I will turn 65 in May and am currently covered by my wife’s employer group health insurance.  Currently, I am fighting stage 3 cancer of the kidney and the prognosis is good because I am participating in a clinical trial for a new cancer medication which costs over $18,000 per month. With this clinical trial, I am paying $0 for a medication which is curing my cancer.

I am not planning to enroll in Medicare until my wife retires next year, when she turns 65. I am concerned about Medicare’s famous donut hole and if this new prescription called Sutent is covered by Medicare’s Part D prescription drug plan. How long will it take me to get into the donut hole or will I even get in it?

Please explain Medicare and clinical trials and what I should do? 

Thanks,

Matthew

Matthew:

You are very smart to remain on your wife’s employer benefits because you both can enroll in Medicare Parts A and B when your wife retires next year. At that time, you will be eligible for a SEP (Special Enrollment Period) avoiding the Medicare Part B penalty and be able to enroll in a Medicare Part D prescription drug plan.

Since you are enrolling in Medicare Part B for the first time, you qualify for the Medigap/Medicare Supplement 6-month enrollment period to begin the month your Medicare Part B begins without having to answer health questions

Original Medicare and your Medicare Supplement will work together with your clinical trial program to cover your medical needs.  Original Medicare covers the routine costs of qualifying clinical trials.  Your Medicare Supplement plans will pay the out of pocket that Original Medicare does not pay that meets Medicare qualifications.

When one chooses a Medicare Advantage plan with a clinical trial for a serious health issue, the Medicare Advantage plans is required to reimburse beneficiaries for the difference in out-of-pocket cost sharing between Fee for Service and their Medicare Advantage plan.

Original Medicare with a Medicare Supplement does not have a network and one’s medical provider must bill Medicare.   With a Medicare Advantage plan, one may have a network with referrals from an HMO or maximum out of pocket with a Medicare Advantage PPO.

Let’s discuss your $18,000 clinical trial prescriptions and if you will go in the “famous Donut Hole”.  Prescriptions are the most important option discussed when a Toni Says® Medicare consultation is performed.

Yes, Matt…you go in the “Donut Hole” the very second you order the prescription Sutent and for that reason, we search the Medicare site for which Medicare Part D plan best meets your Medicare and financial needs.  Always enroll in the Medicare Part D plan which covers all your prescriptions even though the most expensive prescription is covered by the clinical trial programs and costs you $0.  There may be a time when that expensive prescription is no longer covered by the clinical trial and you have the “Donut Hole” experience.

Your Medicare Part D prescription drug monthly costs for the $18K monthly cancer medication Sutent is $2471, 1^st month with you going in and out of the Donut Hole and into Catastrophic coverage with $938.57 monthly, the 2nd month to the end of the year.  If one is not enrolled in a Part D plan that covers the $18K monthly prescription, then you would pay 100% out of your pocket.

Medicare planning is vital especially when one has a serious health condition as you have Matt. Take your time and search what best option meets your needs.

I lost my job July 2017.  My wife and I have enrolled in Medicare Part B in January 2019 since COBRA’s almost over…Now I am finding out that there will be a penalty for us not enrolling when we should have. I have never received a Medicare & You handbook to know how or when to enroll in Medicare properly. I was unaware of an 8-month Medicare Part B enrollment rule. Thought I had to wait until our COBRA ended to enroll in Medicare Part B.

We are now 70 years old and Social Security said in a letter we received last week that the Part B penalty for us is each 50% because it is 5 years since we were 65. Please inform your readers how important it is to enroll at the correct time.

Rick from San Antonio, TX

Hello Rick:

You are right that people should not wait to enroll in Medicare Part B when no longer working full-time with true company benefits. Enrolling in COBRA does not keep one from the “famous” Medicare Part B penalty.  America needs to be aware that this penalty can be extremely costly and will last until you pass away or are no longer on Medicare.

The Medicare & You handbook explains that the 8-month Medicare enrollment rule after 65 begins the month after one is no longer working full-time or your employer group health benefits ends, whichever comes first.  The handbook also states that COBRA or retirement benefits are not considered coverage based on current employment.

During a Toni Says® Medicare consultation, we advise those leaving employer benefits after 65, not to wait and enroll in Medicare Part B as soon as possible.   Don’t wait!

Many enroll in their Part B with a BIG SURPRISE like you have Rick…. they find they are penalized because they could have had Part B but didn’t enroll. The penalty goes all the way back to the day he/she turned 65.

