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Medicare

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Medicare should be a benefit, not a burden.

Medicare Part D can be very confusing and frustrating.

You have better ways to spend your income than throwing money down the dreaded Medicare “Donut Hole!” The “Donut Hole”, or Medicare coverage gap, is when your Medicare drug plan has reached its coverage limit and you have to pay huge costs out of pocket for your meds until the plan reaches a certain out-of-pocket limit, also called catastrophic coverage. It can mean thousands of dollars paid by you(up to $4,950) for what is not covered by this gap. Most people don’t know about it until they get up to the pharmacy counter and their medication cost goes up drastically.

Below is an example of consumer cost breakdown in 2017 for Medicare Part D. Start from the bottom up:

 

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You will 1st pay 100% of your deductible before coverage kicks in. During the initial coverage period, you will have $925 out-of-pocket costs(25% of $3700). Once the initial coverage is used, you will hit the ‘Donut Hole’ which has up to $4,950 in patient costs. Wow!

At GenScripts Pharmacy, we specialize in maximizing your benefit dollars with a personalized, strategic annual plan for every Medicare customer.

Here is an example of a patient GenScripts helped: Lila is 72 years old, on Medicare Part D, and fills 10 different prescriptions every month through her skilled nursing facility. Here’s an example of how we saved Lila money with a FREE, private consultation by a GenScripts pharmacist:

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On half of her prescriptions, Lila could pay out-of-pocket with GenScripts instead of charging it to her Medicare Part D Plan and save $8,453.04 per year! Lila’s huge savings are not something that we see every day, but we typically save almost everyone some money.

Call or message us today for a free private consultation with one of our friendly licensed pharmacists. We will personally review all your medications, and for no charge and no obligation, we will provide you a written audit report. This report will include our prices and suggestions for you and your physician on how to avoid, or at least delay, spending money on “donut hole” prescriptions. It only takes a few minutes of your time, and could literally save you hundreds of dollars next year.

On top of saving money, there are other benefits that GenScripts provides for you and your doctor!  There are Medicare drug plan coverage rules that you can avoid:

  • Prior authorization: You and/or your prescriber must contact the drug plan before you can fill certain prescriptions. Your prescriber may need to show that the drug is medically necessary for the plan to cover it.
  • Quantity limits: Limits on how much medication you can get at a time.
  • Step therapy: You must try one or more similar, lower cost drugs before the plan will cover the prescribed drug.

You can avoid the above hassles by getting your low cost medications directly from GenScripts Pharmacy.

Below are some Medicare definitions.

Medicare Prescription Drug Plan (Part D)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Deductible

The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay

Co-pay

An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug.

Coverage gap (or “Donut Hole”)

A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the “donut hole”) starts when you and your plan have paid a set dollar amount for prescription drugs during that year.

High-deductible Medigap policy

A type of Medigap policy that has a high deductible but a lower premium. You must pay the deductible before the Medigap policy pays anything. The deductible amount can change each year.

Initial coverage limit

Once you’ve met your yearly deductible, you’ll pay a copayment or coinsurance for each covered drug until you reach your plan’s out-of-pocket maximum (or initial coverage limit). You’ll then enter your plan’s coverage gap (also called the “donut hole”).

Out-of-pocket costs

Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance.

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