Tag Archives: donut hole

Consumers Direct Insurance Services of New Mexico Releases Dates and Times for its Medicare Seminar Series

Albuquerque, New Mexico (PRWEB) October 08, 2014

Late enrollment penalties, donut holes, calendar year maximums, catastrophic coverage – oh my. Medicare sure sounds frightening but don’t fret. With a little knowledge you’ll find it’s not nearly as scary as you may think.

Consumers Direct Insurance Services (CDIS), Inc., an Independent, Authorized Senior General Agent for Blue Cross and Blue Shield of New Mexico is gearing up for Medicare’s 2014 Annual Enrollment Period (AEP), which runs from October 15th through December 7th, with the release of its Medicare Seminar Series*.

CDIS’ Medicare Seminar Series, is a grassroots initiative that places experienced local insurance agents in a controlled learning environment for Medicare beneficiaries to gather essential plan benefit information while also providing a forum for answers to their questions.

“Consumers Direct Insurance Services of New Mexico is excited about its upcoming Medicare Seminar Series, because it gives us an opportunity to engage the local public and present all of the new plan options from Blue Cross and Blue Shield of New Mexico,” said Scott Loochtan, President of Consumers Direct Insurance Services, Inc. “Trying to decipher all of this material on your own can be daunting and that is why we offer this complimentary service to make the process much easier.”

The Medicare Annual Enrollment Period (AEP) is the one time of year that Medicare beneficiaries enrolled in either a standalone Medicare Part D prescription drug plan (PDP) or Medicare Advantage (MA) plan can make a change for the next year.

“The AEP is the insurance agent’s tax season,” noted Loochtan. “Medicare beneficiaries all over the country have been eagerly awaiting this time of year to review and analyze their plans so that they can secure the best options to meet their needs in the upcoming year.”

CDIS’ insurance agents go through a stringent Medicare Part D Prescription Drug Plan (PDP) and Medicare Part C, also known as Medicare Advantage (MA), continuing education and certification process each year in order to assist current and potential clients. This certification allows them to provide full service Medicare solutions while making themselves available in a variety of ways through technology, over the phone or in person appointments.

To register for one of CDIS of New Mexico’s Medicare Seminars please visit http://www.CDISofNM.com/seminars or call directly at 888.257.6640. There is limited seating for each seminar.

About Consumers Direct Insurance Services, Inc. (CDIS)

Consumers Direct Insurance Services, Inc., (CDIS), is an Independent, Authorized Senior General Agent for Blue Cross and Blue Shield of New Mexico, Oklahoma and Texas that were founded in an effort to bridge the gap between education and insurance. Headquartered in Riverwoods, IL, the company has an executive team with over 100 years’ experience that has been providing world-class healthcare guidance to over 20,000 active clients. For more information, please visit our state specific websites at http://www.CDISofNM.com, http://www.CDISofOK.com and http://www.CDISofTX.com.

*Not connected with or endorsed by the U.S. Government or the Federal Medicare program.


Check out these medicare insurance images:

medicare insurance
Image by Iowa Democratic Party – iowademocrats.org
Don, from the Alliance of Retired Americans, spoke about how the health insurance reform bill would help close the Medicare Part D "Donut Hole" that so many seniors fall into.

Grand Bargain Watch – Save Social Security
medicare insurance
Image by DonkeyHotey
Don’t let Washington cut Social Security and Medicare benefits.

Hey, Washington, why don’t you do raise the limit on paying into Social Security, stop subsidizing insurance companies and drug companies, and do something about run away medical costs?

Watch out for the Grand Bargain. Wall Street wants to steal your pension and social security.

Stella Johnson On The Impact Of Health Insurance Reform
medicare insurance
Image by Leader Nancy Pelosi
This afternoon at a press conference in the Capitol, Stella Johnson talked about how she will benefit from much-needed health insurance reform:

My name is Stella Johnson, and I am a retired school teacher for Washington, D.C. I am also a member of the Alliance for Retired Americans. Like many seniors, I must take prescriptions every day to manage my high blood pressure and high cholesterol. But unfortunately, along with over 3 million other seniors, I am in what is known as the Medicare “donut hole.”

