The Doughnut Hole

[arnguy]

If she met her doughnut hole in the 7th month of coverage, you know that her meds are expensive. Most of them are brand name with no generic available. I already advised her about the $4.00 generics from WalMart and Target. Thanks again for the input.

 

[senior-advisor-indiana]

I have seen people hit the doughnut hole in the 4th month. If she didn't hit the hole till the 7th month she probably isn't gonna make it out of the hole. Right?

 

[arnguy]

Medicare Advantage plan

• Look at the notice from your plan to find out about Medicare prescription drug coverage availability. During certain times of the year you can change plans if the coverage does not meet your needs. Note: If your Medicare Advantage plan does not have drug coverage, you will not be able to enroll in a Medicare prescription drug plan and keep your Medicare Advantage plan. (Unless your Medicare Advantage Plan is a Private Fee-For-Service plan that does not offer Medicare prescription drug coverage). If you would like to have a Medicare Advantage plan and add Medicare prescription drug coverage, you will have to join a Medicare Advantage plan with Medicare prescription drug coverage (MA-PD).

The above posting is a copy and paste directly from the Aetna website regarding their Medicare Advantage Plans. Notice the last sentence, so maybe this is a Medicare mandate.

 

[senior-advisor-indiana]

They make it sound like you cannot have a stand alone PDP with your MA plan. Or do they mean unless it is a pffs?

 

[arnguy]

I agree with your first sentence, SAI. Apparently you cannot have Part D stand alone with a MA. The same holds true for the BX MA called Keystone 65.

 

[midwestbroker]

You can only have a stand alone Part D plan with a PFFS MA.

A MA HMO or PPO cannot have a Part D plan added to it. If they want a HMO or PPO with Part D, they have to get a MAPD.

Go figure...

 

[arnguy]

Thanks for the information, Midwest. You are 100% correct. Actually I found the answer yesterday by consulting the Medicare & You 2007 Handbook, but I was unable to get onto the forum until very late because Val was "tinkering under the hood" which locked out of access.

To quote from Page 40 of the handbook:

"If you belong to a Medicare Advantage HMO or PPO, you can only get Medicare prescription coverage from your plan (if offered). If you join a stand-alone Medicare Prescription Drug Plan, you will be automatically disenrolled from your Medicare Advantage HMO or PPO and returned to the Original Medicare Plan."

So it definitely is a Federal mandate and not a condition imposed by the MA Plan itself.