Paid Advertisement Ask the Medical Specialist by: Aaron Zolbrod QUESTION: Question from Frank: I'm in my last year of working prior to retirement and currently covered by my employer provided medical plan. I have an annual overall medical and prescription deductible of $1,400 and then 10% coinsurance after that until I hit a Maximum Out of Pocket (MOOP). I ordered my first refill for 2021 of a very expensive prescription that I take and was quoted $2,400 as my portion (which I understand and was okay with). Good news: the drug manufacturer paid that entire cost under their Copay Card. Bad news: it appears their Copay Card is not eligible for use with Government programs, such as Medicare, even in the Doughnut Hole. Why is that? ANSWER: I'm very excited that The Health Insurance Store now has a new next 7 months. We're talking No drug manufacturers honor these Copay Cards for those on about $30,000 in discounts in Medicare. The reason is it costs one year compared to around them much more money because $1,200 for someone with an of the "Doughnut Hole," which employer plan, or the $2,400 employer plans don't have. Most Frank received. I'm sure it's now Tony will be working one people on employer health plans crystal clear why Big Pharma have a copay for brand name medications between $25 and $100. You're an exception Frank, We still need to address Frank's lot of money on medications. He because you have a qualified high deductible Health Savings because when he enrolls in Account compatible plan, aka QDHP, where the deductible must be met first before anything is paid for by the plan, including prescriptions. However, once your MOOP has been met, which I know based team member, Tony Diroma, who has been given the job of Prescription Drug Caseworker. doesn't honor Copay Cards for those on Medicare. on one with any client who we anticipate will fall in the Doughnut Hole or is spending a has been diligently researching programs, making contacts, upcoming dilemma however, Medicare Part B, he's looking at and collaborating with anyone close to $4,000 in out-of-pocket costs for the medication in question, as opposed to the $0 he's paying now. The first order that many on Medicare deal of business in this situation is to With when it comes to their see if he qualifies for PACENET, which has income limits of just Frank has been in contact with over $29,00 for a single person and $39,000 for a married couple. Forest Hills office and plans to Frank doesn't, so the next step is use our services when he goes to research if the manufacture of his medication has a Patient and everyone who can provide information which can help relieve the financial the burden medications. on what you were quoted for your first refill is $2,400, your medication would be fully paid for by your insurance. This means the manufacturer wouldn't have to discount the drug one penny thereafter. Drug Assistance Program (PAP) that manufactures who are offering usually provides medications for that will best help him reduce to lower or eliminate co-pays, are free to those who qualify. They only providing what amounts to a very small discount on a medication that in your case retails for $3,200 a month. me and another agent in our on Part B. He will then work directly with Tony, who will match him up with a program(s) his out-of pocket drug costs. This is an extremely valuable service do, and it has an income limit of 500% of the Federal Poverty which all our clients receive Level, which is $64,400 for a single individual and $87,100 for found multiple options for Frank those who are married. Most drugs have PAP's. However, they anxiety he had. at no charge. Tony has already People on Medicare who fall in the Doughnut Hole, which would happen in February with aren't all the same and can be a medication as expensive as Frank's, must pay 25% of the cost for brand names drugs. One that retails for $3,200 would be discounted $2,400 per month if they allowed those on Medicare to use a Copay Card. Once approximately $2,300 out of pocket is spent on medications for the year, which the manufacturer) useless. If a Frank would reach by May one medication isn't available using coming! When you submit enters the Catastrophic Stage and then pays 5% of the retail cost, which would result in the needs to be spent before relief manufacturer eating the other 95%, or $3,040 per month for the foundations available. and shared them, relieving the If you're facing a similar situation or currently paying very confusing, often by design in my opinion. Some have higher exorbitant costs for medications, or lower income levels. Some won't provide assistance until one has spent a certain amount of money on medications, which may occur right before the end of the year, making the program conveniently (for please feel free to contact myself or Tony, who can be reached by phone at our Connellsville office or via email at tonyégetyourbestplan.com. And thank you for all the great questions! Please keep them a PAP or if one can't afford one, not only are you helping yourself, but other seniors as well. the medication prior to what is provided, there may be other 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents