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Medicare Prescription Drug Premiums to Rise in '09 - BusinessWeek THURSDAY, Aug. 14 (HealthDay News) -- The average monthly premium for Medicare's prescription drug plan will increase to an estimated $28 in 2009, three dollars more than this year's monthly premium, Medicare officials announced Thursday. That 2009 ... Publ.Date : Fri, 15 Aug 2008 00:58:00 GMT Accept the reality of private health care: CMA chief - Globe and Mail LAVAL, QUE. -- The natural next step for Canada's health system is allowing more private delivery, which will give patients more choice, and better access to care, the new president of the Canadian Medical Association says. "My whole career has been ... Publ.Date : Wed, 20 Aug 2008 14:21:00 GMT Inc. Magazine Names Senior Whole Health the Number One Fastest-Growing ... - Forbes CAMBRIDGE, Mass., Aug. 20 /PRNewswire-USNewswire/ -- Inc. Magazine has named Senior Whole Health (SWH), a voluntary health care plan for low-income seniors, the number one fastest-growing private company in the United States. Part of Inc.'s annual ... Publ.Date : Wed, 20 Aug 2008 15:54:00 GMT How to navigate Medicare.gov - Fort Lauderdale Sun-Sentinel When to start? Drug plans and Medicare release details of 2009 coverage in October. Enrollment for next year starts Nov. 15 and takes effect Jan. 1. Health plan or drug plan? Save time by deciding which you prefer. Health plans such as HMOs offer ... Publ.Date : Wed, 20 Aug 2008 12:48:00 GMT Candidates Soft On Medicare On The Trail - NPR News McCain: He has proposed a major overhaul of Medicare's payment system — paying health care providers not by each individual service they perform but by how successfully they treat their patients. He hopes that could serve as a model for private ... Publ.Date : Tue, 19 Aug 2008 01:50:00 GMT RSS to HTML Increase Search Engine Traffic

Making Sense of Medicare Part D - Out-of-Pocket Expenses

By: Jeremy Cockerill

A complete understanding of Medicare Part D Out-of-pocket expenses is critical for all Medicare eligible individuals in order for them to maximize their savings and get the most out of the program.

What are the Out-of-Pocket expenses associated with Medicare Part D?
On the Medicare.gov website “Out of Pocket costs” are defined as “health care costs that you must pay on your own because they are not covered by Medicare or other insurance.”
The Out-of-Pocket (OOP) expenses associated with Medicare Part D are basically any costs for an enrollee’s medications that Medicare will not cover and that they must pay for on their own. These OOP expenses include the annual deductible, which ranges from $0 - $250 depending on the individuals chosen plan, and any other portion of their medication cost that they are required to pay such as the drug cost co-payments. It is important to note that an enrollee’s monthly premium is not counted as an Out-of-pocket expense. These premium payments are an additional expense on top of the out-of-pocket expenses.

The majority of Medicare drug plans have a $250 annual deductible and a 25% co-payment for all enrollee’s drugs until they have reached $2250 in drug expenditures. Under this scenario, at the $2250 expenditure point, enrollee’s will have $750 in Out-of-Pocket expenditures. How do we come up with the figure of $750? This is calculated as such:

The $250 annual deductible + $500 (25% co-payment x $2000 of drug expenditures) = $750

Individuals who have close to or exactly $2250 in annual drug expenditures in 2006 will be the biggest winners of the Medicare Prescription Drug plan. Based on the individual paying only $750 in OOP expenses and assuming that the individual payed the national average monthly premium of $32.20, these individuals save approximately 49% on their drug purchases. However, not surprisingly, the majority of seniors do not fall in this category and the savings drop off sharply when you spend more than or less than the $2250.

For the millions of American seniors who will spend more than $2250 on their drugs in 2006, this is where the Out-of-Pocket expenses start to add up. Beyond the $2250 expenditure amount you are responsible for paying for 100% of your drug cost until you have spent $3600 out-of-pocket (called the Out of Pocket Threshold). This means that between the annual drug expenditure range of $2250 and $5100 you are 100% responsible for paying for the cost of your medications.

