Here’s What You Need to Know About the 2019 Changes to Medicare Part D Coverage

Here’s What You Need to Know About the 2019 Changes to Medicare Part D Coverage

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Medicare plans and health insurance coverage can be confusing. Here’s a breakdown of what Medicare Part D is and what changes are in store for 2019.

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 2019

In January 2019, the Medicare Part D deductible will vary. In some plans the deductible will go from $10 to $415. This means that you must pay $415 before Medicare begins to pay its share of the prescription cost.

Medicare Part D Initial Coverage Limit Changes for 2019

The Medicare Part D initial coverage will go from $3,750 to $3,820 beginning on January 1, 2019.  Once you and your prescription plan have hit $3,820 in 2019 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 2019

With the Affordable Care Act and the Bipartisan Budget Act of 2018, Medicare is trying to close the “donut hole” coverage gap. Beginning in 2019, Medicare Part D enrollees will now receive a 75% discount on the total cost of their brand name drugs purchased between their Initial Coverage and their Out-of-Pocket Threshold.

Medicare Part D Out-of-Pocket Threshold Changes for 2019

In 2019, the out-of-pocket threshold will increase from $5,000 to $5,100. This is the amount of money you must pay to exit the Medicare “donut hole.” In other words, once you’ve payed $5,100 for prescriptions through your plan, you begin your catastrophic coverage benefit.

Medicare Part D Catastrophic Coverage Benefit Changes for 2019

In 2019, the minimum cost-sharing once you’ve met your out-of-pocket threshold of ($5,100) will increase to either 5% or $3.40 for generic or preferred multi-source druga, or to either 5% or $8.50 for all other drugs.

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

Simplefill prescription assistance can often help people in the “donut hole” coverage gap, people who are uninsured, people 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 and a Simplefill Advocate will respond within 24 hours.

 

The Sandwich Generation

The Sandwich Generation

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Are you raising your own children and caring for aging parents? If so, you are part of an ever-growing group called the Sandwich Generation. The sandwich generation is typically people in their thirties or forties, responsible for bringing up their own children while at the same time, responsible for the care of their aging parents.  While this generation is probably well-versed in summer camps, daycares, and immunization schedules, they may also be familiar with topics like Medicare, Long-Term Care Insurance, or how to prepare for a decline in their parents’ independence. If thinking about all of that is enough to send you running for the hills, don’t. Knowledge, in this situation as in most every situation, is power and peace of mind.

The Sandwich Generation is rapidly growing as the number of people over the age of 65 is set to double over the next 25 years. Being a member of that generation means you are taking care of the people in your life who matter the most, but it comes at a cost, both financial and personal.

There are a number of things you can do to prepare for this potential situation and to reduce your stress load.

Take care of yourself. You need to sleep, eat well, exercise, and remember to laugh. Caretaking takes a heavy toll and if you are taking care of your kids as well as your parents, you’re getting hit by a double whammy.

If your parents are still able to manage their finances, you don’t know that they always will be. Talk with them about their finances and be sure to understand what they have, how they have it managed, and if they will need long-term care, how it will be paid for.

Educate yourself about Medicare. It’s an alphabet soup with Part A, Part B, Part C, and Part D and you’ll want to know what your parents have and what they don’t.

  • Part A covers hospitalization, some skilled nursing facility and home health care, and hospice. Both your parents get this coverage free even if only one of them worked and paid Social Security taxes for at least 10 years.
  • Part B covers doctor’s care, lab tests, screenings and preventive services. Your parents will usually pay a monthly premium for this coverage.
  • Part C, also called Medicare Advantage, consists of Medicare-approved plans offered by private insurers that include Medicare Part A and Part B coverage in one package. Some plans also include coverage of prescription drugs.
  • Part D is the Medicare prescription drug benefit plan that your parents can purchase if they are eligible for Medicare. 
The need for help with transportation, growing hospital and medication expenses, and extra homecare increases substantially as we age. Learn about programs that are available for people juggling caretaking on both ends. 
  • Getting Around: Sometimes your aging parent just needs help getting around. Well, there’s an app for that and an app you are most likely familiar with—UBER or LYFT.  If you’re shuttling kids from soccer practice to friends’ houses, you probably can’t take your parent to every appointment. The use of these ride services among seniors is steadily increasing and helping many seniors get to doctor appointments, the grocery store, or invaluable social time with family or friends. One of the worst things for an elderly person’s state of mind can be feeling isolated or stuck. Ride services like Uber or Lyft can help alleviate that isolation and the pressure on the caregiver. See this article on senior.com about using Uber to care for elders.
  • Affording Medications: Getting sticker shock at the pharmacy when picking up your folks medications? Simplefill , the leading prescription assistance company, is here for you. As we age, our medication needs can grow exponentially and managing costs can be overwhelming for the entire family. A prescription assistance company like Simplefill helps patients find ways of affording their increased medication expenses. Simplefill is a service that is easy to use is well known for their customer care. Just call to talk to a service representative and she will walk you through the process.
  • Home Care or Assisted Living: There are reputable companies that can give you help in the home if your parent isn’t ready for a nursing home yet. Home Instead and A Place for Mom are two companies helping the sandwich gen care for their parents.

