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I got a call Thursday, December 5th, at 6:30 pm.  It was Warner, and he wanted to know about Prescription Drug Coverage for those on Medicare.  So, I explained to him the out-of-pocket costs, the donut hole, and how insurance companies “tier” their medications to save money.

I also explained that if he was interested in a Prescription Drug Plan I was offering, he had to make a decision soon.  You see, December 7th was fast approaching, and that was the end of the season for making changes to Medicare coverage.  What he said next I did NOT expect.

Warner was on 16 medications – which was not too far off the reservation for an 80 year old – and has never taken out a Prescription Drug Plan since he was eligible some 5 1/2 years ago.  It was at that point my jaw dropped and I believe I no longer had clean underwear.  You see, Warner was on a Prescription Assistance Plan, aka a PAP, and was only paying $500 per year for his medications.  The good news was that this had been in place for the past 15 years – Warner’s entire time on Medicare.

The bad news: Warner had never been told of the Late Penalty for not selecting a Prescription Drug Plan once he was eligible.

I then had to break it to Warner that the drug plan we had been discussing, which covered ALL of his medication, would have an additional $34.25 added to it, just because he never had a drug plan before.  That meant that every month he would pay, in premiums alone $135.75 just to have drug coverage.  This did not include his deductible, cost-sharing, donut hole amounts, etc.

To make matters worse, time to enroll, if that is what he wanted to do, was running out.  Oh, and the Pharmacy Assistance Plan notified him that, if he did get a Prescription Drug Plan, he would be kicked off the assistance.  They would be making their decision whether to keep him on the assistance or not January 1.

This put Warner between a rock and a hard place: 1. if he took the Prescription Drug Plan, and was still eligible for the assistance, he would incur all those additional costs, and not be eligible for the assistance again 2. if he doesn’t take the drug plan, and then loses the assistance January 1, he has NO coverage, and can not get the drug plan until next year.

How do you think the story ends?

I am an Independent Insurance Agent, licensed in the state of Georgia.  If you need guidance for Life Insurance, Medicare, or Long Term Care needs, please contact me at 404-551-5339 or email me at bob@legacyfinancialpartner.com

Bob Levine
Legacy Financial Partners, LLC
404-551-5339
bob@legacyfinancialpartner.com
http://www.equilife.com/boblevine
@TheBobLevine