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| From the Benefit Specialist |
| By Jackie Miller |
| Transportation |
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| The Commission operates a transportation program for persons 55 and older, as well as handicapped individuals throughout the County with three wheelchair lift equipped buses; three (3) eight passenger buses with additional space for one wheelchair.
On all routes, the destination of the vehicle for the noon meal is the Senior Dining Center. Although participants are urged to eat at the center, it is not mandatory. Usually, there is a trip planned to a local grocery store and possibly the pharmacy after the noon meal. Remember, your donation helps to keep these programs going. Monday: the bus runs through Suring/Spruce/Lena to bring passengers in to the Senior Dining Center in Oconto Falls. Before lunch they shop in Oconto Falls. Tuesday: the bus route is for Special Medical trips, Oconto Falls/Gillett to Shawano. Wednesday: service to the Crooked Lake/Mountain/Lakewood areas. Thursday: the bus travels to Sampson/Abrams/Little Suamico to bring people in to the Little Suamico Dining Center. This group shops in Oconto. Friday: the bus is in the Lena/Sampson/Abrams area bringing participants in to the Senior Dining Center in Oconto Falls, and shopping at the grocery store, etc. There also is service in the city of Oconto five days a week. Check at your local Dining Center for special trip information. |
| Medicare Part D and Your Explanation of Benefits |
| Medicare beneficiaries who have drug coverage through a Medicare Part D prescription drug plan may have received an Explanation of Benefits (EOB) from their drug plan. The EOB may look different depending on the plan that is sending it, but all of the EOBs should offer beneficiaries a look into how much they have spent on prescription drugs while enrolled in a Medicare Part D plan. The EOB should also show how much the plan has paid on behalf of the beneficiary. The EOB provides beneficiaries a way to track their spending, track the plan’s spending, to calculate when the beneficiary will enter into any coverage gaps, and when the beneficiary will reach the catastrophic coverage threshold.
The EOB will contain information about the kinds of prescriptions a beneficiary has, the co-pays or co-insurance amounts for those prescriptions, and how those figures are counted for purposes of determining initial coverage limits and the catastrophic coverage threshold. An initial coverage limit is an amount spent by the beneficiary and the plan on prescriptions. Beneficiaries who reach their initial coverage limits will experience a period without coverage or with limited coverage. Once in a coverage gap, a beneficiary will be responsible for all or nearly all of their drug costs. The EOB should show a beneficiary how close he or she is to reaching a coverage limit. This important information can help beneficiaries better prepare for gaps in coverage. Not all plans have coverage gaps. Beneficiaries who are not sure if they will be facing a coverage gap should consult their plan for more details about their coverage. The catastrophic coverage threshold is a point when a beneficiary has spent $3600 in out-of-pocket costs for prescription drugs. After the threshold is reached, catastrophic coverage begins. Beneficiaries who were in a coverage gap regain coverage. Beneficiaries who did not have a coverage gap but who have met the catastrophic coverage threshold will also have a change in their coverage. Once beneficiaries meet the threshold amount of $3600 in out-of-pocket costs, they will pay the greater of 5% co-insurance or $2 co-pays for generics and $5 co-pays for brand name prescriptions. Monthly premiums do not count towards out-of-pockets costs in calculating the catastrophic coverage threshold. Additionally, beneficiaries who have prescriptions not covered by their plans cannot include the cost of non-covered drugs in their out-of-pocked costs. Out-of-pockets costs are comprised of co-pays or co-insurance amounts, the initial deductible, and amounts spent by the beneficiary during a gap in coverage. Beneficiaries can track their costs with their EOB. The EOB will have a section reflecting the plans calculation of the beneficiaries’ costs that count towards the catastrophic coverage limit.Beneficiaries who are receiving help with their prescription drug costs through the low-income subsidy may find the EOBs they receive more challenging to understand. The subsidy program is often referred to as “extra help” with prescription drug costs. The EOBs track all beneficiaries spending and progress towards initial coverage limits and towards catastrophic coverage. From the plans perspective, the numbers are the same whether a beneficiary is receiving extra help or not. Beneficiaries who are receiving extra help may receive EOBs informing them of how close they are towards the initial coverage limit. Beneficiaries who do get extra help can reach the initial coverage limit and enter coverage gaps according to plans’ calculations. The important thing for those receiving extra help to remember is that they will not experience a gap in coverage. This is because when a beneficiary with extra help reaches a plan’s initial coverage limit, the extra help fills in the gaps so that the beneficiary does not experience a change or a disruption in coverage. Beneficiaries with the low-income subsidy, who reach their initial coverage limit, will still be responsible for their normal co-pays and co-insurance during the coverage gap. Beneficiaries should now receive an EOB for every month during which they use their Part D prescription drug coverage. EOBs should also include important information for beneficiaries about their appeal rights should the plan ever deny coverage. Beneficiaries who disagree with the calculations found in their EOB should consult their plans immediately for a more detailed explanation of the calculations. Remember, the limits and calculations of out-of-pocket costs begin anew each plan year and threshold amounts and limits may change annually. |
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