Medicare Donut Hole Explained Simply

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[MedicareSchool]

We hope that this video of the Medicare Donut hole explained simply helped answer all of your questions! What did you learn about the donut hole?

[CT-mxtz]

Been watching your videos, recommended by friend. I would reach my donut hole in about 30 days. Your suggestions are fine for normal people. When you have serious illness it does not work. My meds out of pocket per year without insurance is $65, 000. I make 19, 000 in Disability/Social Security and no longer will qualify for extra help. FYI most doctors can do samples one month or two.
Short response is people like me don't get what we need and eventually die.

[coolone]

im in nursing school and have a community health exam tommorow and need to know this. this was so helpful thank you!

[jorgesoto]

Clear and concise explanation. Thanks!

[mhagram]

Thank you so much for explaining it easy way!!!

[jen]

I am not yet on Medicare but will be soon and all of this is scaring the daylights out of me. I have insurance through the Marketplace right now covering myself, husband and son that costs only $140 a month. I take 4 meds daily. On one of the pharmacy receipts it said “your insurance saved you $367.” That’s for a generic medicine! That donut hole is a nightmare to me.

[kirkhall]

What a scam insurance companies use retail values to bump up your costs when they dont pay retail. Typical insurance rip off.

[QueenofBlackRoses]

thankyou they were talking about this at work during training and it sounded like another language. You made it simple to understand wish you were my Medicare trainer lol.

[CarlosGarcia-lshn]

Sir, for someone like myself, who has apparently entered this donut hole, would the type of Medicare Advantage plan have any effect on it? Would this happen with any plan?

[brahmireddy]

Great tutorial! Could you please explain further on how to get out of the donut hole? Is there a $$ threshold to meet?

[michaelandrews]

Thank you so much for this explanation. I’m not sure if I understand correctly but having a plan with a deductible will End up being cheaper then say a plan that has $0 deductible?

[project-pely]

omg I get it now.. why do people make it more complicated than it is!?

[myriam]

As a French person this horrifies me but thanks for the clear explanation I needed it for my English test tomorrow 👍

[jorgesoto]

Clear explanation. I Will look if you have a video on HMO vs PPO plans.... Dental is also important to me... will look into that, maybe even call you. Thanks!

[kathey]

I tried using a coupon that I got from a doctor and it says if you are on Medicare or it actually said a government assistance which is Medicare then you cannot use a coupon. I talked to the pharmacist and they really try to work with us but they never mentioned trying to pay cash. Mom is on eliquis januvia and a heart medicine for AFib I can't remember the name of. All three of these put us out. Thank goodness our pharmacy lets us put things on a bill so we can pay them at a later time. I've had to get into some savings to pay for her meds at some point. We both live on her social security so it makes it really tight when this happens. So far the only samples I can get are eliquis.

[AeriaIPenguin]

If you switch plans does this reset the donut hole?

[CarlosGarcia-lshn]

Once a person enters the donut hole, is it too late to reverse that (get out) in the same year, by going to as many generic drugs as possible, or would any changes in the retail prices of the drugs only apply to the following year?

[lynnohrel]

I have only one prescription that costs only $10.00 if I paid for it out of my own pocket. Would I still have a high deductible??

[karenlukin]

You mentioned regarding donut hole that it is calculated on retail price. Isn’t Medicare’s portion per prescription a negotiated price, which would be less than what we would pay with cash and no coupon like GoodRX?
Because that would mean they’re counting dollars that they did not put towards the expense of our prescription, when they calculate our $4000+ figure.
So to estimate how soon I would go into the donut hole, would I look at last year’s pharmacy receipts from my Marketplace plan and see what the retail price is for my meds?

[kokosthoughts]

Is this info still correct in regards to retail threshold in stage 2?