Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 From my understanding he now has to pay 100% of all medications up to $4450 out of his pocket Then insurance will pay 95% and he pays 5%. Since the plans start over Jan 1 then from my understanding he would be out of the donut hole 01/01/11 Lori Davies - Financial Coordinator Porter Adventist Hospital Transplant Services Denver, Colorado Work Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sara Sent: Monday, November 22, 2010 1:13 PM To: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works. For the remainder of 2010, I have a patient who just hit it. How much does he have to pay out of pocket before considered catastrophic? Then, if he meets that out of pocket amount, what % is he responsible for? Next question: Does everything start all over again in January (so he's out of the donut hole)? ***************************************************************************** This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it. ***************************************************************************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 Very helpful Lori! Thanks! Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, IL Phone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Davies, Lori Sent: Monday, November 22, 2010 2:15 PM To: TxFinancialCoordinators Subject: RE: Donut Hole From my understanding he now has to pay 100% of all medications up to $4450 out of his pocket Then insurance will pay 95% and he pays 5%. Since the plans start over Jan 1 then from my understanding he would be out of the donut hole 01/01/11 Lori Davies - Financial Coordinator Porter Adventist Hospital Transplant Services Denver, Colorado Work Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sara Sent: Monday, November 22, 2010 1:13 PM To: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works. For the remainder of 2010, I have a patient who just hit it. How much does he have to pay out of pocket before considered catastrophic? Then, if he meets that out of pocket amount, what % is he responsible for? Next question: Does everything start all over again in January (so he's out of the donut hole)? ***************************************************************************** This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it. ***************************************************************************** This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 Is there a set amount a patient has to meet before entering the donut hole? Or does it vary by plan? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, IL Phone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Davies, Lori Sent: Monday, November 22, 2010 2:15 PM To: TxFinancialCoordinators Subject: RE: Donut Hole From my understanding he now has to pay 100% of all medications up to $4450 out of his pocket Then insurance will pay 95% and he pays 5%. Since the plans start over Jan 1 then from my understanding he would be out of the donut hole 01/01/11 Lori Davies - Financial Coordinator Porter Adventist Hospital Transplant Services Denver, Colorado Work Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sara Sent: Monday, November 22, 2010 1:13 PM To: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works. For the remainder of 2010, I have a patient who just hit it. How much does he have to pay out of pocket before considered catastrophic? Then, if he meets that out of pocket amount, what % is he responsible for? Next question: Does everything start all over again in January (so he's out of the donut hole)? ***************************************************************************** This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it. ***************************************************************************** This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 Between the patient and the insurance company, $2800 (for 2010) beginning January 1st. Once this amount is met, the patient will be in the coverage gap until they pay $4450 in medication costs. After that amount is met, the plan should pay 95% of med cost. However, plans vary. Subject: RE: Donut HoleTo: "'TxFinancialCoordinators '" <TxFinancialCoordinators >Date: Monday, November 22, 2010, 3:25 PM Is there a set amount a patient has to meet before entering the donut hole? Or does it vary by plan? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, IL Phone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Davies, LoriSent: Monday, November 22, 2010 2:15 PMTo: TxFinancialCoordinators Subject: RE: Donut Hole From my understanding he now has to pay 100% of all medications up to $4450 out of his pocket Then insurance will pay 95% and he pays 5%. Since the plans start over Jan 1 then from my understanding he would be out of the donut hole 01/01/11 Lori Davies - Financial CoordinatorPorter Adventist HospitalTransplant ServicesDenver, ColoradoWork Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of SaraSent: Monday, November 22, 2010 1:13 PMTo: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works. For the remainder of 2010, I have a patient who just hit it. How much does he have to pay out of pocket before considered catastrophic? Then, if he meets that out of pocket amount, what % is he responsible for?Next question: Does everything start all over again in January (so he's out of the donut hole)? *****************************************************************************This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it.***************************************************************************** This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 If you look at the resource guide, it is outlined nicely. Itshould give you a clearer picture. Also, with the healthcare reform, next yearwill also have a 50% discount on brans meds during the coverage gap. So, thisshould help patients a little bit as well. At least spreading things around alittle bit... By 2020, the coverage gap should be gone. From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lmk_276@...Sent: Monday, November 22, 2010 12:30 PMTo: TxFinancialCoordinators Subject: RE: Donut Hole Between the patient and the insurance company, $2800 (for2010) beginning January 1st. Once this amount is met, the patient will be inthe coverage gap until they pay $4450 in medication costs. After that amountis met, the plan should pay 95% of med cost. However, plans vary.Subject: RE: Donut HoleTo: " 'TxFinancialCoordinators ' " <TxFinancialCoordinators >Date: Monday, November 22, 2010, 3:25 PM Isthere a set amount a patient has to meet before entering the donuthole? Or does it vary by plan? SaraDanner | Transplant Financial Coordinator |Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSEGREAT. CHOOSE MEMORIAL. