansach8437
@alansach8437 2 жыл бұрын
I think the best plan, if you aren't currently taking any medication when you originally sign up, is to just find the cheapest plan. For me it was like 12 bucks a month. That way you have a plan and won't end up paying penalties later. It's impossible to try and guess what you MIGHT be prescribed at some later date. You can always switch plans during open enrollment later if you are put on a drug that isn't covered. Also, always ask the pharmacist what the cash price is, as sometimes it's cheaper that the copay!!
@jhors7777
@jhors7777 Жыл бұрын
Wow, what a complicated deal. Thanks Stephanie!!😊
@ArthurMorganFTW_RDR
@ArthurMorganFTW_RDR 3 жыл бұрын
This helped a lot of my understanding about part d phases in general, just started working as a benefit adviser so really appreciate your efforts enlightening us....,
@charlestaylor6806
@charlestaylor6806 2 жыл бұрын
Due to having diabetes Type II, high blood pressure, cardiac arrhythmias, and other stuff, I usually hit my "donut hole" around March or April. But, I usually come out around August. But still those months in the "donut hole" are financially painful. It is why I am still working at 71.
@toriless
@toriless 2 жыл бұрын
Diabetes can be especially expensive, I hear. It was used as an example in another video. The problem is even if you qualify for a $8 co-pay they might be paying $300 and then maybe another $150, so boom $4K can go quickly even if you did not pay most of it since it was a generic tier 1 or tier 2 drug. Apparently Eloquis costs $500 even if you only pay $50. Real easy to hit the donut hole.
@Dexion845
@Dexion845 2 жыл бұрын
Shop around. Try generic variants.
@alansach8437
@alansach8437 2 жыл бұрын
Stupidest thing, the donut hole. Seniors can't afford that kind of financial hit.
@taparker6190
@taparker6190 Жыл бұрын
Some drug companies have programs to help pay for drug costs. Also, Medicaid may also be helpful. There are programs that can help, just inquire through Social Services.
@Asdfghjkl1234
@Asdfghjkl1234 2 жыл бұрын
Exceptionally and clearly presented. Thanks very much for posting.
@SCUBAZZR
@SCUBAZZR 2 жыл бұрын
A BIG hint if you use one primary pharmacy for all your Part D, AND you occasionally use a discount club like GoodRX because of a substantial cash saving on a particular drug- use the GoodRX at a different pharmacy. Do not commingle. Reason- the customer database profile often, if not probably, at your main Part D pharmacy gets confused (corrupted) by your different plan and BIN IDs resulting in nightmares at checkout. These days pharmacies are running at sprint speeds and are slaves to their computer spit-outs, thus sorting out conflicts are not a priority. Don’t mix insurance coverage at the same pharmacy.
@billyb.9533
@billyb.9533 2 жыл бұрын
Hi , My name is William and I am 79 years old. I have had Medicare since 2008 and part D also. I take eight generic drugs and one higher tier drug, Eliquis. That is where my problem lies. I have hit the donut about June every year since 2008 and it has almost killed what little savings that my wife and I were able to save over the years. I have tried over and over to get help, but the instant that I admit that I am a responsible person and have insurance, I am always denied any help of any kind. I am at the end of the road and would love some advice from you, if you could please help. You seem to be one of the most sensible, down to earth person on the internet. Thank you in advance. William
@toriless
@toriless 2 жыл бұрын
Yeah, those 8 probably cost you $28 a month and another $90 for medicare but Eliquis costs over $500.
@khaledamin729
@khaledamin729 2 жыл бұрын
Hello, Please continue to post such an informative and creative videos. Therefore, people like us will be motivated and learn in real life.
@bernam8342
@bernam8342 8 ай бұрын
Thank you for making such helpful videos, but it's quite sad that we have to go through so much rubbish just to get our basic human right of healthcare.
@mikedavis7733
@mikedavis7733 2 жыл бұрын
I love listening to you and This year I need to speak to you because with Medicare and my Humana Insurance I’m paying over 500 a month and I only use for mostly My annual Wellness test. I take a little BP med other than that they say I’m ok.
@mikedavis7733
@mikedavis7733 2 жыл бұрын
Thank you looking forward to your Guidance! I have watch lots of your videos and very impressed. I’m 73 and a widow so hopefully to talk soon
@christopherallen9580
@christopherallen9580 2 жыл бұрын
@@mikedavis7733 Humana Medicare Past D?
