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Medicare options discussed at VFW

August 12, 2015
By ED FRANKS ( , Pine Island Eagle

Last Wednesday morning, about 15 people gathered at the Pine Island VFW to hear a presentation about Medicare, Medicare Supplements and Medicare Drug Plans from Insurance Options representative Todd VanOyen.

Asking for a show of hands of everyone on Medicare, everyone in the room raised their hand.

"Great, that's what we're here to talk about," VanOyen said. "This is just an informational meeting and I can't suggest products that are out there. I have been a resident of Matlacha for the last 20 years. Our offices are on Viscaya Parkway and we represent all of the major companies in the area."

Medicare Parts A & B are provided by the federal government and government subcontractors. Medicare pays fees for your healthcare directly to the doctors and hospitals you visit. Medicare Part "A" helps with hospital costs; Medicare Part "B" helps with doctor and outpatient care.

"Medicare Part A and B is an 80/20 situation," VanOyen said. "That 20 percent doesn't have a ceiling or cap and that means you have to find a way to pay the other 20 percent. That's where Medicare supplements come in. These plans will pay all or a portion of the 20 percent Medicare does not pay."

Medicare Plan "F" is the most comprehensive plan available. Plan "F" is also the most expensive costing about $180 a month but the beneficiary doesn't have any out-of-pocket expenses.

"Back in 1996, the government started the prescription drug plan that pays for prescriptions," VanOyen said. "If you decide not to join a Medicare Prescription Drug Plan (Part D) when you're first eligible, and you don't have other creditable prescription drug coverage, you'll likely pay a late enrollment penalty.

"Medicare Part D, the prescription plan, has what's called the coverage gap 'donut hole,'" VanOyen said. "This year the limit starts at $2,960 as to how much Part D will cover. In 2015, once you and your plan have spent $2,960 on covered drugs (the combined amount plus your deductible), you're in the coverage gap. In 2016, once you and your plan have spent $3,310 on covered drugs, you're in the coverage gap. This amount may change each year. Once you reach the coverage gap in 2015, you'll pay 45 percent of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug. If you meet certain income and resource limits, you may qualify for 'Extra Help' from Medicare to pay the costs of Medicare prescription drug coverage."

Medicare Advantage plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), where you have to stay in a network. With Preferred Provider Organizations (PPOs), you have access outside a network. If you're enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

"Open enrollment starts Oct. 15, and runs to Dec. 7," VanOyen said. "So now is the time to do your research and change plans to what you want. January 1 through Feb. 15 is a dis-enrollment period so if you have buyers remorse you can opt out."

VanOyen also fielded questions from the audience.

Question: "I have to buy medications for a dermatological condition that are costing me $400 a month. I've tried the generic brands but they just don't work. Is there any alternative for me?"

Answer: "I would suggest a Canadian drug store. You can often save money with them."

Question: "Do the Canadian drug stores and the drugs meet the same criteria that American drug stores meet?"

Answer: "I would do my own research on that. An awful lot of people are happy with the Canadian drugs especially when it comes to deciding on food or having the medications."

Question: "I've noticed that when one pharmaceutical company buys out another pharmaceutical company the cost of the drugs skyrocket."

Answer: "The pharmaceutical companies, once they lose their patent, the drug becomes generic. After a certain period of time they can change a molecule in the drug and get a new patent."

"My company, Insurance Options, offers all types of plans," VanOyen said. "If you have any questions please call my office. I hope this has been helpful and thank you for coming out today. We will be having meetings in the coming months."

Insurance Options is at 1401 Viscaya Parkway, Unit 2, Cape Coral, FL 33990. Call 239-896-3100.



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