Copyright 2005 Jeremy Cockerill
Laptop Battery A complete understanding of Medicare Part D Out-of-pocket
expenses is critical for all Medicare-eligible individuals in order
for them to maximize their savings and get the most out of the
program.
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Thinkpad What are the Out-of-Pocket expenses associated with Medicare
Part D? On the Medicare.gov website "Out of Pocket costs" are
defined as "health care costs that you must pay on your own because
they are not covered by Medicare or other insurance."
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Microsoft The Out-of-Pocket (OOP) expenses associated with Medicare Part D
are basically any costs for an enrollee's medications that Medicare
will not cover and that they must pay for on their own. These OOP
expenses include the annual deductible, which ranges from $0 - $250
depending on the individuals chosen plan, and any other portion of
their medication cost that they are required to pay such as the
drug cost co-payments. It is important to note that an enrollee's
monthly premium is not counted as an Out-of-pocket expense. These
premium payments are an additional expense on top of the
out-of-pocket expenses.
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Laptop Computers The majority of Medicare drug plans have a $250 annual
deductible and a 25% co-payment for all enrollee's drug costs until
they have reached $2250 in drug expenditures. Under this scenario,
at the $2250 expenditure point, enrollee's will have $750 in
Out-of-Pocket expenditures. How do we come up with the figure of
$750? This is calculated as such:
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Laptop Computer The $250 annual deductible + $500 (25% co-payment x $2000 of
drug expenditures) = $750
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Desktop Computer Individuals who have close to or exactly $2250 in annual drug
expenditures in 2006 will be the biggest winners of the Medicare
Prescription Drug plan. Based on the individual paying only $750 in
OOP expenses and assuming that the individual payed the national
average monthly premium of $32.20, these individuals save
approximately 49% on their drug purchases. However, not
surprisingly, the majority of seniors do not fall in this category
and the savings drop off sharply when you spend more than or less
than the $2250.
Notebooks For the millions of American seniors who will spend more than
$2250 on their drugs in 2006, this is where the Out-of-Pocket
expenses start to add up. Beyond the $2250 expenditure amount you
are responsible for paying for 100% of your drug cost until you
have spent $3600 out-of-pocket (called the Out of Pocket
Threshold). This means that between the annual drug expenditure
range of $2250 and $5100 you are 100% responsible for paying for
the cost of your medications.
Lenovo How do we come up with the drug expenditure range of $2250 and
$5100? Here is the explanation:
Hard Drive When the Medicare Modernization Act was passed in 2003 it was
decided at that time that once people had spent $2250 on drug
expenditures they would then be 100% responsible for paying for
their drugs until they his a threshold of $3600 in drug
expenditures.
Travelstar So between from $0 to $2250 there are $750 in out-of-pocket
expenses as we calculated earlier in this article.
Gateway $3600 OOP Threshold - $750 in OOP expenses at $2250 = $2850
remaining to reach the OOP Threshold.
Laptop Parts Since after $2250 in expenditures enrollees are 100% responsible
for their drug costs we can simply add the $2850 remaining to reach
the OOP Threshold to the $2250 in drug expenditures to get:
Software $2250 + $2850 = $5100
Hard Drives That is how we get the drug expenditure range of $2250 to $5100
in which enrollees are 100% responsible for their drug
expenditures.
Electronics This expenditure range is often called the "doughnut hole". It
is very important that Medicare eligible individuals are aware of
the doughnut hole because for the first few months of 2006 they may
be budgeting based on only having to pay for 25% of their drug
purchases and then all of a sudden when they reach $2250 in drug
expenditures they are hit with responsibility of paying for 100% of
the drug cost. That is a huge and sudden change in monthly
expenditures.
Canon It is also important that Medicare Part D enrollees are aware
that not all purchases are necessarily counted towards their
Out-of-Pocket expenditures. The following are examples of purchases
that will not be counted towards OOP expenses:
Desktop Pc 1. If a drug that an enrollee requires is not on the formulary
of covered drugs for their chosen drug plan (or if their plan
removes that drug from its formulary of covered drugs) that drug
purchase will not be counted towards their out of pocket expenses
and you are 100% responsible to pay for it. Purchasing these
non-formulary drugs, that the enrollee must pay full price for,
from Canada is an excellent alternative to paying high prices at
the local pharmacy. Individuals can save an average of 42% by
purchasing these medications in Canada.
Desktop Computers 2. If an enrollee travels and buys their prescription drug at a
pharmacy that is not included in their drug plan's network of
pharmacies they are 100% responsible for the cost of the medication
and it will not be counted towards their OOP expenses.
Think Pad 3. If an enrollee currently has an insurance plan and they
utilize their insurance coverage to pay for their drug purchase,
the purchase will not be counted towards their OOP expenses.
Repair 4. If an enrollee purchases their medications from another
country that has low-cost, high-quality medications, such as
Canada, these purchases, unfortunately, will not be counted towards
their OOP expenses. However, these individuals may want to explore
this option when they reach the doughnut hole to help them save
even more money. In fact, if an individual spends more than $2250 a
year on medicines but less than $7050 a year, buying their
medicines from Canada once they hit the doughnut hole is an
excellent option for them.
Data Recovery Medicare eligible individuals' knowledge of Out-of-Pocket
expenses and what these expenses entail is crucial for them to save
as much as they possibly can with the Medicare Prescription Drug
plan.
Cisco
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Keyboard Jeremy Cockerill is a licensed pharmacist and the co-founder and
pharmacy manager of Universal Drugstore. Mr. Cockerill graduated
from the Faculty of Pharmacy at the University of Manitoba with
Honors in 1998. Mr. Cockerill is the recipient of the 2005 Manager
of the Year award from the Manitoba Customer Contact
Association.
http://www.universaldrugstore.com
Monitor Jeremy Cockerill is a licensed Canadian pharmacist and the
co-founder and Pharmacy Manager of www.UniversalDrugstore.com. Mr.
Cockerill graduated from the Faculty of Pharmacy at the University
of Manitoba with Honors in 1998. Mr. Cockerill recently received
the 2005 Manager of the Year award from the Manitoba Customer
Contact Association.
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