@toriless
@toriless 2 жыл бұрын
@@christopherallen9580 I have them, they stink.
@christopherallen9580
@christopherallen9580 2 жыл бұрын
@@toriless good to know
@pablohernandez1159
@pablohernandez1159 2 жыл бұрын
Ha ha. How about 1470 my 25%for trulicity, now past gap about 170 now stage 4. Thanks good info.My 1st year on D.
@DanielHernandez-yb6dc
@DanielHernandez-yb6dc 4 жыл бұрын
Great presentation: You convinced me that Part D is something I will need. My wife will as well. I turn 65 in March. Retired Military which provides free medical and prescription coverage for $50.00 per month no matter how many family members I have. I don't plan on taking Social Security until FR (66.4). When does Part A have to be paid? I understand Part B will start @65? I get medication at Military Treatment Facilities and the Veterans Hospital. Will that all stop? Please send a quote for D that provides service in Hawaii.
@barrylitchfield250
@barrylitchfield250 2 жыл бұрын
Daniel - I thought Hawaii had social medical. Just go to the county hospital and wait in line until all the more serious injuries and illnesses are treated, then it's your turn. I'm guessing that most doctors in those hospitals are just out of school, and graduated in the bottom 20% of their class.
@toriless
@toriless 2 жыл бұрын
The cost of part D is cheap compared to the $144 for part A & B, something like $3, SSA messed up and was not paying so I had to pay myself to get it going. It was never explained why they were not paying but without admitting a mistake they covered what I have paid later on. This is why I know how cheap it is. I do not know why anyone would not get Part D.
@alansach8437
@alansach8437 2 жыл бұрын
Barry, my nephew lived in Hawaii for several years. They have some of the best healthcare in the country. Just check out Best Places to Live on the internet. Very highly rated healthcare in Hawaii. Also, not Socialized Medicine, but don't knock it. Countries that have it generally are happier with their healthcare, and in many cases, have better outcomes than in the money hungry US. Just imagine if your healthcare insurance premiums didn't have to support big bonuses for fat cat CEOs, and profits for investors! Your premiums just covered the actual cost of healthcare. That's what your extra taxes would look like with Socialized Medicine, in lieu of premiums.
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
@@toriless I think A and B are now close to $165-$170 month
@taparker6190
@taparker6190 Жыл бұрын
Part A is free, unless you have not worked 10 years or more then you pay a prorated premium. Part B is what you pay for, and it is around 165-175 per month. If you do not have creditable coverage (insurance equal to or better than Medicare) elsewhere like on your job or your spouse's job after reaching age 65 there will be a penalty after 12 months of non-coverage if and when you sign up for Part B.
@michaelguida448
@michaelguida448 4 жыл бұрын
-If you are an inpatient do the drugs you receive in the hospital come out of your part D or out of your hospitalization
@AbtInsuranceAgency
@AbtInsuranceAgency 4 жыл бұрын
Great question. This comes from a CMS document about drug coverage under different parts of Medicare -- "People with Medicare may get drugs as part of their inpatient treatment during a covered stay in a hospital or skilled nursing facility (SNF). Generally, Part A payments made to the hospital, SNF, or other inpatient setting cover all drugs provided during a covered stay." -- Here is a link to the referenced document: www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf
@Mr51Caveman
@Mr51Caveman 2 жыл бұрын
Someone please explain this to me: I am retired Military (served 24 years). I had Tricare coverage supposedly for Life. I also have VA coverage because I'm rated 90% disabled. At 58 or so I had to quit working and go on SSA disability. I did NOT take the Part D at the time because I had (I thought) Tricare and the VA who provided what Med's I needed. Even the Social Security rep told me I didn't need it. But then about a year ago I discovered that my Tricare coverage had been DROPPED!!! After MANY hours on phone calls to every Guberment agency I could reach I was told that I HAD to have Part D to keep my Tricare!!! By LAW supposedly. SO I had to wait until this past January to get the Part D reinstated. And they are penalizing me at like $178 a month. Even though SSA told me I didn't need it. And I'm also paying a fee to Tricare to keep the Family coverage I served 24 years for! I was blown up twice, shot once, ribs broken multiple times, crushed hands, shrapnel wounds, collapsed lung, lots and lots of stitches, some other broken bones, thermal burns in both eyes, and Guano Virus! Whew! I've also been told that when I turn 65 I will get Tricare For Life and I can drop the Part D. Just doesn't make any sense to me. Maybe the Guberment just wants me to die...............
