Thursday, May 6, 2010

2010 Medicare Prescription Drug (Part D) Rebate

Starting in 2010 Medicare Beneficiaries enrolled in a stand-alone Medicare Prescription drug plan (PDP) or Medicare Advantage Plan that includes prescription drug coverage (MAPD) who reach the prescription drug coverage gap (the "donut hole") may be eligible to receive a one-time $250 rebate from the U.S. Department of Health and Human Services (HHS).

Beginning on June 15th, beneficiaries who have reached the prescription drug coverage gap ("donut hole") will get a $250 rebate check. In 2010 the “donut hole” is attained at or above $2,830 in Covered Medicare Part D costs. (Exclusions do apply and are explained below).

Those who have reached this point prior to June 1st (and are eligible for the rebate) will receive their $250 rebate check later in June. Beneficiaries who enter the coverage gap after June will be issued the payment based on the quarter in which they hit the coverage gap. In the event that a beneficiary enters the Coverage Gap at the end of a quarter during 2010, the refund may be processed/mailed during the following quarter.

Beneficiaries should be aware that the rebate checks will be processed and issued by HHS, not by their insurance provider, and HHS will issue rebates based on a beneficiary's qualifications at the time that they reach the coverage gap.

Of course there are some who are not eligible and will be excluded from receiving the rebate. Specifically,

  1. Dual eligible beneficiaries who receive subsidies ("low income subsidy;" LIS) from both Medicare and Medicaid.
  2. Beneficiaries with annual income exceeding the Part B income thresholds. This means that they have annual adjusted individual income above $85,000 or annual adjusted joint income above $170,000.
  3. Beneficiaries receiving Retiree Drug Subsidy (RDS)
For more information about the $250 Part D 2010 rebate go to or phone Medicare directly at 1-800-Medicare (1-800-633-4227), 24 hours a day/7 days a week. TTY/TDD users should call 1-877-486-2048.

For those needing assistance selecting a Medicare Supplement Insurance, Medicare Advantage, and/or a Medicare Prescription Drug coverage is advised to contact the Senior Advisors Group at 610-399-8700 or follow any of the links in this article to their website.


Monday, March 15, 2010

Healthcare Reform Bill – The Un-heard Solution

Political rhetoric thrives as we get close to a vote on the colossal Healthcare reform bill. Republican, Democrats and Independents, all agree that something needs to be done. The debate is whether the proposed Healthcare bill actually solves any of the issues; and if so, at what cost in dollars, deficits, and personal sacrifice by the majority to satisfy a few uninsured Americans.

The broad issues - stabilize health care cost and make Health Insurance premiums more affordable. The dilemma - these are two separate issues; the current healthcare reform bill is so wrought with special interest favors that congress won’t even show Americans, and; the cost, and benefit is so obscure that it is easily distorted. This is a disgraceful, malicious process and we should be as concerned about government processes as we are Healthcare. But I digress. Sure, maybe a few million people will get a break at the expense of the remaining 90% of Americans and maybe the few deserve a break. Unfortunately, with 300+ million Americans, a solution for 5-10 million at a cost of 1 trillion is outrageous.

Fortunately there is a solution that benefits ALL Americans and addresses a large portion of the uninsured. With a few modification down the road we could create a Healthcare and Health Insurance formula for the world. Further, this solution solves both the health care cost issue as well as the health insurance cost issues defined by both parties. NAd provides economic stimulasd to the economy as a side effect.

It is so simple that it is no wonder that it could never have been devised by Congress. Ready? ...

All “Tax Filers” age 18-65 get a $1 for $1 tax credit – up to $2500 – for every dollar spent on health care and/or health insurance premiums. Another $500 credit for every dependent child under 18.

Total cost – $507 Billion (Before any economic benefit)


1)  At least 25 Million Americans get Healthcare and Health Insurance coverage with ZERO negative impact on premiums for everyone else.

2)  The 17 Million uninsured (include in 25m above) who make over $50K and choose not to buy insurance essentially can’t refuse. High Deductible plans cost less than $2500 in most cases they all become insured at no cost to them. And no burden to responsible Americans.

3)  Those w/o insurance can get coverage with the first $2500 essentially paid by government. ($6,000 for a family of 4).

4)  Those making more than Medicaid level but less than $50K get most if not all of premiums covered, for at least basic helth coverage. Premium will be less than $2500 for most; more for those who want cadilac plans, smoke or lead unhealthy lifestyles. All of which is their choice.

5)  Insurance companies get 25 million more customers helping insurance rates for everyone overall.

6)  U. S. Business “Stimulus” - Across the country business will be "stimulated" as they raise employee contributions to employer based healthcare premiums up to the $2500 level or even slightly higher having no impact on those who get coverage via employer plans, but does help their employer, providing further economic benefit to the country.

A few issues still remain which could be added as we dissect impact of Tax Credit. The largest with any real substantive moral value, is that of the uninsurable. A national high risk pool should be created with all insurers contributing proportionately based on some % of gross premiums collected.  Result – Fair distribution of risk; insurability for the uninsurable and premium savings of the same $2500 enjoyed by all Americans.

Layering in other ideas like buying/selling Health Insurance across state lines, and other reforms could be added in over time as these are complicated and involve state and federal insurance reforms.

Finally, any ACTUAL savings derived from fraud and abuse reduction (in Medicare) should be used to improve the Medicare program, not pay for something else. (It's uncertain how much if any savings will actually occur) And, every dollar in saving not actually realized adds $1 for $1 to the cost of the current proposed healthcare bill. Furthermore, Medicare will require additional funds later - either through higher payroll taxes or added deficit spending. This is probably the biggest smoke screen in this frudulent healthcare bill. That is, subsequent bills to support Medicare, fund the "Medicare Doctor Fix"  to make up for these reallocated, questionable savings are forthcoming.  All American support some healthcare reform but stand against the fraud perpetuated by this bill.