How do we come up with the drug expenditure range of $2250 and $5100? Here is the explanation:

When the Medicare Modernization Act was passed in 2003 it was decided at that time that once people had spent $2250 on drug expenditures they would then be 100% responsible for paying for their drugs until they his a threshold of $3600 in drug expenditures.

So between from $0 to $2250 there are $750 in out-of-pocket expenses as we calculated earlier in this article.

$3600 OOP Threshold - $750 in OOP expenses at $2250 = $2850 remaining to reach the OOP Threshold.

Since after $2250 in expenditures enrollees are 100% responsible for their drug costs we can simply add the $2850 remaining to reach the OOP Threshold to the $2250 in drug expenditures to get:

$2250 + $2850 = $5100

That is how we get the drug expenditure range of $2250 to $5100 in which enrollees are 100% responsible for their drug expenditures.

This expenditure range is often called the “doughnut hole”. It is very important that Medicare eligible individuals are aware of the doughnut hole because for the first few months of 2006 they may be budgeting based on only having to pay for 25% of their drug purchases and then all of a sudden when they reach $2250 in drug expenditures they are hit with responsibility of paying for 100% of the drug cost. That is a huge and sudden change in monthly expenditures.

It is also important that Medicare Part D enrollees are aware that not all purchases are necessarily counted towards their Out-of-Pocket expenditures. The following are examples of purchases that will not be counted towards OOP expenses:

1. If a drug that an enrollee requires is not on the formulary of covered drugs for their chosen drug plan (or if their plan removes that drug from its formulary of covered drugs) that drug purchase will not be counted towards their out of pocket expenses and you are 100% responsible to pay for it. Purchasing these non-formulary drugs, that the enrollee must pay full price for, from Canada is an excellent alternative to paying high prices at the local pharmacy. Individuals can save an average of 42% by purchasing these medications in Canada.

2. If an enrollee travels and buys their prescription drug at a pharmacy that is not included in their drug plan’s network of pharmacies they are 100% responsible for the cost of the medication and it will not be counted towards their OOP expenses.

3. If an enrollee currently has an insurance plan and they utilize their insurance coverage to pay for their drug purchase, the purchase will not be counted towards their OOP expenses.

4. If an enrollee purchases their medications from another country that has low-cost, high-quality medications, such as Canada, these purchases, unfortunately, will not be counted towards their OOP expenses. However, these individuals may want to explore this option when they reach the doughnut hole to help them save even more money. In fact, if an individual spends more than $2250 a year on medicines but less than $7050 a year, buying their medicines from Canada once they hit the doughnut hole is an excellent option for them.

Medicare eligible individuals’ knowledge of Out-of-Pocket expenses and what these expenses entail is crucial for them to save as much as they possibly can with the Medicare Prescription Drug plan.