@toriless
@toriless 2 жыл бұрын
From my experience with government apply for everything you can, except EBT. That is only for the poor. By poor I mean $500 a month, not $1000. If you do not qualify they will let you know. Get whatever you can and between them all you will finally get enough.
@mikejensen4636
@mikejensen4636 3 жыл бұрын
great job wish I could find her to talk too. Really good information
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
You can call us anytime, 888-465-9728
@johnrust5278
@johnrust5278 3 жыл бұрын
I’m 70 and my wife is 67. My plan is going up to almost $400.00 per month. I need a new plan.
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
That's what we're here to help with! Please give us a call at 888-465-9728.
@JLilliquist
@JLilliquist 2 жыл бұрын
Probably!!
@timl.b.2095
@timl.b.2095 3 жыл бұрын
Best explanation I've seen.
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
Thank you!
@lcarliner
@lcarliner 2 жыл бұрын
Generally, I find that the included Part D plans with most Part C plans are superior to that of any any stand alone plan offerings, in particular, that only included Part D plans will not have the initial deductible stage!
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
I haven't seen any Part D included in my PartC...
@taparker6190
@taparker6190 Жыл бұрын
@@kayleeguy5471 Some Medical Advantage plans have a drug plan included.
@sreejith9922
@sreejith9922 Жыл бұрын
Thank you a lot for this video. This is very interesting and informative. Keep posting like those amazing videos, this is awesome.
@LadyMaryanne
@LadyMaryanne 3 жыл бұрын
Wonderfully detailed information and great visuals. Thank you🦋
@Ed-kw7vw
@Ed-kw7vw Жыл бұрын
Thanks for your presentation. Even healthy and no medication, I always approach insurance to protect against financial ruin by expensive drugs. Are
@Ed-kw7vw
@Ed-kw7vw Жыл бұрын
Are most if not all of those expensive cancer drugs administer in doctor's office which is covered by plan B but not plan D?
@michaellagrimas3733
@michaellagrimas3733 Жыл бұрын
Wow...THAT was a mouthful but, lucid and comprehensive. Thank you! I'm turning 65 in January so, I'll be a rookie. I wanted to know if a chart exists about the various Plan D's in comparison to each other? Is there a go between agency that I would sign up with or do I deal directly with Medicare? See? i don't even know the basic steps to brace for Medicare. If there is a link to a website you could recommend to find answers to my concern, that would be great! I noticed with info I've been getting in the physical mail and email about Medicare, they only ask, which plan do I want, Plan A or Plan B? No option for a Plan C or Plan D. I'd appreciate any help you could give me. Thank you
@AbtInsuranceAgency
@AbtInsuranceAgency Жыл бұрын
Please call my office! We can help answer all of these questions, and our service is completely free. 888-465-9728
@taparker6190
@taparker6190 Жыл бұрын
Great out-of-pocket tip.
@TeddyCrochet
@TeddyCrochet Жыл бұрын
so confusing. as a person on MS drugs which cost 7K/month i have no idea what i'm supposed to do. all MS treatment is Tier 5 and the manufactures aren't allowed to step in for financial assistance.
@tonyspada2744
@tonyspada2744 2 жыл бұрын
I'm sure I have no idea what I've been doing lol Thanks Stephanie !! I will seriously need to speak with you soon. You Rock 🤗🎸🎶🎶😘 now I want some jelly Donut Holes lol
@pattystephens5977
@pattystephens5977 Жыл бұрын
It’s sad that Medicare does not allow coupons for seniors. We work so hard all of our lives, and what do we get in return!
@RJMEL24
@RJMEL24 2 жыл бұрын
Your explanation is very good “except” you don’t fully explain the “Almost” full retail cost while in the Donut Hole in getting to the Catastrophic phase. That is a grey area. Who determines the “Almost” portion? And how is it derived? Most insulin dependent diabetic seniors end up in the Catastrophic phase simply because of the high prices set by the pharmaceutical companies.