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Davies, LoriSent: Monday, November 22, 2010 2:15 PMTo: TxFinancialCoordinators Subject: RE: Donut Hole Frommy understanding he now has to pay 100% of all medications up to $4450 out ofhis pocket Then insurance will pay 95% and he pays 5%. Sincethe plans start over Jan 1 then from my understanding he would be out of thedonut hole 01/01/11 Lori Davies -Financial CoordinatorPorter Adventist HospitalTransplant ServicesDenver, ColoradoWork Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of SaraSent: Monday, November 22, 2010 1:13 PMTo: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works.For the remainder of 2010, I have a patient who just hit it. How much does hehave to pay out of pocket before considered catastrophic? Then, if he meetsthat out of pocket amount, what % is he responsible for?Next question: Does everything start all over again in January (so he's outof the donut hole)?*****************************************************************************This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it.***************************************************************************** This message (including any attachments) contains confidentialinformation intended for a specific individual and purpose, and is protectedby law. If you are not the intended recipient, you should delete thismessage. Any disclosure, copying, or distribution of this message, or thetaking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2010 Report Share Posted November 22, 2010 TrOOP – True Out-of-Pocket Costs Medicare D ______________________________ § TrOOP is the amount a member must spend on Part D covered drugs to reach catastrophic coverage. § Payments counts at TrOOP if paid by: · Beneficiary · Another individual (family member or friend) · State Pharmacy Assistance Program (SPAP) Note: Most third party assistance does not count towards TrOOP (i.e. insurance from former employer/union). Medications obtained through the special generic programs at such as Wal-Mart, Target, or Walgreens do not count toward the TrOOP. TrOOP – Part D Covered Drugs ________________________________ (Annual percentage increase for 2010 is 4.66%) Member Pays D Plan Pays Totals Deductible (with most plans) $310 (when applicable) $0 $310 Medications $630 (25%) $1890 (75%) $2520 Coverage Gap $3610 $0 $3610 Sub-total $4550 $1890 $6440 Catastrophic* Member pays: · Monthly D plan premium · Minimum of $2.50 copay for generic medications · Minimum of $6.30 copay for all other medications * “Catastrophic” applies after member costs of $4550 for the year (for premiums, deductible, & medications). **Applicable if deductible is part of the Medicare D plan you choose; some Medicare D plans do not have a deductible. If your plan does not have a deductible, you would pay $940 of drug costs before reaching the “coverage gap.” Costs to member prior to reaching catastrophic coverage have increased since 2006 (start date for Medicare D) by$250 in 2007, $269 in 2008, $500 in 2009, $130 in 2010 for a total increase of $1,149 since 2006 to members. Ms. Daryl Battin, MSW/LICSW Financial Coordinator/Social Worker Department of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805 Ph: Page: FAX: Q Please consider the environment before printing this email From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lmk_276@... Sent: Monday, November 22, 2010 3:30 PM To: TxFinancialCoordinators Subject: RE: Donut Hole Between the patient and the insurance company, $2800 (for 2010) beginning January 1st. Once this amount is met, the patient will be in the coverage gap until they pay $4450 in medication costs. After that amount is met, the plan should pay 95% of med cost. However, plans vary. Subject: RE: Donut Hole To: " 'TxFinancialCoordinators ' " <TxFinancialCoordinators > Date: Monday, November 22, 2010, 3:25 PM Is there a set amount a patient has to meet before entering the donut hole? Or does it vary by plan? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, IL Phone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Davies, Lori Sent: Monday, November 22, 2010 2:15 PM To: TxFinancialCoordinators Subject: RE: Donut Hole From my understanding he now has to pay 100% of all medications up to $4450 out of his pocket Then insurance will pay 95% and he pays 5%. Since the plans start over Jan 1 then from my understanding he would be out of the donut hole 01/01/11 Lori Davies - Financial Coordinator Porter Adventist Hospital Transplant Services Denver, Colorado Work Fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sara Sent: Monday, November 22, 2010 1:13 PM To: TxFinancialCoordinators Subject: Donut Hole I'm still not 100% clear on the way the donut hole works. For the remainder of 2010, I have a patient who just hit it. How much does he have to pay out of pocket before considered catastrophic? Then, if he meets that out of pocket amount, what % is he responsible for? Next question: Does everything start all over again in January (so he's out of the donut hole)? *****************************************************************************This communication is for the use of the intended recipient only. It may contain information that is privileged and confidential. If you are not the intended recipient of this communication, any disclosure, copying, further distribution or use thereof is prohibited. If you have received this communication in error, please advise me by return e-mail or by telephone and delete/destroy it.***************************************************************************** This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.