It’s stressful answering the needs of young children or teenagers while juggling the needs of an aging parent. It can feel like a never-ending battle. Remember to take joy in having your family around—at whatever stage of life. Know that you are able to give back to your parents all the love and support they gave to you. And know that you’re teaching your own children that we do what we can for our family.

October is Breast Cancer Awareness Month

October is Breast Cancer Awareness Month

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October is Breast Cancer Awareness Month. Although Breast Cancer can be found in men as well, it is the most common cancer in Women. About 1 in 8 U.S. women will develop invasive breast cancer over the course of their lifetime. Breast cancer is a disease I am familiar with. I have had 6 people in my life diagnosed with breast cancer at all stages and are all survivors and cancer free today! However, although they won that battle, watching what they had to endure was terrible.

Simplefill is made up of almost all woman and we feel passionate about doing our part in spreading the awareness of this disease.

Let’s first start with the facts.

• In the US, 1 in 8 women will be diagnosed with breast cancer in their lifetime.

• The most significant risk factors for breast cancer are being female and aging. About 95% of all breast cancers in the US occur in women 40 and older.

• Getting a mammogram can help reduce the number of deaths from breast cancer by 30 to 40% among women ages 40 to 70.

• Breast cancer deaths have been declining since 1990 thanks to early detection, better screening, increased awareness, and new treatment options. Contact Simplefill if you have been prescribed a medication you cannot afford.

• Each year it is estimated that over 220,000 women in the United States will be diagnosed with breast cancer and more than 40,000 will die.

• Breast cancer is the second leading cause of death among women.

• In the US today, there are more than 2.9 million breast cancer survivors — the largest group of all cancer survivors.

• One woman will die of breast cancer every 13 minutes in the US.

• Every 19 seconds, someone in the world is diagnosed with breast cancer.

• A man’s lifetime risk of breast cancer is about 1 in 1,000.

Breast Cancer Risk Factors

Take a minute to read through these protective steps you can take that can help keep your risk as low as possible.

Limit alcohol. The more you drink, the higher the risk. The general recommendation is 1 drink per day.

• Don’t smoke. C’mon people, you know this! Don’t smoke. If you are having a hard time beating this habit. Contact us about getting help with Chantix – a medication proven to help patients kick the habit. APPLY HERE

• Control your weight. Again, you know this! Being overweight or obese increases the risk of breast cancer and can cause many other negative health factors.

• Be physically active. Physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer. For most healthy adults, the Department of Health and Human Services recommends at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly, plus strength training at least twice a week.

• Breast-feed. If you can do this, then I would recommend it. However this is a touchy subject since there is a lot of unnecessary pressure put on moms and if this is not an option, don’t stress yourself out. Like you don’t have enough on your plate already!

• Limit dose and duration of hormone therapy. Combination hormone therapy for over three years increases the risk of breast cancer. If you’re taking hormone therapy for menopausal symptoms, ask your doctor about other options. If you decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose that works for you.

• Avoid exposure to radiation and environmental pollution. Medical-imaging methods, such as computerized tomography, use high doses of radiation. Some research indicates a link between breast cancer and radiation exposure. Reduce your exposure by having such tests only when absolutely necessary.

• Be vigilant about breast cancer detection. If you notice any changes in your breasts, such as a new lump or skin changes, consult your doctor. Also, ask your doctor when to begin mammograms and other screenings based on your personal history.

Simplefill is a full-service prescription assistance company that is dedicated to making prescribed medications affordable for our members. We have been able to help many of our patients afford their treatments.
The following is a list of medications that we can help with. If you need help with a medication that is not listed on here, Contact Us to find out if we can still help.

Drugs Approved to Prevent Breast Cancer

• Evista (Raloxifene Hydrochloride)
• Keoxifene (Raloxifene Hydrochloride)
• Nolvadex (Tamoxifen Citrate)

Drugs Approved to Treat Breast Cancer

• Abitrexate (Methorexate)
• Abraxane
• Afinitor
• Arimidex (Anastrozole)
• Aromosin
• Cabectabine
• Cytoxan (Cyclophosphamide)
• Faslodex
• Femara (Letrozole)
• Gemzar (Gemcitabine Hydrochloride)
• Herceptin (Trastuzumab)
• Ibrance (Palbociclib)
• Megestrol Acetate
• Nolvadex (Tamoxifen Citrate)
• Taxotere (Docetaxel)
• Tykerb (Lapatinib Ditosylate)
• Xeloda (Capecitabine)
• Zoladex (Gosereline Acetate)

Call Simplefill today to learn how we can help. 1-877-386-0206 Ext. 1

June is Alzheimer’s Awareness Month

June is Alzheimer’s Awareness Month

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My uncle, Francois, was kind, sweet and always had something to say. Always. He was a quirky man with an adventurous spirit which is what made it difficult for us to identify what was happening to Francois.

