Date registered: Mar 2006
Vehicle: 04 SL55 AMG
Location: Sacramento, CA - US
Mentioned: 0 Post(s)
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I was selling Medicare last year during the initial breakout of the Part D. I'd never heard so many seniors swear and call me names like I invented it.
Even worse is what's called Medi-Medi - those who are on Medical and Medicaid.
If people take medication that the retail cost exceeds $5600 annually, the Part D works for them. Most - it just sucks.
Although this is a simplified diagram, it's the basic outline of how it works.
Let's say someone has 4 prescriptions (2 Generic and 2 Brand Name)
The Brand RX cost $250.00 Retail each, with a $20 co-pay
The Generic cost $125.00 Retail each, with a $5 co-pay
We would pay $50 a month for the meds. The insurance company is tracking the retail cost. Once that cost reaches $2000, we're on our own. So in this example, after 2.6 months, we've hit our $2000 limit, even though we've only spent about $120 in co-pay.
Now, we're on our own for the following $3600.00 (warning - people are being told that it's $1600 (3600 minus the initial 2000) which is wrong. So, we take our $3600 out of pocket obligation, minus the initial co-pays and are left with an obligation of $3480 worth of meds. After that (even though most people never exceed that number), the insurance kicks in again and we're back to co-pays.
yes... it almost requires a slide rule. This is a very simplified explanation. Most insurance brokers don't fully understand. When I was being trained in this, even the government appointed instructor had to double check the math.
I had one woman in her 90's actually say "I wish someone would assassinate that bastard". Part D is on the same anger scale as closing the all-you-can-eat buffet. I always recommended that when they're in the black out period, go to Costco. You don't have to be a member and the prices are cheaper than anywhere else. Stores set the price - not the pharmaceutical companies.