Wellness

[Shiloh09]

I will continue with the UHCAdvantage plan. My particular plan does not allow for the "donut hole" that others are shocked about when their med isn't covered for part of the coverage year.i have one med that retails at almost $2000/month. Before medicare, my insurance and discount card thankfully reduced it to a little over $600/90days. I recently paid $75/90 days for the same med through my advantage plan. 

I declined the wellness visit from UHC and kept the "Welcome to Medicare" appointment with my PCP. Clearly everyone has different needs and different experiences with Medicare, Medicare Advantage, Medicare Supplemental, and Part D. I am grateful for the donut hole coverage.

[Skyegirl21]

We all realize this is to benefit THEM ( less incidents, less payouts)! I don't answer these calls under any circumstances and tell my Mother ( she is alone) to keep saying they aren't home- No visits thank you. 

[Tinkrbl44]

Well, since we don't have the statistics they developed this program on .....  what comes to mind is "prevention" in all ways possible.

Early detection saves lives. 

Everyone knows that, but I think covid turned a lot of people into hermits .... or semi-hermits.   

I've recently read that seniors have dramatically avoided dentists for the past few years, too, and now supposedly need a ton of dental work.   

If this correct,  this is not good.

[RedTop]

@Tinkrbl44 

I was in the dentist office 3 weeks ago, and had a 40 minute wait on my dentist, as the elderly patient in the room beside me had not seen a dentist in at least 25+ years!

She probably wouldn't have been there that day, had it not been for the fact her teeth were loose and starting to fall out!  Depending on what choice she makes, her neglect is going to cost $1200 off the bat for the deep root cleaning, and about $6000 for option 1 and $10,000+ for option 2.   

[gertrudecloset]

https://www.hellahealth.com/blog/medicare/the-medicare-donut-hole-explained-what-it-is-how-it-works-...

The donut hole, also known as a Medicare Part D coverage gap, is a part of the Medicare program that leaves many older Americans with high out-of-pocket costs for their health care.

 

What is the donut hole in Medicare Part D? 

That’s right – there is a coverage gap in Medicare Part D (Prescription Drug Plans) that can often leave older Americans responsible for healthcare costs they didn’t expect. The donut hole is a gap in Medicare coverage that begins when you and your plan have spent a certain amount of money on covered drugs.

 

How does the donut hole work in Medicare?  

Once you reach the donut hole, you’ll be responsible for a portion of the prescription costs. The good news is that the donut hole has been gradually closing since 2010, and it’s scheduled to close completely by 2025. In 2022, once your plan has spent $4,430 on covered drugs, you will be in a Part D coverage gap. While that gap means you will need to pay something, you won’t pay more than 25% of the cost of your plan’s brand-name prescription drugs that are covered.  

In 2022, once your plan has spent $4,430 on covered drugs, you will be in a Part D coverage gap. However, won’t pay more than 25% of the cost of your plan’s brand-name prescription drugs that are covered. 

 

Medicare Part D donut hole closed 

In 2020, the Medicare Part D donut hole closed for all drugs. However, you still might need to pay a small portion of the prescription drug cost. If you enter the Part D Medicare coverage gap, you will only be responsible for paying 25% of the drug cost, versus a higher percentage in the past. For example, if the drug cost is $100, you may need to pay $25 for the drug once you enter the Medicare coverage gap. 

 

What you can do about the Medicare donut hole in 2022?  

If you’re concerned about the donut hole, there are a few things you can do. First, talk to your doctor about ways to lower your costs. There may be generic drugs or therapeutic alternatives that cost less. You can also ask your pharmacist if there are any manufacturer coupons or patient assistance programs or Medicare donut hole assistance that can help lower your costs.  

Finally, consider enrolling in a Medicare Advantage Plan or Medicare Part D plan without a donut hole. These plans typically have lower out-of-pocket costs and may offer additional benefits like coverage for vision, dental, and hearing care. However, they will usually have the same coverage gaps. 

Do Medicare Advantage plans cover the Part D donut hole?  

You might want to include Medicare prescription drug coverage in your chosen Medicare Advantage plan, but the plan will still have a donut hole, similar to a regular Part D plan. During a coverage gap, your Medicare Advantage plan will not be able to cover extra Part D costs.  

 

Why is there a donut hole in Medicare?  

The donut hole existed because Medicare is a federal program that requires seniors to pay for a portion of their own healthcare costs. The Medicare donut hole amount 2022 was designed to encourage people to shop around for the best deal on their prescriptions and to use generic drugs when possible. 

Now that the donut hole is closed for generic drugs, it is technically closed for all medications. However, that doesn’t mean you will pay nothing for drugs, and you’ll have to pay up to 25% of the cost of covered brand-name prescription drugs once in a Medicare coverage gap for Part D.  

 

How to find the best Medicare plan with the most coverage?  

There are a few things to consider when looking for a Medicare plan that will work for you. First, you should start with your needs: what type of coverage do you need? What are your budget constraints? Once you’ve considered your needs, you can start shopping around for plans.  

 

The best place to start is the Medicare website 

There, you can compare different plans and find the one that offers the best coverage for your needs. You can also contact the insurance companies directly to get more information about their plans. You can also try using a Medicare donut hole calculator to figure out your Medicare donut hole amounts. 

 

Other Medicare plans to help with the costs when in the donut hole  

Although Medicare coverage gaps for Part D are an issue for some enrollees, there are other Medicare plans that can help. For example, Medicaid provides coverage for low-income enrollees. There are also a number of private insurance companies that offer supplemental Medicare plans.  

 

Medicare Part A and B cover most things  

While there are some gaps in Medicare coverage, the program does cover most things. Part A covers hospitalization, and Part B covers outpatient care. Together, these two parts of Medicare cover a wide range of services.  

However, there are some services that Medicare doesn’t cover from time to time. These include long-term care, dental care, cosmetic surgery, and others. If you need coverage for these services, you may need to purchase a supplemental insurance policy.  

[chlema]

Just came home from my yearly Wellness appointment.  Big waste of time.  No, I do not drink, no I do not smoke, no I haven't any scatter rugs around, yes I have grip bars in the shower and yes I have a fire escape route - the closest window.  She was going to do the memory test but I told her "apple, table, penny and baby, kitchen, tree - the 3 words from 2 years ago and last year.  So she said the test was optional anyway and I don't really need it lol.  So I guess I passed?????

[teganslaw]

My husband and I got flyers from Aetna saying that we might be interested in obtaining an Aetna DSNP Advantage. (Dual special needs plan.) One has to have both Medicare and Medicaid to be eligible. We aren't eligible for Medicaid in IN, as our income and assets are over the limit. Not interested in anything to do with Advantage plans.

Another flyer from United Health Care letting us know about UHC Advantage seminar events around the city. They say no obligation (yea, right!). I know if we attended that they would push attendees to join and only detail the parts people want to hear. 

Medicare is really pushing the Advantage plans now. Not many phone calls, but dozens of flyers.