@toriless
@toriless 2 жыл бұрын
It is based upon the medicare negotiated price just like with services. I had a diabetic cat, we only paid $100 per bottle for the good stuff that lasts all day. Of course with a cat it would lasts months not weeks. I guess it is more now??
@melanieharris5595
@melanieharris5595 4 жыл бұрын
Stephanie, Thanks so much for explaining Medicare. I’m turning 65 in Jan 2021 and received my Medicare card in the mail today. Currently I’m not taking any prescriptions so I’m wondering would I need plan D coverage?
@AbtInsuranceAgency
@AbtInsuranceAgency 4 жыл бұрын
That's a questions I get a lot! In fact, I make this video to answer it -- kzfaq.info/get/bejne/e82EoLWInZPFqWg.html . Basically, you don't have to get a Part D Plan, but if you don't get one when you're first eligible then you may get penalized down the road. Let me know if I can be of any assistance! (888) 465-9728
@melanieharris5595
@melanieharris5595 4 жыл бұрын
Abt Insurance Agency Stephanie, you are definitely a blessing....I reviewed the recommended video regarding partD, logged into Medicare.gov, located an affordable option available in my zip code area and have successfully enrolled (yippee 😂)! Thanks again for your wonderful help❤️
@toriless
@toriless 2 жыл бұрын
Why is that damn thing made of flimsy paper and not a plastic card. I am always ordering a replacement one.
@alansach8437
@alansach8437 2 жыл бұрын
Same situation when I turned 65. I just got the cheapest plan I could find, just to say I did. You can always change it later, but if you don't get anything you have to a penalty every month for the rest of your life when you do sign up. I hate paying penalties, even if it's small. Premiums for everything are high enough!! With part d, though, there are some pretty cheap plans out there.
@lting001
@lting001 2 жыл бұрын
informative, clear, and good recommendations. Thank you.
@samchandlerllc5104
@samchandlerllc5104 3 жыл бұрын
WHAT perverted, damaged brain conceived the intricacies of Part D?? Doughnut hole? This is THE most convoluted policy I've ever seen.... was any rational for this type of logic ever explained? Again, though, thank you for making it as clear as possible under the circumstances. Your videos are awesome!
@jenmidwest2432
@jenmidwest2432 3 жыл бұрын
Congress. I always thought Medicare was to blame, but it was explained to me that Congress makes the rules and Medicare follows their sick, perverted rules. Especially for those who have Medicare instead of MediCAID. Medicare recipients pay a lot of money for the higher tiered medications.
@jgjg3848
@jgjg3848 2 жыл бұрын
@@jenmidwest2432 Not only do we spend our working lives paying for our own Medicare coverage for our retirement years, we also have to pay for every person on Medicaid through taxes we are required to pay.
@bdickinson6751
@bdickinson6751 2 жыл бұрын
Polititians! They are scum.
@SandfordSmythe
@SandfordSmythe 2 жыл бұрын
@@jgjg3848 And many on Medicaid have also paid into Medicare.
@shudtt09
@shudtt09 2 жыл бұрын
@@jenmidwest2432 GWB was in charge when the bill was written and passed. Repubes held majorities in both the House and Senate at that time. The big takeaway about the whole program: The federal government is not permitted to negotiate Part D drug prices with drug companies, as federal agencies do in other programs. Basically, a handout to big Pharma.
@davidson_oldbull_sectionhiker
@davidson_oldbull_sectionhiker 3 жыл бұрын
Thanks Stephanie I am from NJ and have gained substantial value from your videos. I have been with AARP UHC Plan F since retirement in 2007 but I am shopping this year. Thanks again you are very informative.
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
Warren thanks so much for taking the time to leave a comment! I am so glad we've provided value to you. Please don't hesitate to call or email us with questions, I am licensed in NJ and would be happy o run you some comparison quotes (888-465-9728). Have a great day!
@davidson_oldbull_sectionhiker
@davidson_oldbull_sectionhiker 3 жыл бұрын
@@AbtInsuranceAgency hi Stephanie do you currently have clients in NJ?
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
@@davidson_oldbull_sectionhiker yes, I do!
@denniswhite9721
@denniswhite9721 2 жыл бұрын
Another excellent presentation/explanation and Stephanie is pretty easy on the eyes!
