Bucky Broadrick, licensed pharmacist and associate counselor for The Rapha House, presented this information recently on Medicare Part D and the Affordable Care Act. Feel free to contact The Rapha House with your questions. To contact us call 706-264-1920 or visit www.theraphahouse.org

1. Medicare D and the Affordable
Care Act
BUCKY BROADRICK
PHARMD, MA, LAPC

2. Why am I here?
 Born in Dalton
 Graduated from UGA College of
Pharmacy 2005
 Several Years as pharmacist
 2008-2013 Masters of Arts in
Professional Counseling- Richmont
Graduate School Chattanooga
 Part time at The Rapha House

3. What is Part D?
 Part A, hospital services, is free if either you
or your spouse paid Medicare payroll taxes
for at least ten years
 Part B covers doctor visits and outpatient
services-- for most people in 2013 is
$104.90/month
 Part D, which covers prescription drug
costs, the average Part D premium is $30+/
month.
 subject to co-payments, deductibles and
other out-of-pocket costs.

4. When am I eligible?
 You are eligible for Medicare when you turn 65.
 If you are already taking Social Security
benefits, you will be automatically enrolled in Parts
A and B.
 For those who have not started Social
Security, sign yourself up for Parts A and B, or
Medicare Advantage.

seven-month initial enrollment period – 3 and 3
 People still working may want to delay signing up
for Medicare, but they will need to follow the rules
carefully to avoid significant penalties when they do
eventually enroll.

5. Enrollment Periods
 General Enrollment for Part B
 Jan 1- March 31- 10% penalty for life for ea 12-month
period delay
 Still Working- Special Enrollment
 8 months after you stop working
 Open Enrollment
 Every Year October 15- December 7th
 Change Part D plan or Medicare Advantage Plan
 NOTE: PDP = Prescription Drug Plan
 MA-PD- Medicare Advantage Plan w/ Drug

6. Part C????
 Medicare Advantage Plans
 Monthly Cost in Addition to Part B
Premium
 No need for Part D or MEDIGAP
 Subject to Co-Payments, Deductibles,
and Out-of- Pocket
 May LIMIT Providers
 Lower Premiums, Higher Cost
Sharing

7. Medigap
 For traditional Medicare can sign up for a





Medigap supplemental to help cover
deductibles, co-payments and other gaps.
You can switch at at anytime
Charged or denied if you choose or change >6
months after signing up for part B
Identified by letters A through F
Plan F most popular, most comprehensive
http://www.medicare.gov/find-aplan/questions/medigap-home.aspx

8. BASIC PART D-ESIGN
Coverage Phase
Part D Plan Pays
You Pay
Annual Ded ($310)
$0
100% ($310)
Coverage Period
75% of 2,450 ($1905)
25% of 2,450
($635)
Coverage GAP
(DONUT HOLE)
$0 (discount on brands
50%, 28% on generics)
47.50% of Brand Drugs +
dispensing fee
72% of covered generics
95% of drug cost - copay
Greater of 5% of drug cost
or $2.55 generic or $6.35
for brand
Drug Plan + COSTS >
$2850
Catastrophic
Coverage
(total annual drug cost

9. Phase 1 Deductible….Phase 2 Initial Coverage
 100% of Drug Cost…..$310 in 2014
 Phase 2- 25% of total drug Costs…drug
plan pays 75% of Drug Costs

10. Phase 3-Coverage GAP AKA Donut Hole
 Total Drug cost exceeds $2850
 Cost sharing
 47.5% of covered brands
 72% of covered generics
 Discount and Subsidy will increase
until 2020 til you only pay 25% of drug
costs in Donut Hole

11. Phase 4- Catastrophic Coverage
 5% of covered drug cost
 Begins when you reach out-of-pocket
threshold ( 4,550 in 2014)
 Sum of deductible, 25% of
coinsurance, and drug costs plus
manufacture’s discounts in Donut
Hole

12. medicare.gov plan finder
 www.medicare.gov
 It’s easy!

13. Affordable Care Act for Seniors
 First Year- Received a one-time, tax-
free $250 rebate help pay for
prescriptions
 The reduction in donut hole cost
sharing
 Preventive Services
 Yearly Wellness Exam
 Every Five years- Free Cardio Exam,
 Every Year-Mammogram, Colorectal,
Cervical, Prostate Screen, Flu Shot

14. ACA for Families
 Teens /Young Adults….under the age of 26
 Children Pre-existing Conditions
 Under
age 19 for new individual and jobbased plans
 No Lifetime Limits
 Preventive Care- Vaccines for kids, well
visits, etc
 Accountability to Insurers – premiums on
healthcare vs. bonuses,advertising….justify
rate hikes

15. ACA for Women and Pregnancy
 No longer can deny or exclude coverage to




baby for job-based and individual plans
Starting 2014, pregnancy and newborn care
will be covered in all individual, smallbusiness, and Exchange Plans
Job-based can’t exclude or deny for
pregnancy
No-out-of pocket for mammogram and birth
control
In 2014, can’t charge women more for
insurance premiums

16. Resources
 www.medicare.gov
 www.healthcare.gov - market place
 www.pcip.gov - pre-existing condition
insurance