How We Know the Morons in Washington Hate Us: The MedicareRx Plan By John T Jones, Ph.D Utterly confused by the MedicareRx Plan? Who isn’t? As a public service to Idaho potential participants, our public television station broadcast a program to clear everything up. The host was as confused as I am, but she intended to get everything right in our minds. Two state officials were her experts. One knew how much the new plan was going to cost the State of Idaho. The other knew how the plan worked and how it didn’t work. We were invited to call in with our questions. Well, the call-in part was premature. There should have been a more complete explanation of what is going on. But some boldly called in expecting a comprehensive answer. As each caller was left confused as much as I was thankfully the power was lost at the stations control center and the screen went blank! I didn’t get too much in that first 15 minutes. I was glad we didn’t delve deeper. The last couple of days the station manager has been apologizing for the disruption. He said to go to our computers and look for the new schedule for the program explaining the MedicareRx plan. I know that will be the end of it for those who don’t have a computer. Lucky them? I anxiously waited for materials from AARP. They promised to get the information out on their MedicareRx plan. I wondered if it would be one of the 46 plans or so that are acceptable in Idaho. Gee, I hoped so! The first thing I learned from AARP in their 4-page introductory letter was that their plan was only $30.18** each and every month. The ** led me to two long paragraphs of legal jumble. I never read legal jumble. It might get me in trouble. Calculating the annual cost for me and my wife I found that it would ONLY COST US $724.32 EACH YEAR! That caused me not to read the rest of the 4-page introductory letter. I next looked at the Enrollment Form. This is a 4-page document mostly composed of legal jumble. There was a list of agreements buried in long paragraphs that we would have to agree to. Bypassing the return envelope and going right at the 7-page Introduction to the Summary of Benefits for AARP MedicareRx Plan I found a list of benefits. I found there were 28 paragraphs on what the benefits are if we paid $724.32 EACH YEAR! Not being an expert, I figured we could save about $30.18 a month by staying out of the plan and I wouldn’t have to prove my great great-grandfather was Ute Chief Walker. Carefully storing the aforementioned documents in my waste basket I went right to the 36-page booklet Introducing the AARP Medicare Plan. Skipping the jumble, I found on page 7 a table that looked almost like the one I saw on television before the channel bombed out. It seems that if you have cost up to $2,250.00, that a co-pay (listed elsewhere or somewhere) will cover your drug cost. From $2,250 to $3,600.00 you get nothing. For over $3,600.00 it is a co-pay or 5% whichever is greatest. On page 8, I learned that some could actually save money by buying the insurance. At this point you must gather up all of your drug cost for the year, and calculate if you would have a savings. I say, “Good luck” to that 85-year-old man that called in from Pocatello! The last 20-page booklet is called Formulary. I was majoring in pharmacy at one time so they were not able to fool me here. It is a list of drugs. The drugs are in tiers. A table gives you the number of your drug tier-wise and a key code that tells you if it is covered and how. For example, “PA” means Prior Authorization. Only certain pharmacies are allowed in the AARP plan. I suppose they are listed somewhere in all of that documentation. Gee, I hope we have one in Idaho! Let me ask you this: Why did the nitwits in Washington come up with this plan? Why get a zillion different insurance companies involved? Why not just make it part of Medicare part B with the instruction: It could list the most expensive prescription and generic drugs that are covered, the lower limit in dollars that must have been spent before payment is made, and the upper limit in dollars beyond which it would not pay. The payment should be 80-90 percent. The cost would be partly raised by a slight increase in Medicare part B premiums. The first half of the television show indicated that state and insurance folks would be going aroung the state to make sure all of the seniors would be signed up before the deadline as to not require a penalty for when they did sign up. That was a clever trick to scare the hell out of everybody. Join or get fined? Anyway, I hope those presentations do more for us than the television show! To those who created this bill, WE KNOW YOU HATE US! Copyright©John T. Jones, Ph.D. 2005 John T. Jones, Ph.D. (tjbooks@hotmail.com)is a retired R&D engineer and VP of a Fortune 500 company. He is author of detective & western novels, nonfiction (business, scientific, engineering), poetry, etc. Former editor of international trade magazine. Jones is Executive Representative of International Wealth Success. More info: http://www.tjbooks.com Business web site: http://www.bookfindhelp.com (IWS wealth-success materials / TopFlight flagpoles) Article Source: http://EzineArticles.com/

IFAS: Home
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Medicare's Program Integrity
Health Care Financing Administration's page that explains what Medicare fraud
is, how to recognize it, and how to report it.

Medicare Rights Center
A not-for-profit organization that is the source for Medicare consumers and
Medicare professionals.

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Information on Medicare for beneficiaries, their families and providers.

HIC - Entry Page
Administers many health programs on behalf of the Commonwealth Government.

Friends of Medicare - Preserving Public Healthcare in Alberta
Committed to creating a single comprehensive public health care system accessible
to all provincial citizens.

Medicare.gov - The Official US Government Site for People with ...
Official US government site for Medicare information.

National Committee to Preserve Social Security and Medicare
Seniors group outlines their positions on Social Security and Medicare issues.

Centers for Medicare & Medicaid Services
Benefits information and description of government programs.

Medicare Information
Background information on Medicare from Health Symphony, a commercial health
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