@thienho6373
@thienho6373 2 жыл бұрын
Dear Stephanie, thank you very much for your videos. Your explanation is very informative and easy to absorb. I wish that I could find a video which explains in what situation, one person may be declined by either a Medicare Supplement Insurance Carrier or a Part D plan, when they apply for switching.
@tomordr
@tomordr 2 жыл бұрын
Your videos are so helpful. Thank you!
@1shakasean
@1shakasean 3 жыл бұрын
Thank you!
@helgawithem2313
@helgawithem2313 3 жыл бұрын
Wonderful easy to understand expl
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
helga withem thank you!
@rubangeorge7
@rubangeorge7 3 жыл бұрын
Awesome video.... Grt work
@peterwatts5361
@peterwatts5361 2 жыл бұрын
I think us new and soon to be Medicare recipients should consider moving to Sweden 🤔
@RFKPeaceNIK19
@RFKPeaceNIK19 Жыл бұрын
Best in business.
@AbtInsuranceAgency
@AbtInsuranceAgency Жыл бұрын
Thank you! ☺️
@searay26
@searay26 2 жыл бұрын
Tier 1 and Tier 2 medications are so cheap you don't need a D policy. The copay can actually be more than the discount price for the drug without using your insurance.
@toriless
@toriless 2 жыл бұрын
Depends on the drug, for instance, Benadyrl cost about 1/5 as much in a retail bottle off the shelf but a steroid can cost $200 instead of $3. I have seen a medication as high as $600 for one container. Size count a lot too, you could pay $200 for 60 22.5g pills but $8 for 90 15g pills. Those are actual prices I have seen and it get even more extreme for some other medications. Form matter too, an ointment may be $7 but a cream $200. Part D is the least problem with medications.
@alansach8437
@alansach8437 2 жыл бұрын
Funny how, in real life, they almost never prescribe a tier one or two drug, though!
@gardeningforfunandlongevit6076
@gardeningforfunandlongevit6076 2 жыл бұрын
The best explanation ever
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
Thank you!
@davinayoumagul8398
@davinayoumagul8398 2 жыл бұрын
Thank you Stephanie take care stay safe and stay healthy
@mlaine1112
@mlaine1112 Жыл бұрын
Please mention that when the company is calculating the initial coverage the drug company calculates what you pay and what they pay. So if you have a prescription that's total cost is 1200 you will reach the donut hole quickly.
@AbtInsuranceAgency
@AbtInsuranceAgency Жыл бұрын
Yes - I believe that is mentioned here, “the total amount you PLUS the insurance company pay together” counts toward the donut hole. It is important to know!
@ftrkhan
@ftrkhan 2 жыл бұрын
I spend about $15 monthly on my generic medicines. I am unable to spend $480. Which plan you recommend. I am in GA Thanks
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
I would advise using the Medicare.gov tool to search for the best drug plan for your needs! I cover that here:kzfaq.info/get/bejne/q9Zyi9ifxMu2n6c.html
@diliprama4715
@diliprama4715 3 жыл бұрын
Thank you🙏
@lolalittlefeather6193
@lolalittlefeather6193 2 жыл бұрын
Can you do an updated video of the new 2021 information ?! Love your explanations!!
@toriless
@toriless 2 жыл бұрын
Only the amounts change each year, $425 to $435 to $442 to $447 to $454, etc. It is like anything in government. SSA payments creep up a few bucks each year too. It is never significant except when it come it estate taxes but I doubt you have to worry about that or you would probably have a retirement advisor and various types of trusts.
@landonfinnerty2391
@landonfinnerty2391 2 жыл бұрын
Thanks Stephanie, Now I have to add adderal for my upcoming depression.
@JLilliquist
@JLilliquist 2 жыл бұрын
That is for ADHD not depression, it has some nasty side effects unlike some other drugs for ADHD.
@swingoutmuseum6454
@swingoutmuseum6454 2 жыл бұрын
Very informative, thank you.
@caroljohnson9237
@caroljohnson9237 3 жыл бұрын
I would love to speak to you. You are very knowledgeable.
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
Give us a call anytime at 888-465-9728 🙂
@christopherallen9580
@christopherallen9580 2 жыл бұрын
Excellent explanation!
