- Welcome to this week's weekly Wednesday wrap up!
Hi, I'm Rebecca Gordon,
and Sylvia Gordon is out on location this week,
so, I will be womaning the show!
Stay tuned,
to find out more information about the donut hole.
( upbeat music playing )
All right, well, we are super lucky,
that we have our superstar,
Erin Bennett,
talking today about the donut hole,
and really training on it.
We've had several of you comment
on some of our previous shows,
that this is something
that always needs to have a refresher, how it works,
and also a great training platform,
for some of your newer agents.
Especially since we are on the cusp of A-E-P.
So, we've got the guru talking about it!
Get out a sheet of paper and a pen.
Take notes, so you'll get smarter, and enjoy Erin Bennett.
- Hi everyone. It's Erin Bennett,
your national Medicare trainer, here with Gordon Marketing.
And, today we're going to tackle the task of the donut hole.
So many agents have been,
"How do I explain this to my clients?"
Well, as you can see up here, we have a donut.
And as agents, we all know this,
but, it's trying to get it to your client to understand,
because, as soon as their costs go up,
they really do start calling our phones,
and making sure that we are explaining to them.
'Cause they didn't understand it was gonna cost that much.
So, we have four different phases of the donut hole.
Your first phase is a deductible.
So, not every plan has a deductible.
But, every plan that does have a deductible,
your client has to meet that,
on all of their name brand drugs,
prior to the plan helping cover it.
In 2021,
the highest deductible is $445,
but, they can be all the way down to 0,
just depending on the cost of the plan and how that works.
Your client,
If they do have a plan that has a deductible of $445,
and they're taking several name brand drugs,
probably within the first month or two,
they will hit that deductible.
And then, they'll go into the initial coverage period.
Once your clients are in the initial coverage period,
they will pay co-pays or co-insurance.
And the insurance carrier will pay the larger portion of it.
Once the insurance carrier
and the client together, meet $4,130,
they go into, what they call the coverage gap or donut hole.
The dreaded donut hole.
As an agent, we were all excited that,
"Oh my gosh, the donut hole's gonna close in 2020,
our clients are gonna save so much money!"
Well, they did close the donut hole,
but, they didn't close it like we thought,
like it would go away,
and the client would continue to pay
their copays throughout.
what it did, is,
they reduced, where at one time,
the client paid 100% of the cost of the drug,
through the donut hole,
they now only pay a 25% of the cost of the drug.
Although that's a savings,
to your client,
If they have, for example,
100$ a month retail drug,
and they've only been paying maybe $20 a month,
for that plan,
now, all a sudden they're in the donut hole,
and they're paying $25.
And yes, for $5 they are going to call you and complain.
They have to understand, they're in the gap.
What gets you to the gap?
How is the gap understood?
That once your client's in the donut hole,
or the coverage gap,
they're going to pay 25% for their name brand drugs,
even if they were paying zero for it,
they're now gonna pay 25%.
When it comes to a name brand drug,
they're still gonna pay 25% of the cost.
The manufacturer themselves pay 70%
and the plan pays 5%.
So, then you get to the catastrophic coverage.
Well, what gets you to the catastrophic coverage?
And that's when you reach.
Once you're in the donut hole, it's 41-30.
To come out of the donut hole,
It's 65-50, in 2021.
Well, from that 41-30 to that 65-50,
how do you get there?
And it is your portion, that you pay
or your client's portion,
that they pay in their 25%.
It's also the 70% that the manufacturer's paying in.
But, it does not include the 5% that the plan puts in.
But, once your clients hit that 65-50,
their costs drop dramatically!
They pay 5% of the retail cost of the drug,
or they pay $3.70 for generics,
and $9.20 for name brand drugs,
depending on whichever is higher.
And then once they hit catastrophic coverage,
that stage goes through all the way,
'till the end of the year.
And, when the new year will reset on January 1st.
So, that is a donut hole in a nutshell.
Have any questions?
Give me a call,
shoot me an email ebennett@gordonmarketing.com.
I'm always here to help.
Hopefully, this gave you a little bit of a understanding,
that you can help your clients with.
Thanks so much!
- Wow! What great information.
Thank you so much, Erin Bennett.
That's all for today's show.
Be sure to tune in next week.
And if you haven't subscribed to our channel,
please consider doing so.
Until then, good selling!
We'll talk to you soon.
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