Francois lived in North Miami, Florida with my aunt. When my aunt asked him to run to the store to pick up a few items, she thought nothing of it. After all, he had done it 100 times in the past. Hours later my uncle was still not back. We began to panic. We filed a missing person report and was told that all we could do at that time was wait. We waited and waited for that phone to ring. Hours after we filed the report, the phone rang. It was not Francois on the other line, it was the state police department.
Instead of going to the store, Francois got on I-95 North and drove 200 miles to the Georgia state line. He drove until he literally ran out of gas. The state police picked him up and saw he was on the missing person’s report. The state police kept him at the station until we got there to pick him up. They enjoyed my uncle, they even gave him a jacket to coronet his adventure! When we asked my uncle why he drove so far he had no answer. He did not remember. He was diagnosed with Alzheimer’s later that month.

June is Alzheimer’s awareness month. At Simplefill, we believe it is important to help spread the awareness.

I watched my uncle struggle with this disease and what seemed harder was watching my aunt manage his illness. She went from having a best friend and partner in life, to having a full time caregiving job that left her financially and emotionally exhausted. My aunt is not alone. There is an estimated 5.4 million Americans with Alzheimer’s and over 15 million caretakers that tend to Alzheimer patients.

Notable Facts
1. Every 66 seconds someone in the United States develops the disease
2. Family caregivers spend more than $5,000.00 a year caring for someone with Alzheimer’s
3. In 2016, Alzheimer’s and other dementias will cost the nation $236 Billion
4. Alzheimer’s kills more than breast cancer and prostate cancer combined

Sometimes the signs of Alzheimers are not noticed until the disease has advanced. Keep in mind these 10 warning signs and contact your doctor if these behavior patterns become more common.

10 Early Signs and Symptoms of Alzheimer’s
1. Memory loss that disrupts daily life
2. Challenges in planning or solving simple problems
3. Difficulty in completing familiar tasks at home, at work or at leisure
4. Confusion with time
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Changes in mood and personality
10. Withdrawal from work and social activities

The team at Simplefill hopes to spread the awareness of this debilitating disease and let people know we can help alleviate some of the financial burden that falls onto families of Alzheimer’s patients. There are several medications that have been developed to slow down the progression of the disease. Unfortunately, these medications come with a high price tag. Often the medication(s) are unaffordable for patients. If you know of someone who needs assistance paying for their Alzheimer medication which includes but is not limited to Namzaric, Exelon Patch, or Namenda please call Simplefill today (1-877-386-0206). We look forward to helping you.

The Medicare Donut Hole Explained

The Medicare Donut Hole Explained

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!

Screenings and Preventions for Men’s Health Month

Screenings and Preventions for Men’s Health Month

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In the 1400s, scholar Erasmus noted that “prevention is better than cure”. At Simplefill, we believe that this quote is as true today as it was then. In observance of Men’s Health Month, we’re encouraging men out there to put these words into action. Take preventative measures to nip any health issues in the bud by scheduling the following screenings. Continue reading

Chronic Obstructive Pulmonary Disease (COPD): The Symptoms, Treatments & Medications

Chronic Obstructive Pulmonary Disease (COPD): The Symptoms, Treatments & Medications

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Chronic Obstructive Pulmonary Disease, commonly known as COPD, is one of the country’s most common illnesses, but at Simplefill Prescription Assistance, we have found that it is also one of the most misunderstood. The term describes a condition where airways to the lungs are partially blocked, making it difficult to draw breath. Chronic bronchitis and emphysema are both forms of COPD.

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How to Get HIV Medication Cost Assistance

How to Get HIV Medication Cost Assistance

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An estimated 1.1 million Americans live with HIV every day. Proper medical attention is essential in order to cope with this taxing illness, but too often the AIDS and HIV treatment cost hinders patients’ access to this vital care. If you cannot afford the cost of HIV medication, then there is a solution. Simplefill is dedicated to helping individuals who are under- or uninsured, providing that crucial link between patients and Prescription Assistance Programs.

To get support from Simplefill, fill out and submit the short application. A Simplefill Advocate will give you a call within 24 hours of submission to get more details and, if you are eligible, will promptly enroll you in the program. Once you are a Simplefill member, Advocates will help you complete your tailored Prescription Assistance Program applications to provide access to free or low cost medication. No two patients are alike, and by combining our extensive knowledge of the health care system with the individual needs of our members, we are able to get you the affordable medicine you need to live with HIV. We also research alternative funding programs and prescription options to relieve the financial burden of most prescription medicine.

Simplefill members don’t just get access to affordable medicine for AIDS; they also have the peace of mind that their needs are being taken care of by a team of specialists. Our services include personal medication management, so that you don’t have to feel insecure about when your prescription will arrive. We believe that our members should be focusing on their health, so we focus on providing them with reliable access to affordable or free HIV medication.

If you are living with HIV, support is just a phone call away. Reach out to a Simplefill Advocate today at 1.877.386.0206 to get prescription assistance you need.