@Isabel-of4wq
@Isabel-of4wq 2 жыл бұрын
Hi Stephanie, I’m newly Medicare eligible turning 65. I’m choosing traditional Medicare and a supplement plan. Since I’m healthy and not on any meds at all I was wondering if i should just skip Part D insurance. My question is - are there any disadvantages like penalties that are timing related that I would confront later if I chose a Part D plan only after I needed meds?
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
There are some penalties to be aware of if you skip Part D now. This Video explains more! kzfaq.info/get/bejne/e82EoLWInZPFqWg.html
@toriless
@toriless 2 жыл бұрын
Do not skip part D, supplement plans only cover the 6 gaps in Part A & B. N cover 4, G cover 5.
@josephroth8761
@josephroth8761 2 жыл бұрын
Many thanks for your video
@carolynthomason3746
@carolynthomason3746 2 жыл бұрын
Good RX gold is better than my med coverage
@clausbohm9807
@clausbohm9807 Жыл бұрын
Thank you for the info but this sounds so much like the issue with our pharma companies and that everyone is angry about. This is WAY TOO MUCH for just getting your subscriptions. We must be the only industrial country that has this high cost problems. It is so reflected in all the exceptions that come out of pocket in the Part D plans! Our taxes is already being used to support the research and other countries pay way less for the same drugs. But I guess Wall Street needs to make their money$$$$.
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
We ARE the only country in the world with such despicable healthcare; check out Thom Hartman, Ro Kanna, to find out more
@ted70281
@ted70281 Жыл бұрын
Thank You
@Lala11701
@Lala11701 3 жыл бұрын
I was told if I get a different plan, such as add on dental, vision etc (I have regular Medicare and Medicaid.) I would lose my part d help
@AbtInsuranceAgency
@AbtInsuranceAgency 3 жыл бұрын
Clarissa it sounds like you may be referring to a Medicare Advantage Plan. If you enroll in a Medicare Advantage Plan then your stand alone Part D coverage would terminate. You can’t have both a stand alone Part D Plan and a Medicare Advantage plan. However most Advantage Plans include Part D Rx benefits. We’d be happy to help explain this in more depth - feel free to give us a call at 888-465-9728.
@JLilliquist
@JLilliquist 2 жыл бұрын
Do NOT get a Medicare Advantage plan, all medical rights are gone, the HMO decides, not your doctor like with original medicare or a supplemental plan.
@Itsme-jv4cd
@Itsme-jv4cd 4 ай бұрын
Can you pick up a part D plan when you switch from MA to Medigap , when it is not open enrollment?
@gdobie1west988
@gdobie1west988 Жыл бұрын
Stephanie, I plan on retiring in September at the age of 65, I plan on taking Social Security and signing up for Medicare. My wife is currently 63 and is on Social Security disability, she is currently on my health care plan at my work. When I sign up in September, will my wife be able to sign up as well?? I was told she would be eligible to sign up for Medicare under a "special enrollment" period. I want to make sure this is correct, since my wife will not be 65 until February of 2024. Thank you.
@kevinoconnell8242
@kevinoconnell8242 Жыл бұрын
Great video thank you. I wonder is there any benefit to starting when new to medicare, a prescription benefit part D plan when you have no need of medications at the moment , but expect you will in the future. that is to say, is there any penalty to not enrolling out of the gate? thanks again.
@doreennurse
@doreennurse 2 жыл бұрын
Qestion: I am a employee, soon to retire, just turned 65 in July.. I have medical thru government. Now that I am looking at other medical insurance plans I have found I am paying a lot more than other seniors. I keep hearing how wonderful our medicare advantage plan is but I'm not so sure. It seems to me that a should suspend or drop my government plan and look for other more affordable medical insurance.
@toriless
@toriless 2 жыл бұрын
Medicare Advantage is a scam, HMO's are garbage compared to Medicare. If the doctor says you need a surgery you are covered under medicare but not under Medicare Advantage. Drop that garbage !!
@kayleeguy5471
@kayleeguy5471 Жыл бұрын
I would stay away from any ADVANTAGE plans; they are NOT government plans (owned by YOU) they are private insurance that can kick you out any time they want to
@anonymouspost9144
@anonymouspost9144 2 жыл бұрын
Why does medicare make it so complicated for seniors when it should be simple and straight forward?
