Medicare coverage Archives - Simplefill | Prescription Assistance, Rx Assistance, Patient Assistance

Here’s What You Need to Know About the 2020 Changes to Medicare Part D Coverage

Medicare plans and health insurance coverage can be confusing. Below, we’ll provide you with a simple breakdown of what Medicare Part D is and what changes are in store for 2020 to help keep you updated.

What Does Medicare Part D Cover?

Medicare Part D is Medicare’s prescription drug coverage. It has its own list of drugs that are covered, which is called a formulary. Drugs are then placed in different tiers, which have different costs and coverages.

Medicare Part D Deductible Changes for 2020

In 2020, the Medicare Part D deductible will vary. In some plans, the deductible will go from $415 to $435. This means that you must pay $435 before Medicare begins to pay its share of the prescription cost.

Medicare Part D Initial Coverage Limit Changes for 2020

The Medicare Part D initial coverage went from $3,820 to $4,020 as of January 1, 2020. Once you and your prescription plan have hit $4,020 in 2020 for covered drugs, you’ve reached the Medicare “donut hole.” In the donut hole coverage gap, your prescription coverage is temporarily limited until you reach your out-of-pocket threshold.

Medicare “Donut Hole” Changes for 2020

In 2020, if your plan has a deductible, you’ll pay 25% of your drug costs (both generic and brand-name) while in the donut hole. If your plan is designed with a copay after the deductible but before the donut hole, what you’ll pay for prescriptions will change when you reach the donut hole.

Medicare Part D Out-of-Pocket Threshold Changes for 202o

In 2020, the out-of-pocket threshold will increase from $5,100 to $6,350. This is the amount of money you must pay to exit the Medicare “donut hole.” In other words, once you’ve paid $6,350 for prescriptions through your plan, you begin your catastrophic coverage benefit.

Medicare Part D Catastrophic Coverage Benefit Changes for 2020

In 2020, the minimum cost-sharing once you’ve met your out-of-pocket threshold of $6,350 Medicare will cover at least 95% of your prescription costs for the remainder of the year.

How Can Simplefill Help Those Who Can’t Afford Their Prescriptions?

Simplefill prescription assistance can often help people in the “donut hole” coverage gap, those who are uninsured, those whose copay is unaffordable, or people whose medication isn’t covered. If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1(877)386-0206. A Simplefill advocate will respond within 24 hours.

What Does Medicare Extra Help Cover?

by Simplefill Medicare Prescription Assistance

With so many moving parts, Medicare plans and health insurance coverage can be quite confusing. While we’ve already covered the 2019 changes to Medicare Part D, understanding the Medicare Extra Help Program could help you afford your prescriptions in 2019.

What Is the Medicare Extra Help Program?

Anyone who qualifies for Medicare can get Medicare Part D Drug Coverage, but some people with limited resources and income may qualify for additional financial resources through the Medicare Extra Help Program. This program serves as supplemental prescription help for the people who need it most.

What Does Medicare Extra Help Cover?

The Medicare Extra Help Program is estimated to be worth an additional $4,900 per year, on top of the regular Medicare Part D Drug Coverage. Extra Help can cover costs including monthly premiums, annual deductibles, and even prescription co-payments.

How Do I Qualify for Medicare Extra Help Coverage?

To qualify for Medicare Extra Help, you must meet financial need requirements, which are based on your income, savings, investments, and real estate holdings outside of your home. You must meet both a resource and an income limit in order to qualify for Extra Help.

What is the Extra Help Resource Limit?

While there are many resource variables to consider, people generally qualify for Extra Help when their annual resources are limited to $14,390 for an individual or $28,720 for a married couple who lives together. Resources include outside real estate, bank accounts, stocks, bonds, mutual funds, IRAs, and any additional cash outside of a bank account.

What is the Extra Help Income Limit?

In addition to meeting the resource limit, you must also have an annual income limited to $18,735 for an individual or $25,365 for a cohabitating married couple to qualify for Extra Help. That said, you may still be eligible to receive Extra Help with a higher annual income if you support additional family members, have earnings from work, or live in Alaska or Hawaii. It’s also important to note that some payments, including food stamps, housing assistance, and earned income tax credit payments do not count as income, so receiving this assistance does not prevent you from eligibility.

How to Get Help with Prescription Drug Costs Without Extra Help?

Simplefill prescription assistance can often help people who are having a difficult time affording their medication(s). This includes uninsured, privately insured and Medicare patients. If you suffer from a chronic disease like cancer, HIV, diabetes, high blood pressure, or depression and are having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206. A Simplefill Advocate will respond within 24 hours.

4 Tips for Dealing With Chronic Medical Issues While on Medicare

by Simplefill blog Chronic Disease Series Medicare

Dealing with medical issues is always challenging but coping with a chronic illness is especially difficult. These four tips for dealing with chronic diseases while on Medicare can help you live your happiest, healthiest life.

Choose the Right Medicare Plan

The Medicare system can be confusing, and the internet is full of misinformation about how Medicare works and what it covers. When choosing your Medicare plan, be sure to check information against the official U.S. Government Site for Medicare to ensure that you’re getting the right information. That said, no one should be denied Medicare coverage based on a pre-existing, chronic condition, and if you’re having trouble securing coverage related to a chronic medical issue, there are people who can help. Groups like the Center for Medicare Advocacy can help answer your questions about Medicare coverage and skilled coverage, as well as helping you choose the right Medicare plan for your health journey.

