Important information about Medicare
By October, many Medicare recipients are deep in the doughnut hole. Medicare prescription drug plans (Part D) typically have a “doughnut hole”, or coverage gap, which imposes a temporary limit on coverage for drugs. Most people enter this gap after they have reached a spending threshold for covered drugs. For the year 2014, this threshold is $2850. Once this ceiling is reached, you have reached the coverage gap. The good news is that this threshold will be higher in 2015, with increasing subsidies to help you save in the coverage gap.
Medicare coverage for the remainder of 2014
Currently, once you reach the coverage gap, you pay 47.5% for brand-name drugs and 72% for generic drugs for the remainder of the year. You are required to make these copayments until you get out of the doughnut hole. How do you climb your way out of the hole? Although you’re paying 47.5% of your plan’s cost for brand-name prescription drugs, 97.5% of that price gets counted as out-of-pocket costs, which go toward getting you out of the coverage gap. For generic drugs, all of what you pay will be counted as out-of-pocket spending to help you get out of the coverage gap. For 2014, you are free of the doughnut hole once your out-of-pocket spending reaches up to $4550. http://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html
How Medicare is changing through 2020
Fortunately, the Affordable Care Act (ACA) incorporates improvements to Medicare Part D prescription drug coverage for future years. These improvements were designed to help seniors afford their prescriptions while they are in the doughnut hole. In 2015, beneficiaries will pay 45% for brand names, and 65% for generics. Gradually, copayments required for both brand name and generic drugs are being reduced to 25% for both drug types in the year 2020. This is the same percentage you pay from the time you meet the deductible until the out-of-pocket spending limit is reached (up to $4700 for 2015). http://www.medicare.gov/part-d/costs/coverage-gap/more-drug-savings-in-2020.html As 2015 rapidly approaches, now is a good time to determine if your health care plan is meeting your needs. An appointment with Phoenix Home Health Care can help you organize your appointments, screenings, and prescription needs in order to optimize your insurance coverage.
Additional assistance for low-income seniors
The ACA also offers further assistance for low-income beneficiaries by eliminating copayments for beneficiaries who may be recipients of home and community-based services, and who are eligible for both Medicare and Medicaid. Assistance is also available in order to allow widows and widowers to preserve their low-income eligibility.
Home Care Phoenix can help you determine whether you are eligible for this additional assistance.
For tips on how to lower drug costs, visit us at MD Home Health, where you can learn more about Homecare Phoenix. Find health and drug plans, stay educated, and learn more about what Medicare covers through the Phoenix home health care team!