@toriless
@toriless 2 жыл бұрын
profits
@naturegirl5681
@naturegirl5681 Жыл бұрын
Just get blink if your tier one or two
@revgant6661
@revgant6661 2 жыл бұрын
the polis (politicians) have allowed this fiasco.......why can't we get the same med coverage as the polis....
@SandfordSmythe
@SandfordSmythe 2 жыл бұрын
Fedeal employees have Medicare coverage also
@TheEtbetween
@TheEtbetween 3 жыл бұрын
Thank you so! My Mom need this! Thanks
@rodrigojones4439
@rodrigojones4439 3 жыл бұрын
For people with VA drug benefits , would you advice them to enroll in a Part D plan perhaps for expediency?
@lakeladossantos9732
@lakeladossantos9732 3 жыл бұрын
They, of course, do not have to as they are considered to have creditable coverage. If they are not close to a Va facility or a med is not covered by the VA or they frequent a civilian doctor may be some reasons veterans would choose a PDP. If it's you, thank you for your service!
@toriless
@toriless 2 жыл бұрын
I would, it does not hurt. All VA service MUST be done through them and not a civilian doctor.
@charlenegubanche8522
@charlenegubanche8522 Жыл бұрын
We are on SS and have part D.my husband has many co-morbities requiring so many medications .dr wanted my hubby to start a new medication Vesceba for his cholesterol and stop the script omega 3 .vesceba is 471.00 a month .kindly the Dr handed us a pharmaceutical prescription for 90 day supply for 9 dollars.went to fill it and the pharmacist said we could not use this coupon when we have government insurance .shouldn’t the dr be educated on these things?charlene
@roccogant4057
@roccogant4057 2 жыл бұрын
what about " Wing Plan Attack R "....
@artoanoush9239
@artoanoush9239 2 жыл бұрын
EXCELLENT
@barbarasmith9211
@barbarasmith9211 2 жыл бұрын
how does Wellcare do with insulin plans and other drugs, thanks
@rickybrown6710
@rickybrown6710 Жыл бұрын
Turning 65 in September 9 The G plan seems to today OK the D plan how to Ian Road
@AbtInsuranceAgency
@AbtInsuranceAgency Жыл бұрын
Call us! We can help. 888-465-9728.
@bobbienicholas8770
@bobbienicholas8770 2 жыл бұрын
WHEN CVS CHARGES $1,700 + FOR ONE RX....90 TABLETS OF FARXIGA 5 MG...YOU GET DONUT HOLED REALLY FAST.
@chanvalentine8283
@chanvalentine8283 2 жыл бұрын
When I went on Medicare I had A, B, D. Then sometime in the Obama administration I got a letter telling me I no longer have a D plan. What gives?
@JLilliquist
@JLilliquist 2 жыл бұрын
A f up, Were you on SSA. They screw up sometimes. They did not pay my part D. I paid it myself and complained. The eventually got their crap together and started paying again. They eventually sent a refund for the amount I paid. Mine happened under DJT. I have had similar things, they will send a letter saying I do not qualify for this or that and when I go they say I automatically qualify and show them the letter, they have to talk to supervisors etc. It takes a while but they eventually fix it. SSA messes up a lot.
@bettylougilliard4097
@bettylougilliard4097 Жыл бұрын
I just received a paad card and need a supplement for the 20% that medicare doesn't pay can you advise me thanks
@angus6032
@angus6032 2 жыл бұрын
Why don't all the government employees have the same medical we have? Maybe they would make medical more user friendly. Why do we have to pay for their medical when they don't have to pay for ours?
@juttahanss1828
@juttahanss1828 2 жыл бұрын
As a medicare beneficiary ,not taking any Medication pay monthly Penalty $1:30 /month for life - any advise who to contact for a waiver .
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
Unfortunately there are no waivers for the Part D penalty. But if you never enroll in Part D drug coverage, then you will never see the penalty.
@barbarademarco355
@barbarademarco355 Жыл бұрын
I don’t take any medications at this time. How does Plan D work for me?
@mssummer4790
@mssummer4790 Жыл бұрын
Hi, I do not take any medication, what plan should I select? I will be eligible for Medicare in August. Do I need Plan D? Is it possible to select the plan when I might need medication? thank you.
@lindarobey8935
@lindarobey8935 2 жыл бұрын
My husband and I get "extra help" with our Part D Medicare. We have no co-pays, premiums, or deductibles.
