Medicare Part D Exclusive Interview

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Exclusive Interview With Top Medicare Part D Experts

Our Exclusive Interview Question 1: Who does medicare part d benefit the most?

Alex Moschella, Esq, Moschella & Winston in Somerville, MA It helps those with multi drug use the most if their medications are on the approved list of coverage on the plan they accept and keeps them out of the “donut hole,” of the dollar limits of the both the plan coverage and Part D ceilings.

Jacob Milbradt, PharmD, founder and president of MrMedSaver.com The people who are helped the most by Medicare Part D are those with extremely high drug costs. These people don’t just enter the Doughnut Hole . . . they come out on the other side into Catastrophic Coverage. Before Medicare Part D, many of these people wouldn’t have been able to afford their medications. On the other hand, people with low drug costs aren’t necessarily helped that much by Medicare Part D. I wouldn’t say these people are “hurt” by Medicare Part D, though. For example, even though you pay for car insurance each month, it’s not considered a bad thing if you don’t wreck your vehicle.

Katalin Goencz, founder of O&K Consulting, MedBillsAssist.com I haven't notice any differences per conditions; only limitations of how many drugs are covered within the same treatment management. However, it is penalizing people who takes brand name drugs, both by higher co-pays and by not having coverage in a "doughnut hole" or what Medicare prefers to call "the gap".

Our Exclusive Interview Question 2: What happens if you enroll in a program one year and find its the wrong program.

Alex Moschella You can disenroll at set time periods and the local SHINE programs that operate as part of all city and town Council’s On Aging - very important resource.

Jacob Milbradt After you enroll in a Medicare Part D plan, you’re stuck with it for the duration of the year. This is why it’s so important to make sure you select the best plan for your needs during the enrollment period. If you’re really unhappy with your current plan, you can always cancel your coverage at any time. However, you can’t enroll in a new plan until the following year.

Katalin Goencz Open enrollment close at the end of each year; if a "wrong" policy chosen the person will have to wait a year for the next open enrollment period. With that said, there are exceptions, such as most things in Medicare. A dual eligible person (those whom are covered by both Medicare and Medicaid) can change their policy any time of the year.

Our Exclusive Interview Question 3: Are there common things that certain policies or companies are known for?

Alex Moschella Yes ­ certain medications, anti-depressants and antipsychotics. But you must do a comparative review based on the medications you are taking and check the Medicare web site.

Jacob Milbradt While every plan is different for each unique patient, there are a few trends. For example, in 2006, Humana’s basic plan had some of the lowest premiums available, at less than $10.00 per month. This year, the premiums for this same plan are more than $40.00 per month.

Katalin Goencz It is all in the Formulary (a list of covered drugs and all the additional policies/restrictions that comes along with that). There is a lot of repetition on restrictions by insurance companies, but some covers a wider range of drugs, while others limit treatment option to one or two. Each plan has to have drugs for all Medicare defined category. There isn't an actual list of what drugs mandated for coverage. The real common thing is the rising cost and reduction of benefits every renewal year. Every state has between 40-50 policies to chose from. Medicare recipients had difficulty to pick the first plan and they are mostly stay with that year after year. This is a problem, or in some cases a waste, as policies change every year.

Our Exclusive Interview Question 4: Are people and the health care industry satisfied with the program?

Alex Moschella No. The President is proposing that drug companies pick up the donut hole costs and the program is under review as part of the national health care debate. The donut hole is a controversial issue and expense for elders to bear.

Jacob Milbradt While Medicare Part D is obviously better than not prescription coverage at all, the plan still has its flaws. Most enrollees would probably point to the Doughnut Hole as the worst feature of these plans. However, selecting an appropriate plan can be so complicated and confusing that this is also a major area of frustration as well. Even though Medicare Part D has increased pharmacy prescription volumes, it’s also cut reimbursement and led to cash flow problems that have resulted in many pharmacies actually closing their doors. In addition, this plan has increased the amount of paperwork and hassles that both pharmacists and physicians have to endure.

Katalin Goencz It helps in cost sharing for seniors and brought more paperwork for physicians.

Our Exclusive Interview Question 5: Look through your crystal ball and let us know if you see things that are already changing or need to change in Medicare Part D.

Alex Moschella As stated, the donut hole and expansion of coverage and affordable premiums.

Jacob Milbradt Pharmaceutical companies have recently offered to cover half the cost of brand-name drugs while patients are in the Doughnut Hole. Of course, patients still want the Doughnut Hole completely eliminated, but this would be far too expensive for the federal government to fund. One possible way to eliminate the Doughnut Hole would be to increase patients’ copays. This would also lead to a lower utilization of prescription drugs and lower costs. Of course, no one wants higher copays, and I don’t think this will happen.

Katalin Goencz Changes takes place every year and not for the better. The cost for each policy is rising, while coverage decreasing. The simple fact still remains that most retirement benefit prescription coverage is superior to this one. Furthermore the VA offering prescriptions at $4 per drug per month.

Medicare Part D Expert Bio's

For more than 25 years, Alex Moschella has dedicated his legal career to helping elders and their families navigate the issues surrounding estate and tax planning, Medicaid, long term care and probate. He has been certified as an Elder Law Attorney by the National Elder Law Foundation. Alex is past President of the Massachusetts Chapter of the National Academy of Elder Law Attorneys, and serves on the Board of Directors of the Massachusetts Alzheimer’s Association. He teaches elder law at Suffolk University Law School. A graduate of Villanova University and Suffolk University Law School, Alex earned the prestigious Charles P. Kindregan, Jr. Award for Extraordinary Contributions to the Center for Advanced Legal Studies.

Jacob Milbradt, PharmD, is the founder and president of MrMedSaver.com, a revolutionary prescription drug cost-management service that empowers consumers with tools to drastically cut their healthcare costs. Dr. Milbradt also currently practices as a pharmacist in an independently-owned pharmacy and is an Adjunct Assistant Clinical Professor for the University of Kansas. http://www.MrMedSaver.com is a different type of prescription assistance website. This revolutionary service specializes in empowering clients with the information required to save huge amounts of money on their medications. After entering the required prescription information, MrMedSaver.com clients receive a customized Rx Savings Report that demonstrates numerous methods that can be used to save money on prescription drugs.

Katalin Goencz, founder of O & K Consulting is a certified insurance consultant licensed by the State of Connecticut, New York, and Virginia. She has been working in the healthcare industry all her life. Katalin started her career as a trauma nurse in Hungary. In the US she provided direct patient care in nursing home settings as well as in private nursing. In the late 1990, she has focused her career on the financial aspect of medical care. She has acquired extensive knowledge of commercial and Medicare insurance procedures, rules, and regulations. Presently runs her own company, MedBillsAssist, helping individuals and families whom are struggling with medical bills. She also helps people better understand and chose their insurance policies and Medicare. You can learn more at http://medbillsassist.com

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