I have a client who is 79 years old and had always been on his wife’s company health plan.  He never enrolled in Medicare’s Part B because his wife was the “working spouse”, but she lost her job … She was 62 and because she had health issues and the cost of COBRA was less than an individual health plan, she enrolled herself and her 79-year-old husband in COBRA.

When COBRA ended 18months later, they went to Social Security to enroll him in Part B and were shocked!!!  His premium for Part B was not $135.50. It was $135.50 plus $189.70 penalty for late enrollment for a total of $325.20 per month. This was a 140% penalty (79-65) which is 14 years x 10% each month for the rest of his Medicare life.  He did not enroll in “Part B” at the right time or the correct way!

What happens when the Medicare Part B premium increases? Your penalty amount will increase. The penalty amount will not stay the same each year.

Toni Says®: Always have Medicare Part B in place when leaving your job or losing your company benefits and want to enroll in COBRA because the penalty goes back to the day you turn 65.  Chapter 1 of the new Medicare Survival Guide Advanced edition explains the rules of enrolling in Medicare the right way.

I am concerned about the difference in premiums between many of the Medicare Supplement plans and companies and it seems that plan F is considerably higher in monthly premium than Plan G.

My husband, Joe enrolled in Plan F a few years ago and I’m concerned that his Medicare Supplement Plan F premium is going to skyrocket and force him to leave. because Plan F is leaving in 2020.  Is there anything he can do to protect himself?  

I am turning 65 in May and am being bombarded with telemarketing calls about my Medicare and many of the callers are discussing Plan N which I’ve never heard about.

I need a little clarity on this change because we do not want to make a mistake.  I understand the Medicare Advantage plans and know that our doctor is not in anyone’s network.  I’ve seen a sign in his office.

Thanks,

Connie from Sugar Land

Connie:

During a Toni Says® Medicare consultation, those who are new to Medicare or wish to apply for a new Medicare supplement are made aware that Medicare Plans F and C are available until January 1, 2020 and may not be a good option because both plans will not be offered.

After January 1, 2020, no one will be able to enroll in either plans and those who are already enrolled in either Plan F or C can keep them which is what “grandfathered” is.

Connie, your husband Joe will be “grandfathered” for his current Medicare Supplement plan F and able to keep the plan, but no one knows what the yearly rate increases will be when Plan F and C become “grandfathered”.

A good option for Joe right now is to explore what new Medicare Supplement Plan G rates currently are and which Medicare Supplement Plan G that he could qualify for with medical underwriting. Medicare Supplement Plan N is also an option with a lower premium but more out of pocket than Plan G.

Since Joe has had Medicare Part B longer than 6 months and will have to meet underwriting qualifications.

Connie, you are turning 65 and will have Medicare Supplement Open Enrollment protection when your Medicare Part B becomes effective. A Medicare Supplement insurance plan cannot use underwriting to approve your policy and will automatically be issued when you apply.

Let’s discuss the differences in Plan G and Plan N:

• Plan G: offer lower rates and the same Medicare benefits as Plan F except the Medicare Part B deductible is not covered and will be paid for by the enrolled Medicare beneficiary. Part B deductible for 2019 is $185 which is Plan G’s out of pocket.
• Plan N: generally, has lower premiums than Plan G with generally more out of pocket. There is a $20 co pay for a doctor visit with $50 co pay for emergency room.  Part B deductible is not covered, and Part B excess charges are not paid for by the insurance company which Plan G includes.  Plan N can have more out of pocket cost than Plan G.

I believe I have received wrong information from my friends who suggested that I enroll in Medicare Part A which I did by going online and delaying my Medicare Part b for a later date.

Now I have a problem.  I own a small law firm with a small group plan of 2 employee, me and my assistant who is now covered under her husband’s group health plan and is no longer in the group plan.  Since there is only 1 person left on the group plan, it is being turned into an individual plan and I must now enroll in Medicare Part B. 

I turn 65 on March 6^th and because I’ve delayed my Medicare Part B, I have no idea of how to now let Medicare know that I need to enroll in Part B with a March 1^st effective date. 

What do I do?

John from Tucson, AZ

Hi John:

You are not alone because enrolling in Medicare confuses most Americans especially when friends and even Social Security or Medicare can give you inaccurate information.  This is how the Toni Says® Medicare consultation was born because someone received inaccurate Medicare enrollment advise from a Social Security agent from over the phone which cost him over $10,000.