@RG-hf4et
@RG-hf4et 2 жыл бұрын
What is the definition of "extra help"?
@toriless
@toriless 2 жыл бұрын
I get co-pays but same $0 deductible and they cover the $144. It also covers premiums if you get any. You do have re-apply annually though which seems dumb if you are on SSA since that amount never changes much.
@alansach8437
@alansach8437 2 жыл бұрын
@@RG-hf4et Probably like Medicaid.
@RG-hf4et
@RG-hf4et 2 жыл бұрын
@@alansach8437 Then Linda should explain that.
@laurice8056
@laurice8056 2 жыл бұрын
They need to lower this maximum cost and include more of Seniors total out of pocket expenses. This may help prevent the Donut hole, and or lower the overall expense of part D. Fill in the gaps faster. Otherwise most seniors will be paying for more of their medications every year if they’re not on some high price medications. Most people, especially those who are on a fixed income want lower priced drugs. But these don’t help people reach their out of pocket costs. What a Devious Treadmill 😣!!
@toriless
@toriless 2 жыл бұрын
You often pay more for medications than for services under medicare.
@marshaneal2327
@marshaneal2327 2 жыл бұрын
Very good info...thank you!
@Hutchbullterrier1
@Hutchbullterrier1 Ай бұрын
The RX plan sucks. I have to pay $68 a month with a $500 deductible. And large co pays for my meds. I have a very low ss check. I have $35 left after I pay for my health insurance and vehicle insurance.
@lcarliner
@lcarliner 2 жыл бұрын
The included Part D plans with most Medicare Advantage plan products are substantially superior to any of the stand alone Part offerings! Most do not have any initial annual deductibles, and provide more substantial coverage in the gap!
@toriless
@toriless 2 жыл бұрын
Yep, because you give up all right for treatment under those scummy HMO plans. Medicare Advantage is just a HMO. They can reject any service or medications no matter what your doctor says. They are all scams. You will be fine until you need something expensive done and then they just deny it. You have NO rights under a Medicare Advantage plan which us why you see all those ads. It is a scam.
@lcarliner
@lcarliner 2 жыл бұрын
@@toriless In Florida, the marketplace for Medicare Part C plans is very competitive. Fortunately, I have not had to be hospitalized since I became eligible for Medicare back in 2006, except in one day hospitalization for my prostate surgery. All of my medical needs have been well attended to, including parathyroid surgery by the Norman parathyroid center, based at Tampa General Hospital on an outpatient basis, which is probably the finest such clinic in the world. With the once-a-year open season, word about inadequate HMO part C setups gets around quite quickly. A Medigap plan plus the necessary Part D plan is just not affordable!
@alansach8437
@alansach8437 2 жыл бұрын
Drug, vision and dental coverage is vastly superior with Advantage Plans. That's how they lure you in. But if you actually end up seriously ill and hospitalized, the coverage with a supplement is vastly superior.
@ernestwilson35
@ernestwilson35 Жыл бұрын
Why I'm I going to pay $34 a month if I'm required to pay 100% until $435.00. I noticed these companies raise the total drug cost. We are getting robbed.
@ComputerGuyAndy
@ComputerGuyAndy 2 жыл бұрын
I need to find someone who does what you do in NJ. I've been disabled for over 20 years, I'm approaching retirement age and I still have no clue how to navigate medicare. Is there a company or agency that can help me get the most out of my really limited insurance?
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
We are licensed in NJ - you can reach us at 888-465-9728.
@stevepoore589
@stevepoore589 2 жыл бұрын
My wife is taking a tier 5 drug for Metastatic Breast Cancer-our current plan D initial monthly cost $3,000 followed by monthly co-pay of $750-once I reach the catastrophic limit will the cost automatically be calculated
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
Yes. And a search on Medicare.gov should show you your expected Rx costs during each coverage level.
@JLilliquist
@JLilliquist 2 жыл бұрын
Yes, they will calculate the percentage based upon their negotiate cost. It is not like GoodRX where the prices are random.
@-myal-8691
@-myal-8691 2 жыл бұрын
Stephanie, are you licensed in Missouri? If not, how do we find a knowledgeable & reliable independent broker for Medicare?
@AbtInsuranceAgency
@AbtInsuranceAgency 2 жыл бұрын
Yes, we are licensed there! 888-475-9728 🙂
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