For several months of the year, I have to pay full price for my prescriptions, even though I am still paying my Medicare premiums. In other words, I pay the money but get nothing in return. For an example, in 2008, I received a letter from my insurance company stating that I would not receive any money for my medicine during the month of December. No you know how that is, that is supposed to be a very joyful month. However, I found myself, during that time, quite desperate for I would not receive any money until the new year for my insurance began. I had to use my utility bill money in order to buy my medicine. And then, in order to catch up these bills, I had to even go to borrow money from my food money. I became quite desperate, and I didn’t know what to do. Because in times like this, it is very hard for me to make ends meet. I have to chose between taking the medicines I need and paying my monthly bills. Because my prescription costs so much, I fall behind on some of these bills. When I get hit with late penalties, things even get worse.

The health care bill will help seniors like me, who struggle every day to afford the prescriptions they must have. Retirees all across the country desperately need this bill to pass right away.

Medicare Donut Hole Is Getting Closed By The Affordable Care Act

medicare donut holeCurrently, most Americans who receive Medicare prescription drug benefits have what is known as a medicare donut hole, which means there is a coverage gap when you and your insurance plan have reached a certain payment amount for covered medications. The maximum drug benefit in 2013 is $ 2,970 and once this has been met, you are required to pay more for your prescription medications.

Closing the Gap

In 2013 and 2014, if you meet your maximum benefit, you will pay 47.5 percent of the cost of your medications. The insurance plan will cover the rest. You can access these benefits when you purchase brand-name medications at a pharmacy or through a mail order service. The discount is applied to the price of the drug as determined by your insurance plan.

The amount you pay (47.5 percent) for your medication is counted toward your out-of-pocket maximum, which will eventually remove you from the coverage gap. For example, if your brand-name medication is $ 60 and the dispensing fee is $ 2, you would be responsible for 47.5 percent of the plan’s cost. This amount is $ 29.45, which you would be required to pay. This amount, along with the $ 30 discount payment will apply to your out-of-pocket maximum.

For generic medications, you will pay 79 percent of the cost of your drugs. This percentage will decrease each year until it bottoms out at 25 percent in 2020. Only the amount you actually pay for generic medications will count toward your out-of-pocket maximum. For instance, if the price of your generic medication is $ 20 plus a $ 2 dispensing fee, you would pay $ 17.38 for the drug after the 79 percent payment is applied. This is the full amount that will apply to your out-of-pocket maximum, which will eventually get you out of the Medicare donut hole.

What Charges Can Be Applied to the Medicare Donut Hole?

The Affordable Care Act includes provisions that will close the Medicare donut hole by 2020, but until then, you will have to pay more out-of-pocket costs for prescription medications after you reach your maximum benefit. Once you are in the donut hole, you will need to pay a percentage of your medications until you reach your out-of-pocket maximum. The charges that go toward your maximum are:

  • Yearly deductible
  • Coinsurance
  • Copays
  • Discount on brand-name drugs once you’ve reached the Medicare donut hole
  • The percentage you pay for your medications while you are in the donut hole

The following payments that will not count toward your out-of-pocket maximum are:

  • The dispensing fee
  • Your drug plan premium
  • Any amount you pay for medications that are not covered by your plan.

Schedule for Closing the Medicare Donut Hole

As mentioned above, the Affordable Care Act has a goal of closing the Medicare donut hole entirely by 2020. Your percentage of the costs of medications will decrease until it reaches 25 percent in 2020. Here is the schedule for closing the gap:

Your Brand-name %
Your Generic %
2013 47.5 79
2014 47.5 72
2015 45 65
2016 45 58
2017 40 51
2018 35 44
2019 30 37
2020 25 25

Your out-of-pocket maximum may change from year to year as well, but in 2013 it is $ 4,750. This is the amount you must reach in payments before Medicare will begin paying for your drugs at 100 percent.

More information on medicare is available at http://www.medicare.gov

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