It is September. Many of us hit the Medicare "donut hole" in July.
The "donut hole" is the period when there is NO CO-PAY.
A person pays 100% prescription cost until an additional $3,000.00
Just to get an idea of how much an individual
pays for medication when there is no co-pay
from Medicare Part D, I have listed
this month's cost for medicine for one person.
(30 day supply.)
Razadyne for Alzheimer's $180.23
Plavix for Stroke prevention $132.67
Digoxin for Atrial Fibrillation $4.00
Diltiazem ER Atrial Fibrillation $155.04
Gabapentin for Diabetic Neuropathy $6.30
Levothyroxin for Hypothyroid $4.00
This individual takes more medication, but has
more than 30 day supply in stock at this time.
The Medicare deductible was increased from
$100 annually, to $250 annually.
Monthly deduction from Social Security for Medicare premium
is currently $96.40 every month.
Medicare Part A and Part B pays approximately 80%
of doctor's visits and medical costs. Some tests and
other necessary items are not covered.
A good supplemental insurance plan is strongly recommended.
Most supplemental plans do not cover medicine.
CMS Announces Medicare Premiums,
Deductibles for 2009
The standard Medicare Part B monthly premium will be
$96.40 in 2009, the same as the Part B premium for 2008. This is the
first year since 2000 that there was no increase in the standard premium
over the prior year.
The 2009 Part B premium of $96.40 is the same as the amount
projected in the 2008 Medicare Trustees Report issued in March. This
monthly premium paid by beneficiaries enrolled in Medicare Part B
covers a portion of the cost of physicians’ services, outpatient hospital
services, certain home health services, durable medical equipment, and
By law, the standard premium is set to cover approximately one-fourth of
the average cost of Part B services incurred by beneficiaries aged 65
and over. The remaining Part B costs are financed by Federal general
revenues. The income to the program from premiums and general
revenues are paid into the Part B account of the Supplementary Medical
Insurance trust fund, and Part B expenditures are drawn from this
Normally, the Part B premium increases at the same rate as average
Part B expenditures from year to year. A number of factors explain why
the premium can be kept level for 2009.
Growth is expected in 2009 for most areas of the Medicare Part B
program, including growth in the cost and use of physician and
outpatient hospital care, home health services, physician-administered
drugs, ambulatory surgical center services, durable medical equipment,
independent lab and physician’s office lab services, as well as growth in
the Medicare Advantage program. In most years, this would result in the
need for an increase in the Part B premium and general revenue
2009. Medicare Part A pays for inpatient hospital, skilled nursing facility,
hospice, and certain home health care services. The $1,068
deductible for 2009, paid by the beneficiary when
admitted as a hospital inpatient, is an increase of
$44 from $1024 in 2008. The Part A deductible is the
beneficiary’s only cost for up to 60 days of Medicare-covered inpatient
hospital care in a benefit period. Beneficiaries must pay an additional
$267 per day for days 61 through 90 in 2009, and $534 per day for
“lifetime reserve days” that can be used for hospital stays beyond the
90th day in a benefit period. The corresponding amounts for calendar
year 2008 are $256 and $512, respectively. Daily coinsurance for the
21st through 100th day in a skilled nursing facility will be $133.50 in
2009, up from $128 in 2008.
Today, the Centers for Medicare & Medicaid Services (CMS) Acting
Administrator Kerry Weems announced the 2009 Medicare prescription
drug and Medicare Advantage plan options. Approximately 97 percent of
beneficiaries enrolled in a stand-alone prescription drug plan (PDP) will
have access to Medicare drug and health plans in 2009 whose premiums
would be the same or less than their coverage in 2008.
“As we enter the fourth year of the Medicare Part D prescription drug
program, we continue to see high satisfaction rates among beneficiaries
and high participation among plans,” said Weems. “However, plans do
change their offerings from year to year. Some beneficiaries may see
significant premium increases or changes, such as reduced coverage in
the gap, if they stay in the same prescription drug plan in 2009. We and
what other options are available to them to determine which plan best
meets their needs.”
Details about the specific plans in each region will be available mid-
October at www.medicare.gov and 1-800-MEDICARE.
Open enrollment for prescription drug coverage
begins November 15 and ends December 31.
The list of national stand-alone prescription drug plans and state specific
fact sheets can be found at:
To read the CMS press release issued today (9/25) click here:
Specific Plan Enrollment Information: www.medicare.gov
List of National Plan Sponsors and State Fact Sheets:
Landscape Data Available:
If you are willing to share your monthly out-of-pocket
cost during the coverage gap, please itemize
medication and send e-mail to: Some site visitors have no idea
how much this policy costs each household when you hit the coverage gap.
Let's inform them.
Need to see the doctor? Find reviews on the best doctors in your area at Angie’s List. Check the List!
The Society of St. Vincent de Paul St. Louis Council
Through an arrangement with Express Scripts of St. Louis, the Council provides
pharmaceutical vouchers to area Conferences to give to their clients who are
uninsured or underinsured. This program was funded by a grant from the Missouri
Foundation for Health. The Vincentians assist the clients in filling out the
vouchers. The client takes the voucher to their doctor who fills in the scrip portion
and mails the voucher in the pre-paid envelope to Express Scripts.
Express Scripts fills a 90 day prescription and mails the medicine to the client.
This program is available to all 8 Districts.
If Vincentians have any specific questions regarding this program they can contact
Express Scripts RX Outreach's pharmacist at email@example.com
|AARP Medicare Rx Plan
24 hours a day,
7 days a week
Filling the Medicare Part D “Donut Hole”
Closing the Prescription
Drug Coverage Gap
You Could Be Eligible
For A $250 Rebate
This Year 2010 to Help with your
Medicare Drug Costs
The Affordable Care Act passed by Congress and signed by President Obama this year contains
some important benefits for Medicare recipients. If you have Medicare prescription drug coverage,
and aren’t already getting Medicare Extra Help, Medicare will automatically
send you a tax free, one-time $250 rebate check after you
reach the coverage gap (also called the “donut hole”) in
2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap.
What is the coverage gap and how will I know if I’ve reached it? Most Medicare drug plans have a
coverage gap. This means that after you and your plan have spent a certain amount of money for
covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit). The
Explanation of Benefits notice, which your drug plan mails to you each month when you fill a
prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the
Will I need to do anything to get this rebate check?
No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you.
You don’t need to provide any personal information like your Medicare, Social Security, or bank
account numbers to get the rebate check. Don’t give your personal information to anyone who calls
you about the $250 rebate check.
Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this.
TTY users should call 1-877-486-2048.
C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S
When will I get the rebate check?
If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-
time $250 rebate check if you are not already receiving Medicare Extra Help. These checks will
begin to get mailed to beneficiaries starting in mid-June. Checks will be mailed monthly throughout
the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and if you
qualify, you will only receive one check after you reach the coverage gap.
Will I have to pay taxes on this rebate check?
No. You don’t have to pay taxes on your $250 rebate check. It is tax free.
What if I don’t get the rebate check when I should?
If you hit the donut hole after the program has begun, you should expect to receive your check
within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your
Medicare drug plan showing that you reached the coverage gap in time to include you in the next
mailing. You should call your Medicare drug plan to make sure all of
your information has been sent to Medicare. If you don’t get your
rebate check, contact Medicare at 1‑800‑MEDICARE.
Individuals receiving Medicare Extra Help will not receive a rebate check. You can also check to
make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social
Security office. TTY users should call 1-800-325-0778.
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