Paid Advertisement Ask the Medical Specialist by: Aaron Zolbrod QUESTION: Question from Frank: I'm in my last year of working prior to retirement and currently covered by my employer provided medical plan. I have an annual overall medical and prescription deductible of $1,400 and then 10% coinsurance after that until I hit a Maximum Out of Pocket (MOOP). I ordered my first refill for 2021 of a very expensive prescription that I take and was quoted $2,400 as my portion (which I understand and was okay with). Good news: the drug manufacturer paid that entire cost under their Copay Card. Bad news: it appears their Copay Card is not eligible for use with Government programs, such as Medicare, even in the Doughnut Hole. Why is that? ANSWER: I'm very excited that The Health Insurance Store now has a new next 7 months. We're talking No drug manufacturers honor these Copay Cards for those on about $30,000 in discounts in Medicare. The reason is it costs one year compared to around them much more money because $1,200 for someone with an of the "Doughnut Hole," which employer plan, or the $2,400 employer plans don't have. Most Frank received. I'm sure it's now Tony will be working one people on employer health plans crystal clear why Big Pharma have a copay for brand name medications between $25 and $100. You're an exception Frank, We still need to address Frank's lot of money on medications. He because you have a qualified high deductible Health Savings because when he enrolls in Account compatible plan, aka QDHP, where the deductible must be met first before anything is paid for by the plan, including prescriptions. However, once your MOOP has been met, which I know based team member, Tony Diroma, who has been given the job of Prescription Drug Caseworker. doesn't honor Copay Cards for those on Medicare. on one with any client who we anticipate will fall in the Doughnut Hole or is spending a has been diligently researching programs, making contacts, upcoming dilemma however, Medicare Part B, he's looking at and collaborating with anyone close to $4,000 in out-of-pocket costs for the medication in question, as opposed to the $0 he's paying now. The first order that many on Medicare deal of business in this situation is to With when it comes to their see if he qualifies for PACENET, which has income limits of just Frank has been in contact with over $29,00 for a single person and $39,000 for a married couple. Forest Hills office and plans to Frank doesn't, so the next step is use our services when he goes to research if the manufacture of his medication has a Patient and everyone who can provide information which can help relieve the financial the burden medications. on what you were quoted for your first refill is $2,400, your medication would be fully paid for by your insurance. This means the manufacturer wouldn't have to discount the drug one penny thereafter. Drug Assistance Program (PAP) that manufactures who are offering usually provides medications for that will best help him reduce to lower or eliminate co-pays, are free to those who qualify. They only providing what amounts to a very small discount on a medication that in your case retails for $3,200 a month. me and another agent in our on Part B. He will then work directly with Tony, who will match him up with a program(s) his out-of pocket drug costs. This is an extremely valuable service do, and it has an income limit of 500% of the Federal Poverty which all our clients receive Level, which is $64,400 for a single individual and $87,100 for found multiple options for Frank those who are married. Most drugs have PAP's. However, they anxiety he had. at no charge. Tony has already People on Medicare who fall in the Doughnut Hole, which would happen in February with aren't all the same and can be a medication as expensive as Frank's, must pay 25% of the cost for brand names drugs. One that retails for $3,200 would be discounted $2,400 per month if they allowed those on Medicare to use a Copay Card. Once approximately $2,300 out of pocket is spent on medications for the year, which the manufacturer) useless. If a Frank would reach by May one medication isn't available using coming! When you submit enters the Catastrophic Stage and then pays 5% of the retail cost, which would result in the needs to be spent before relief manufacturer eating the other 95%, or $3,040 per month for the foundations available. and shared them, relieving the If you're facing a similar situation or currently paying very confusing, often by design in my opinion. Some have higher exorbitant costs for medications, or lower income levels. Some won't provide assistance until one has spent a certain amount of money on medications, which may occur right before the end of the year, making the program conveniently (for please feel free to contact myself or Tony, who can be reached by phone at our Connellsville office or via email at tonyégetyourbestplan.com. And thank you for all the great questions! Please keep them a PAP or if one can't afford one, not only are you helping yourself, but other seniors as well. the medication prior to what is provided, there may be other 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents