Something New to Me, That I Need Your Help On:

[G.Gordon]

Frank,

I read between the lines. I think he may have been asking about the PDP/MA enrollment period for T65'rs.

 

[houcoogster]

I don't know how things work in your state but in Texas most teachers do NOT receive medicare part A they are allowed to buy in to part B.

The supplement that they offer them sort of functions like Medicare part A and fills in some gaps and includes Drug coverage too.

I have never replaced one.

 

[Medigap]

Jessica,

Please take G. Gordon's advice and have your prospect check to see if the drug coverage provided by the retirement plan has a coverage gap. You don't want to assume it does. That could end up being his biggest expense and if the retirement plan does not have a gap in drug coverage (many of them don't) and he decides not to take it in order to get a Medicare supplement you could be doing more harm than good. You seem like the type that is more interested in helping than getting a commission at any cost.

Just wanted to 2nd G. Gordon's recommendation.

 

[Frank Stastny]

Frank,

I read between the lines. I think he may have been asking about the PDP/MA enrollment period for T65'rs.

Thanks, it's been a really long day for some reason.

 

[houcoogster]

Jessica,

Please take G. Gordon's advice and have your prospect check to see if the drug coverage provided by the retirement plan has a coverage gap. You don't want to assume it does. That could end up being his biggest expense and if the retirement plan does not have a gap in drug coverage (many of them don't) and he decides not to take it in order to get a Medicare supplement you could be doing more harm than good. You seem like the type that is more interested in helping than getting a commission at any cost.

Just wanted to 2nd G. Gordon's recommendation.

Here it is from PSERS-HOP site see page 4 and 5 Jessica
http://www.hopbenefits.com/pdfs/2010/2010SumofBenefits_Final.pdf


What's the "coverage gap"? Do the HOP Enhanced and Basic Medicare Rx Options have a coverage gap?

In 2011, under the Basic Medicare Prescription Drug Coverage, once your total drug costs (what your plan has paid plus your deductible and copays) exceed $2,840, Medicare will not cover any more covered expenses in the year until you spend $4,550 out of pocket. This gap in coverage is called the "coverage gap." During the Coverage Gap Stage, you receive a discount on brand name drugs and pay only 93% of the cost of generic drugs. You stay in this stage until your out-of-pocket costs reach $4,550. This is the amount you must pay out-of-pocket to leave the Coverage Gap Stage and qualify for Catastrophic Coverage. When you reach the $4,550 limit, catastrophic drug coverage kicks in automatically. At that point, for generic drugs, you pay the greater of 5% or $2.50 to a maximum of $100; and for brand name drugs, you pay the greater of 5% or $6.30 to a maximum of $100.

In 2011, under the Enhanced Medicare Prescription Drug Coverage, once your total drug costs (what your plan has paid plus your deductible and copays) exceed $2,840, you receive a discount on brand name drugs and pay 50% of the cost of generic drugs (to a maximum of $7 for up to a 33-day supply or $21 for a 34- to 90- day supply). You stay in this stage until your out-of-pocket costs reach $4,550. This gap in coverage is called the "coverage gap." When you reach the $4,550 limit, catastrophic drug coverage kicks in automatically. At that point, for generic drugs, you pay the greater of 5% or $2.50 to a maximum of $100; and for brand name drugs, you pay the greater of 5% or $6.30 to a maximum of $100.

 

[Jessica Durphy]

Wow, thanks guys for all of the information! I wasn't able to get back on the forum until just now!

Anyway, this fella pays $15.00 for generics, $30 for brand names, $60 for preferred brand names... 2 of which drugs he takes are considered Preferred and 1 Brand!!

houcoogster... Thank you for the post! I found that to be very informative!! Much thanks!

G.Gordon... You and Frank have an abundance of knowledge in this field and I only hope to one day attain a portion of it!! Thanks for your help!

bourbonlegend... You asked if the $100.00 only applied to that specific plan... I asked him that exact question yesterday and from what he gathered when enrolling, this was his only option! I found that hard to believe~ but I'm not certain! I can maybe do a little more research into that for him!? He has a mound of paperwork that I could possibly go through! I don't mind, because this man is very influential in our area, He knows people and they KNOW him... so I feel that if I do my best for him, I know that he's going to tell people about me! That's what I'm looking at, REFERRALS!

P.S. By the way, you're right it is a VERY overpriced (dumpy) MAPD

BUT... if it's not a smart choice for him to step out of this plan then by all means, I'll be totally honest and upfront with him!! My biggest fear in this field is "hurting" not helping!

 

[wilkin]

Hi Jessica,
I notice you are in PA as I am. Are you familiar with Ritter Insurance Maketing in Harrisburg? They are an FMO specializing in the senior market and are a great source of information and products.

 

[Jessica Durphy]

Hi Jessica,
I notice you are in PA as I am. Are you familiar with Ritter Insurance Maketing in Harrisburg? They are an FMO specializing in the senior market and are a great source of information and products.

Yes, Ritter is great! Thank you for your input!

 

[Josh]

I read through your post a few times and there are certainly some holes in the in the picture, but I think you misnamed his plan an MAPD. If it's truly an MAPD $225 would be the highest premium I've ever seen anywhere. I think it's a retiree benefit and to be honest, I think he'd be an absolute moron to lose it. MA plans are not getting increases to keep up with the cost of the rising cost of healthcare and benefits are getting cut, slashed, and/or dropped altogether. Most retirees are ungrateful for what they have unless a professional explains to them what they would be facing without the benefits. If he leaves what he has now he'll likely not be able to get it back and if is health is as poor as you say it is then he really should stay exactly where he's at. With a $500 out of pocket maximum and drug coverage that I'm assuming doesn't have a hole he's getting an absolute steal for $125/month. I would triple check on everything before you suggest he moves unless you'd like to be staring down the barrel of a legitimate e&o claim.

 

[houcoogster]

I read through your post a few times and there are certainly some holes in the in the picture, but I think you misnamed his plan an MAPD. If it's truly an MAPD $225 would be the highest premium I've ever seen anywhere. I think it's a retiree benefit and to be honest, I think he'd be an absolute moron to lose it. MA plans are not getting increases to keep up with the cost of the rising cost of healthcare and benefits are getting cut, slashed, and/or dropped altogether. Most retirees are ungrateful for what they have unless a professional explains to them what they would be facing without the benefits. If he leaves what he has now he'll likely not be able to get it back and if is health is as poor as you say it is then he really should stay exactly where he's at. With a $500 out of pocket maximum and drug coverage that I'm assuming doesn't have a hole he's getting an absolute steal for $125/month. I would triple check on everything before you suggest he moves unless you'd like to be staring down the barrel of a legitimate e&o claim.

You're a whack job!

She knows better than to cancel his plan.