Medicare Part D Explained (Part 2 - Avoid the donut hole)

Welcome to Part two of Medicare Part D Explained. This is a continuation of the Medicare Part D Explained first video. While the first video included information about Part D for everyone researching their Medicare options, this video includes more advanced concepts that are important to those who are paying hundreds of dollars a month for their prescriptions. I will assume in this video that you have already seen Part 1 of Medicare Part D Explained.

In this video we are going to talk about the four stages of the Medicare Part D prescription drug coverage. This includes the deductible, your initial coverage, the coverage gap (formerly referred to as the donut hole) and catastrophic coverage. We will discuss these stages are impact by your TROOP (True Out-Of-Pocket Expense). Then last, but not least I will touch on Low Income Subsidy options that can be used to help relieve the financial burden of prescription drugs and Part D premiums for those who qualify. If you are having difficulty paying for your prescriptions, this will be very important for you.
If you are spending a lot of money on prescriptions it is important to understand each of these four stages and how the right Part D plan can help you manage your out-of-pocket costs. My objective is to help you understand what you need to know about Medicare Part D plans so that you do not spend more than you have to for your prescriptions.

Four stages…
The first stage is the deductible. A deductible is the amount of money you pay before your insurance will pay any benefit. Each year Medicare sets a maximum deductible that a Medicare Part D plan can charge. They can charge the maximum. They can charge less than the maximum or have no deductible at all. For 2021 the maximum Medicare Part D deductible is $445. I would suspect the amount of the deductible will continue to increase a little each year.
The second stage of your Part D coverage is your Initial Coverage.
After you meet your deductible, for those prescriptions that are not exempt, your Medicare part D Plan will help pay your prescription costs. The Initial Coverage is where you would pay a copay or coinsurance for part of the prescription costs, and the insurance company will pay the rest.

For Stage Three, I need you to understand a new term. You may want to write this down. The term I need you to understand is your True Out-of-Pocket cost, often abbreviated as your TROOP.
TROOP is your total out-of-pocket costs on the prescriptions in your Medicare Part D plan formulary.
Your TROOP includes the money you spend on Part D prescriptions. It also includes money spent on your prescriptions on your behalf. For example, the pharmaceutical manufacturer contribution or discount, or an HSA plan or Medicare Saving Account (MSA) or Flexible Spending Account (FSA). It can also include the Extra Help from a Low-Income Subsidy.
Your TROOP does not include your Part D monthly premium. It does not include drug you pick up over the counter or by using Good Rx.

During Stage Three, or the Coverage Gap, you pay 25% of your dug costs. Your costs go up during this stage. The Part D Plan
You pay 25% of the cost of the prescription. The Pharmaceutical Industry will pay 70% of the prescription and Medicare will pay the remaining 5%.
Catastrophic Coverage is Medicare is simple.
In this stage Medicare will typically pay the greater of 95% of your prescription drug costs or $3.70 for a generic prescription or $9.20 for a brand name prescription.

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[artsisland]

Do not sell yourself short, you are the best personality for what you do. You explain everything very well, the customer does not feel any high pressure, you are thorough and have such a calm demeanor. Thank you!

[alicemuratore]

Matthew is great. Husband started looking for help to figure out the Medicare enrollment situation. He called the toll free number and was astonished to discover that Matthew's office is, literally, three miles from our home. We went and visited with him and got husbands coverage all set up. He is a great asset to anyone trying to figure out this enrollment. I, too, now am watching these videos as I need to sign up for part D now. Thank you, Matthew, for your help.

[petersola]

Thank you for explaining Medicare Plan D. Why would the government make things so complex. You make it easier to understand.

[padellina]

This whole series has the best information, and it’s presented in the clearest way anywhere on YouTube. I trust this guy.

[ferozalimomin]

I am an agent myself, and learn a lot from your videos.
Thanks for doing this. You are the greatest.

[jeanettesugay]

Matt, you are the most honest person I’ve ever known. As I always said, your videos are very invaluable, straightforward and very caring💞 keep up your good work! You are awesome!

[wvldent]

Wonderful way to stay current with Medicare part D Thank you!

[johnlutz]

Your the best our stage 3 is Killin me and my wife. That dought hole can't keep taking everything so yes I will be calling asap. God bless. John

[teresaelaine]

Thank you, Matthew. I have been trying to gather information about Medicare for over a year now, and just 3 months ago, I happened upon your Medigap Seminars. I am so impressed on how you present the material, but more telling is the genuine care and concern you express while doing it. I hope you keep doing this for people who come after me looking for logical, concise, and clear explanations on all of the Medicare information you present.

[dianenoyes]

I never really knew how my Part D plan worked. I'm sure going to change this year. Thank you Matthew so much for these videos.

[gsb]

The best videos on Medicare I have seen. Clear, detailed, and extremely helpful in making the right decisions. Bless you, Matt.

[maureenmckenzielueder]

Your videos are so robust and comprehensive. Thank you so much for all the information.

[Coyotedown]

I’ve had Medicare for 10 years and never knew some of this info. Thank you so much!

[michaelhooker]

These videos are invaluable. I wish they were available when I first started researching Medicare five years ago. Matthew presents the information in a succinct and understandable format.

[avideshmukh]

Great video and in depth info.
Avi Deshmukh, MD, FACS, MBA, MS

[patrickcurtis]

Thanks for the detailed update. It really clears up a lot of the fog of medicare.

[michaelcostantino]

Very well done as per the other 10 or so videos I have watched. Your "4 Stages of Part D" handout (see above link) which you explained in the video (6:50 - 15:50) was very helpful. I also think your written summaries under the "Show More" link are very helpful. I print them off and read through them to review and reinforce your video presentation. Finally, your story at the 2:20 mark as to why you make these videos was very touching. For me, they were a confirmation of the type of person you genuinely are and that you truly have the best interests of your clients at heart. Thank you again and God Bless.

[playandlearnwithjc]

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You are amazing Matthew! More power to you!

[rosenealon]

Your honest and knowledgeable presentations are better than a professional polished actor.

[SinanDM]

Great information. I've been binge watching catching up on all your Medicare videos. This helps us tremendously in navigating through the maze of medicare. Thank you so much.