Mattox Insurance Agency/Senior Healthcare Advisors
50 Years of Experience

 (815) 626-7445

Mon - Fri, 9 AM - 5 PM

After-Hour Appointments Available

MEdicare D Drug Plans

We may not like it but the Government has mandated that we buy a Medicare D Drug Plan when we first go on Medicare unless you have "credible coverage." Your provider is mandated to inform you on an annual basis whether or not your drug coverage is credible or not.

As you approach your Medicare effective date you have an Open Enrollment Period of 7 months, three months before your effective date, the month you go on Medicare, and the next 3 months. The other period is when you are Medicare eligible and you lose your "credible coverage." You have 63 days to purchase a Medicare D Plan or you must wait until the next Open Enrollment Period which is October 15th to December 7th.

What happens if you fail to have coverage as mandated? You are subject to a "fine" of 1% of the average national premium cumulative for each month you should had coverage. Medicare will determine the total and tell your Medicare D insurance company how much to add to your monthly premium and remit to Medicare. For example, if you were without coverage to 23 months you will pay an additional 23% "fine" for the balance of your life.

Medicare D plans are not standardized except for the annual deductible of $435 for 2019 for the plans that have deductibles.

The private insurance companies that have Medicare contracts can determine which drugs they cover (subject to limitation), the co-pays assessed for each, and the tier value that they assign to that drug.

The total coverage for each person is $3850 then you go into the "Gap" or "Donut Hole" where you generally pay more when you purchase a prescription. Now it becomes complicated. Once you, the drug company, and the insurance have spent $5100 you then go into Federal Catastrophic Coverage where you pay a small percentage at the pharmacy counter.

This is a complicated plan and one that is nearly impossible to understand but we work hard to do our best to give you the very best coverage that is possible. How do we do it? We ask you to bring in your bottles and boxes of medications. Jonathan Mattox will line them up on his desk and then enter each into a computer plan nothing the name of the drug, strength, and number you will take in a day, week, or month. Then he will do a cost comparison of the plan, deductible if any, total co-pays if you buy every drug for a year and the cost of non-covered drugs. What Jonathan is looking for is the plan with the lowest overall cost at the pharmacy of your choice. We want to give you the very best "bang for your buck" and cover all of your drugs.

We go to 4 companies and compare 12 plans for answers. Humana, Silvercripts, BlueMedicareRx, and Mutual of OmahaRx for the comparison.

What we do not want is a January surprise with you going to the pharmacy and finding out that one of the drugs you have depended on for months, if not years, is not covered for the remainder of the year. That is not acceptable!! I have taken the calls from individuals that have gone to a not-for-profit organization for assistance and are stuck with a plan for the year and having to pay thousands of dollars out of their pocket for a non-covered drug.

We want you to have the confidence in your plan and results that we have predicted to be "worry-free."

We do free reviews for everyone during the Annual Enrollment Period each year. We find that nearly 25% of the individual review we do need to be rewritten to a new plan.

I can honestly tell you that we are not paid a single cent by anyone to do these reviews and rewrites. We are paid in January or February each year an annual fee for every client that we have on the books with that company. I wanted to get that statement written and published to verify that we are not profiting from our efforts.

Call us at 815-626-7445 for an honest assessment of your needs.