Ask Doctors for Written Instructions

Especially if you have a chronic condition, it can be hard to keep track of changing treatment plans, medication schedules, and lifestyle instructions. Asking for written instructions from your doctor prevents confusion and ensures that you have the information you need to make smart medical decisions. It can also be reassuring for family members who might not be able to attend a doctor’s visit with you.

Take Small Steps Toward Better Habits

We’ve all heard the saying, “It’s hard to teach old dogs new tricks.” But just because you’ve developed bad health habits doesn’t mean you’re doomed to repeat them. Small changes can make a big difference, especially when it comes to chronic conditions, and it’s much easier to commit to a small habit change than a large one. Think about your health challenges and find low commitment habits that might help. You might, for example, try to take a short walk after dinner or make a certain day of the week “dessert free.” You can work toward bigger lifestyle changes in the future but starting small will help keep you from getting overwhelmed or discouraged.

Take Advantage of Prescription Assistance Services

Especially when you’re suffering from a chronic condition, it’s so important to consistently take any medications that have been prescribed to you. Still, millions of Americans are forced to ignore doctor’s orders because they can’t afford the medication they need. Even with the closing of the Medicare Part D Donut Hole Coverage Gap, you may still find yourself in need of Medicare prescription help, either because your co-pays are too high or because your medication is not covered by Medicare. Using a prescription assistance program like Simplefill can help you afford the medication you need to treat your chronic illness.

If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206 and a Simplefill Advocate will respond within 24 hours.

The Medicare Donut Hole Explained

by Simplefill Medication Assistance

What is the Donut Hole?

The coverage gap, commonly called the “Donut Hole” is a temporary limit on what your Medicare Prescription drug plan will pay for your prescription drug costs.

While you are in the “Donut Hole”, you will pay higher costs of for your brand-name drugs. Often times these increased costs make your medications unaffordable.

If this sounds like you or someone you know, call Simplefill Prescription Assistance programs to enroll in their program during this period. 1-877-386-0206

The experts at Simplefill make understanding your Medicare Part D plan…well Simple!

There are 4 stages to your part D plan. Let’s break it down for you.

Stage 1: Deductible Phase
In this stage, you must pay a certain amount out of pocket before your prescription drug plan will kick in. This amount varies by plan.

Stage 2: Initial Coverage Phase
After you hit your deductible, you will start paying the plan’s cost share for covered medications. Once you and your prescription plan have spent $3,310.00 in 2016 for covered drugs; you’ve reached the “Donut Hole”.

Stage 3: The Donut Hole, Coverage Gap Phase
This is the stage where you start getting that sticker shock. Unless you want to wait until January 1st when your plan resets, you will now be paying 50% of the retail price of your medications. This can be very expensive and not an option for most patients, especially ones who are on fixed incomes.
This is why we urge you to contact us at 1-877-386-0206 or apply for assistance online.

Stage 4: Catastrophic Phase
You get a bit of a break in this stage since you have spent so much out of pocket for the year. During the catastrophic stage, you pay whichever amount is greater –either 5% of the covered drug cost or $2.65 for generics and $6.60 for brand name drugs.

What if I am not in the coverage gap but I still cannot afford my medications or my medication is not covered at all?
It never hurts to pick up the phone and ask. Often times we can help patients when their medication is not covered or if they have a copay is unaffordable. We always advise our patients to call us and we can find them the best way to save money on their medications. Think of the team at Simplefill as your Medication Savings Advisors!

Important Fall 2014 Healthcare Open Enrollment Tips and Deadlines

by Simplefill blog Prescription Assistance

The Open Enrollment period for healthcare under the Affordable Care Act is coming up soon, and we want our Simplefill community to be prepared for this important time of year. Grab a pen and get ready to mark your calendars with the information you need about coverage from a Qualified Health Plan.

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Important Medicare Dates You Need to Know for 2014

by Simplefill blog Medication Assistance News

If you have Medicare, get your calendars ready! These important dates will keep you organized and ensure that you enjoy all of your coverage benefits; Simplefill has gathered these dates to keep you prepared:

January 1

Starting the first day of 2014, your Medicare insurance plan goes into effect. Any changes made by you or Medicate to your plan started on New Year’s Day.

January 1 – February 14

This is the Medicare Advantage Disenrollment Period. During this time you can:

· Drop your Medicare Advantage Plan
· Switch to Original Medicare
· Enroll in a Medicare Cost Plan
· Add a Medicare prescription drug plan (if you switched to Original Medicare)

October 1-15

Set aside time to compare different Medicare health plans to see which one best meets your needs. Doing research in advance will help you evaluate your alternatives.

October 15 – December 7

This is Medicare’s Annual Enrollment Period. During this period, you can:

· Change your Medicare health insurance or prescription drug coverage for 2015
· Join or drop a Medicare Advantage, Medicare Part D, or Medicare Cost plan

If you don’t wish to make any changes to your Medicare coverage, your plan will remain the same in 2015. It isn’t necessary to enroll if you are keeping your plan the same.

January 1 – December 31

People turning 65 can enroll in the Medicare Part D plan for the current year. If you’re a Medicaid recipient, you can make changes or enroll in the Medicare Part D plan for the current year.

Mark these dates on your calendar to take advantage of your Medicare coverage. If you have any questions about your prescription drug services under Medicare, please don’t hesitate to get in touch with our support team.