Enrolling in Medicare Part A when someone is turning 65 and receiving their Social Security check at 65 is automatic because Social Security knows you have turned 65 and your Medicare Part B will be included when you receive your “Welcome to Medicare” kit.  This is not your situation John because you were not receiving your Social Security check, so Medicare did not know that you were turning 65.  You have now enrolled in Medicare Part A but delayed your Medicare Part B. You need to enroll in Medicare because you are no longer on an employer health plan. Now you are in an individual health plan.

Here is my advice to what you should do:

• Since you have delayed your Part B, you will need go online to www.ssa.gov and print a Medicare Special Enrollment form CMS L564 “Request for Employment Information”. Fill this out and have it signed by your HR or office manager and take the form to your local Social Security office in person.
• Explain in person to the Social Security agent, your story about enrolling in Medicare Part A and that you delayed your Medicare Part B but your Medicare Part B to begin March 1^st.
• Turn in your “Request for Employment” signed form and ask the Social Security agent to fill out CMS-40B “Application for enrollment in Medicare Part B” with a March 1^st effective date by February 28^th.

Let’s discuss the various scenarios of enrolling in Medicare Part A when turning 65:

• Turning 65 with employer health benefits: You now have a choice of enrolling or not enrolling in Medicare Parts A and/or Part B because you are covered under an employer health plan. Always discuss your Medicare decision with your company’s HR or email Toni at info@tonisays.com with your Medicare enrollment questions.
• Turning 65 with individual health insurance: It would be wise to enroll in both Medicare Parts A and B to avoid the “famous” Medicare Part B penalty.
• Turning 65 with an HSA if you enroll in Medicare Part A, then you can no longer fund your HSA.

I am turning 65 in March and called Social Security for help with enrolling in Medicare. I was surprised when Social Security told me to go online to sign up. They did not want me to go to the Social Security office to sign up and that I now need to start a “My Social Security Account” to begin the process.

I am concerned that if I go online, I will have to begin receiving my Social Security check. I retired in 2016 and want to not begin my Social Security check until I am 70.

Can you please explain in simple terms where to go online, so that I can enroll in Medicare the right way?

Thanks in advance,

Carla from Arizona

Carla:

With budget problems, Social Security discovered 2 years ago how much payroll or should I say “our” tax dollars could be saved by finally going online to have people file for their Medicare cards when they were turning 65 and not receiving their Social Security check.

You ask, what does a Social Security check have to do with me receiving my Medicare card? I have been filing taxes for years.

Remember, nothing is easy with a government system and enrolling in Medicare is no different. Unless you are receiving your Social Security check at least 90 days prior to turning 65, then Medicare has no idea that you are turning 65 and should be receiving your Medicare card with Parts A and/or B because Social Security doesn’t know that you are turning 65.  Social Security processes all Medicare applications for Medicare. Medicare does not enroll their own applications.

Carla, you mentioned that you are not receiving your Social Security check, not working full time with true company benefits and that Social Security advised you to enroll online. The best timeline is 90 days prior to turning 65 to the month prior to your 65^th birthday and you should visit www.ssa.gov/benefits/medicare to enroll for Medicare to begin the 1^st day of the month you turn 65.

When you begin the process of enrolling in Medicare, Social Security will ask if you have a have a “My Social Security account”.

If you do have a “My Social Security account”:

• please have your user name and password handy to begin your Medicare enrollment in Parts A and/or B application.

If you don’t have a “My Social Security Account”:

• Carla starting a “My Social Security Account” does not begin your Social Security check.
• Please register yourself and your spouse now for a “My Social Security Account” months before applying for Medicare to be prepared when you are ready to apply when turning 65 and need to apply for both Medicare Parts A and/or B with an account by visiting ssa.gov/myaccount.
• You should know your credit history because Social Security will pull credit information from your credit history to verify that this information is unique to only your and/or your spouse’s credit file. Don’t worry this confuses many.
• Can’t open a “My Social Security Account” then you may need to call Social Security at 1/800-772-1213 or visit your local Social Security office for help. This system stops those with the highest education. It is not easy!
• Call the Toni Says office at 832/519-8664 or email info@tonisays.com for assistance.
• Next week, the discussion is what information will be needed to enroll in Medicare online turning 65.

Last week, you wrote about how to apply for Medicare online by having to start a “My Social Security” account.  I had no problem opening the “My Social Security” account and answering the credit questions because I knew those answers. When it came to fill out the application for Medicare that was another story.

