Monitor Your Medicare Costs

Monitor Your Medicare Costs

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Insurance Matters….

By Amira Wazeer

Jennie L. Phipps from says If you're enrolled in a Medicare Part D plan and you're being overcharged for the prescription drugs you take, it can throw you prematurely into the infamous "doughnut hole."

There is nothing sweet about this “donut hole” or coverage gap.

This issue isn't straightforward because what a pharmacy charges can vary greatly. "This is one of the most confusing aspects of Medicare," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor.

Whether you choose professional help or you do it yourself, choosing a Medicare drug plan is a very complex and personal decision.  Once you have made the choice you are stuck with it until the enrollment period for 2015, which opens in October.

So it definitely pays to monitor what you're spending and figure out if you're getting what you're entitled to.

The doughnut hole for 2015 opens when your total retail drug costs reach $2,960. This is the total retail cost of the covered medications, not what you alone have spent at the pharmacy.

As a Medicare Part D beneficiary, you pay only a portion of the $2,960 and your Part D plan pays a portion. Your total retail cost of prescription medications is calculated from your Medicare Part D plan's negotiated retail drug price – and every Medicare Part D plan can have a different negotiated retail drug price.

Generally, if you just have a Part D plan, you'll pay the first $320 dollars as a deductible, and then you'll be responsible for paying 25 percent of the next $2,640, for a total out-of-pocket cost of $980.00, plus whatever you pay in premiums for the plan.

If you go into the donut hole you will pay 45% of covered brand name and 65% of generic drugs of the next 3,720. To sum it up you will pay more for drugs  in the donut hole.

To monitor this, you need to know what the negotiated retail drug price is for the drugs you take and you need to know what you are being charged. You should get a monthly drug Summary Notice from your plan letting you know where you stand.

If you're computer savvy, you can also easily keep this information on a spreadsheet. If you're not, use a pencil, paper and a calculator. If you're being overcharged, point it out as soon as possible to your pharmacy and your plan administrator.

You also can file a grievance through the Quality Improvement Organization in your state or contact your part D plan.

Confused yet? It's crazy that Medicare is this complicated – but it is – and the Medicare error rate for traditional Medicare is 10.1 percent; for Medicare Advantage plans, it's 14.1 percent. So make paying attention to these details part of your retirement planning.  Read more: at

(Amira Wazeer is a state licensed and federally certified insurance agent with over 14 years experience.  She specializes in Medicare plans, Affordable healthcare plans, dental and vision plans, Life insurance for diabetics and Janazza (final expense) insurance. Consultations and assistance is  free. Need a speaker at your upcoming events or have Questions and comments contact or call 404-202-1926.)


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