I had a problem with some of Medicare’s personal questions. I knew my name, address, Date of Birth, Social Security number, etc. When it came to answering what kind of citizen that was another issue because I am not a US born American, but a naturalized citizen. I was born in Greece and am very proud to say that I received my American citizenship about 15 years ago.  The application asked me what date and I could not answer that exact date and had to estimate.  Now I must take my original citizenship papers to the local Social Security office or send the original by mail. 

Toni, America needs to know that even though this is supposed to be an easier process that it does have a few kinks which can confuse those with more than a high school degree.  Please let your readers know not to give up when having a problem, had my wife and I not scheduled a Medicare consultation at the Toni Says® office I would have been totally lost applying online. 

Thanks,

Nick from Meyerland area

Nick:

What a great compliment!  I was very glad to find out that you found your original citizenship papers and could take them to your local Social Security office.  You had hidden them so well that it took you time to find them.

Let’s discuss how to apply online and a few of the problems we are discovering when helping others apply for Medicare online when turning 65 by going online to www.ssa.gov/benefits/medicare.

What if you cannot open a “My Social Security Account”, then what?  Click on the EXIT button and proceed you should proceed to the Medicare sign up page. This information about apply for Medicare cannot be found anywhere on any Social Security information on “How to Enroll in Medicare”. If you cannot proceed with applying for Medicare without opening a “My Social Security Account” than what?  Go directly to your local Social Security office and inform the Social Security agent that you are not able to open a Social Security account and are locked out and you need help.

Information to apply only for Medicare is below:

1. Begin with your information: Name, Social Security number, Gender and Date of Birth
2. Contact information with address, phone number, email address
3. Citizen information about you with what language your read and speak
4. Questions about your health benefits
5. Then submit your application online and view your receipt which explains what additional information may be needed such as marriage license when you are short of 40 quarters and applying under your spouse’s Medicare benefits or may be like Nick and must take your citizenship papers. Take this information to the local Social Security office to be verified.
6. Once your beneficiary verification letter that comes first and includes your Medicare number and Part A and/or B dates, or your new Medicare Card which comes next, then enroll in a Medicare Supplement or Medicare Advantage Plan and Medicare Prescription drug plan.

I am a weekly follower of your Toni Says® Medicare column and would like to let your readers in on a wonderful experience I had regarding saving serious dollars on an expensive generic prescription.

I recently received a generic prescription for my Parkinson’s disease.  When I went to my Plan D preferred Walgreens pharmacy and was informed that specific generic was not in my Part D plans formulary and would cost $460 per month.   I then went to Kroger and was told the retail price was $199 per month.  

When I discussed my experience to a friend, she told me about a web site “GoodRX.com”. What a blessing this was!  GoodRX.com gave me a printout of drug stores which sell the drug at a discounted price by entering my zip code with no strings attached I went to Wal-Mart with the GoodRX coupon in hand. Wal-Mart’s cost for one-month drug supply was only $43.00.

How can the price of a generic drug range in price from $43to $460?  Something is wrong with our American prescription drug system.

Tell your readers not to give up if they get an outrageous price for a drug.  There are several web sites like GoodRX which provide a similar service.  Just do your homework!

Julia from Arizona

Julia:

Guess What??  I tried GoodRX this week and want to tell the Toni Says® readers that GoodRX.com really does work!  I had a generic antibiotic and allergy medication prescribed last week and when I went to pick them up, they were over $120 for generics.  I was shocked and remembered Julia’s email about GoodRX.com.

I looked online at GoodRX to check the cost at HEB and the savings was over $68.  The antibiotic was $30 and allergy med was $28.  Had I gone to Wal-Mart instead of HEB the savings would have been $84, but my prescription had already been called to HEB.  It was too late to change.

Next time I get a prescription, I will go to the GoodRX.com site and do research on which pharmacy has the lowest price.

For a nice Christmas present, visit www.goodrx.com/medicare and search their Medicare section to help make the cost of expensive and common prescriptions affordable. This way one might avoid or delay the famous “Donut Hole”.

The GoodRX Medicare site will search Part D drug prices at pharmacies in your zip code that may be less than your Part D co-pay — especially if a drug isn’t covered by your Part D plan.

On the GoodRX website, it states, “that over 140,000 doctors nationwide recommend GoodRX to their patients and more than $1billion dollars has been saved nationwide on prescription drug costs.”

GoodRX is 100% free and no personal information is required.

2019 Medicare Part D costs are below:

• Initial Deductible: $415
• Initial Coverage Limit: $3,820 in 2019 where the 2019 “Donut Hole” begins.
• Out of Pocket Costs: You will spend 25% of the brand name drug, the Drug company will spend 70% and the chosen Part D plan will spend 5% until the total spend of your prescriptions is $5,100.
• Catastrophic Coverage: Once the $5,100 has been spent, you will enter Catastrophic Coverage phase where your “covered” generic prescription drugs co pays are $3.40 or 5% of the “covered” generic prescriptions above $68 cost or for “covered” brand name prescriptions the co pays are $8.50 or 5% of the “covered” brand name prescription drugs above $170 cost.

My 86-year-old mother with Alzheimer’s needs 24-hour care and lives in a local personal care home. She is enrolled in a Medicare Advantage HMO and taking her to the doctor is quite an ordeal.

Friends have suggested that I disenroll my mother from this HMO and return her to Medicare, then use a “House Call doctor”. Financially, it is costing over $4,000 per month for her personal care home and what happens if my mother does not qualify for a Medicare Supplement due to her Alzheimer’s and other health issues.

How do I find a doctor that makes house calls like Dr. Welby did in the “good old days”? Is this something that Medicare or Medicare Advantage plan will pay for it? 

Thanks,

Trish from Crowley, LA

Trish:

I have good news for you because the Dr. Welby days are back for those on “Original Medicare” and for Medicare Advantage plans. Doctors are now making “old fashion” house calls to keep the sick from having readmissions back to the hospital.

My advice to you, Trish and the Toni Says® readers is to ask your family member’s primary care doctor or specific healthcare provider about which “House Call” or “Visiting Physician” organization that their office is contracted with, whether your family member has “Original Medicare with or without a Medicare Supplement, a retiree group medical plan or a Medicare Advantage plan.

A house call visit can help keep those who are having a minor ailment turn into a major illness situation and helps Medicare or the Medicare Advantage plan from paying for an expensive hospital stay.

Doctor or medical provider visits at home or at a long-term care facility such as assisted living, personal care home or nursing home are being accepted and paid for by Original Medicare, Original Medicare with a Medicare supplement and Medicare Advantage plans (depending on your house call provider being in the Medicare Advantage plan’s network). 

House call doctors are generally board certified and the providers consist of doctors, physician assistants and nurse practitioners. The patient does not have to be home bound to qualify. The house call doctor can schedule regular appointments, especially if there is a chronic illness or you can schedule appointments as needed.

In 2018, who would believe that doctors making house calls would be making such a comeback?  You might not see a doctor show up in a horse and buggy or even carrying an old black medical bag…but today the new house call doctors are coming to your home with many of today’s modern marvels such as X-rays, ultra-sound machines, physical therapist and even a hypodermic needle to draw blood.

Not only are doctors making house calls, but dentists, eye doctors and even mobile x-ray/ultra-sound machines with technicians are visiting homes, assisted living facilities, nursing homes and personal care homes such as what your mother lives in.

Trish, you are wise to examine your mother’s options regarding disenrolling from her current Medicare Advantage plan with her serious health situations. One must qualify with medical underwriting for a Medicare Supplement which helps to pay Original Medicare Part A(Hospital) and Part B (Medical) out of pocket. If she does not qualify, then she will be responsible to pay the Medicare out of pocket costs herself.

Therefore, it is vitally important to look over all of one’s Medicare plan options because no one knows when their health will begin to deteriorate and then they cannot change Medicare plan options.

You have been referred to me as a resource that can answer some of the questions I have about Medicare.  I am turning 65 this December and have not received anything in the mail regarding what I need to do to begin Medicare?

Like many in the Houston area, I have recently lost my job and am confused as to whether start my social security check? Do I stay on COBRA or enroll in Medicare plans? What if I get another job?

I am sure there are others in Medicare land, which also needs answers to these worrisome, yet semi-simple Medicare questions.

Thanks,

Jill, Lubbock, TX

Jill:

Our motto at the Toni Says® office is that “your Medicare needs are not the same as your friends”, so discussing your Medicare wants and needs with those who do not know Medicare’s specific rules, can only confuse you.  Below are a few of the Medicare questions you asked about, which we discuss during a Medicare consultation.

1. Is the Medicare enrollment process automatic?

A: Medicare enrollment is automatic only when you are already claiming your Social Security benefits by the time you turn 65.  Jill, you must not be receiving your Social Security check and is why you have not received your Medicare card.

If you are not collecting your Social Security check, then Medicare requires you to sign up in a seven-month window which starts 3 months before turning 65, the month you are turning 65 and 3 months after your 65th birthday.  If you have employer coverage through your or your spouse’s employment, then you may want to delay your Medicare Part B.

Failing to sign up at the right time is costly.  The monthly Part B premium penalty is 10% for each full 12-month period that you should have been enrolled in Medicare Part B. Penalties also are applied for late enrollment in Part D (prescription drugs).

2. Should I enroll in Medicare even if I am offered COBRA health insurance when I leave my job?

A: Yes. You should enroll in Medicare Parts A and B when leaving company benefits and enrolling in your company’s COBRA.  Not enrolling in Medicare may keep your COBRA from paying claims because normally COBRA pays the 20% and wants Medicare to pay the 80%.  No Medicare, then who pays the 80%…You do.

In today’s health insurance world, many COBRA health plans will allow the COBRA retiree who has Medicare Parts A and B to opt out of the COBRA plan, while the family remains on COBRA. You can then apply for a Medicare supplement, which can assist in picking up your Medicare Parts A and B Medicare medical out of pocket.

3. What if I become unemployed or retire, enroll in Medicare and then go back into a full-time job?

A: If your new employer provides health insurance, you can disenroll from Medicare Part B and re-enroll in Part B when you finally retire without paying late enrollment penalties by filling the “Request for Employment” form.

Contact Social Security (1-800-772-1213) and request the form to delay your Medicare Part B because you now have true group health benefits provided by your current employer.

Medicare courses available at ABBS4U.com, can help you understand your Medicare options and educated the public on how to enroll in Medicare properly.

I have recently enrolled in Medicare and have received my first Medicare and You handbook for 2019.

Do you have any idea what the new Medicare costs will be? I didn’t see anything in the handbook. 

Thank You,

Sandy from Sun City, CA

Hello, Sandy:

Every year the Medicare and You handbook is mailed out before October 1^st and states that at the time of printing the 2019 Medicare and You Handbook, the premiums and deductible amounts for Part A and Part B were not available.

Medicare confusion is why Toni Says.com writes the Medicare column and designed the new Medicare Survival Guide® Advanced edition. On Friday, October 12^th, the new Medicare Parts A and B premiums and costs were released by the “Centers for Medicare and Medicaid” aka CMS (Medicare).

The new 2019 Medicare Parts A and B costs are below:

• Part A Costs (Inpatient Hospital): The new 2019 Medicare Part A inpatient hospital deductible will be an increase of $24 to $1,364. Remember, the Part A deductible starts over every 60 days. It is not a once a year deductible, but 6 times a year.  Skilled Nursing costs for 2019 will be days 1-20 $0 co pay per day and days 21- 100 will be $170.50 per day.
• Part B Costs (Medical): The new 2019 Medicare Part B medical/doctor deductible will increase by $2 to $185.00. Medicare pays 80% of the Medicare approved amount and you (Medicare beneficiary) pay the remaining 20% of the Medicare approved amount.
• Part B Premiums: Premium for 2019 will increase by $1.50 to $135.50. Not a big increase from the 2018 Part B premium of $134.
• Part D Costs (Prescription Drug Plan): The new 2019 Part D deductible is $415 once a year. You will pay your share for your prescription drugs until the combined amount reaches $3,820 and then you have reached the famous donut hole. At this time, you will pay 25% for your prescription drug plan’s cost for “covered” brand name drugs and the drug manufacturer will pay 70% with your prescription drug plan paying the remaining 5%.  For generic drugs, you will pay 37% for the plan’s cost for “covered” generic drugs and the drug plan pays 63%.  When a total of $5100.00 has been spent as out-of-pocket, then you will fall out of the “famous” donut hole for the year and into “Catastrophic” coverage. Once in “Catastrophic” coverage you will pay$3.40 or 5% of the “covered” generic prescriptions above $68 cost. For “covered” brand name prescriptions, the co pays are $8.50 or 5% of the “covered” brand name prescription drugs above $170 cost.

Toni Says® Tips: If your prescriptions are not in your Medicare Part D formulary, then YOU WILL pay 100% of the prescription drug cost.

• Be sure that all prescription drugs are covered on the new Part D prescription drugs MA standalone or MAPD plan which you choose and enroll by Dec. 7^th for a January 1^st effective date.

• Visit ABBS4U.com for Toni’s 2019 Prescription Drug Survival Guide or visit Course #3, 5 & 6 to learn what your Medicare Part A, Part B and Part D options can be.