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Medicare Advantage Plans Are the BEST?

1/29/2021

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Medicare Advantage Plans ARE the BEST?
So let's first talk about what is a Medicare advantage plan also known as part C of Medicare. Medicare advantage plans are another way to receive your Medicare health insurance, these plans are run by private health insurance carriers. Companies like BCBS or Humana and many others offer these plans as an alternative to straight Medicare parts A & B. These plans will cover everything Medicare covers plus many times include prescription drug coverage also known as part D. All Medicare advantage plans have a contract with the federal government and are subsidized by Medicare taxes , this is why you will see many plans offered for $0 per month. If you watch Television at all I am sure you have seen some of the commercials with famous athletes promoting all of the fantastic benefits like, Dental Vision Hearing Transportation Gym Memberships Free Meals $144.00 part B giveback Ect….. Who wouldn't want all of these benefits right? However the bottom line is these television commercials are not run by agents or agencies most of the time but rather third party marketing firms who are looking to sell your phone calls to agents/agencies. So on the other end of the phone you have someone who has paid to speak with you and probably has sales quotas and no other agenda then enrolling you in a plan. With Medicare advantage plans the benefits vary greatly from area to are zip code to zip code. So the burning question is can you get these great benefits for $0 per month? The answer is yes if you are lucky enough to live in the very limited zip codes and states that offer these benefits or if you happen to be dual eligible for both Medicare & Medicaid. As a licensed agent in multiple states for many years I have seen these benefits offered, but in very few counties in only a couple of states, which they certainly do not say on the television commercials.
It’s the old bait and switch, the commercials are designed to generate excitement and a phone call giving a sales agent the opportunity to enroll a customer in a plan, with or without all the benefits you were hoping for. The bottom line Medicare advantage plans can be great and they serve a lot of people well across the country, but they do not all offer all of those amazing benefits. So buyer beware, Medicare has become big business and if you are turning 65 or are already on Medicare someone wants to sell you. If you would like FREE advice or help understanding Medicare options I would be honored to assist you in anyway your comfortable, call me at 631-358-5793 email medicare@paulbinsurance.com schedule a free consultation

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Medicare Part D Insulin Savings Program

1/29/2021

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Insulin savings through the Part D Senior Savings Model Starting January 1, 2021, you may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a 30-day supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.
Things to know Part D covers these: Injectable insulin that's not used with an insulin pump Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs However, if you use an external insulin pump, Part B may cover insulin used with the pump and the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump. Ok so what does this mean to you if you are on insulin? Not all insurance carriers are participating or have plans nationwide offering these benefits, so you will need to research your plan options to see who indeed is offering these benefits. Select insulins include all Tier 2 and Tier 3 insulins found on the list of covered drugs for each participating MAPD plan or prescription drug plan. They include at least 1 each of rapid-acting, short-acting, intermediate-acting, and long-acting insulin vials and pens. If you have questions about the insulin savings program or how you may be able to reduced you out of pocket drug cost, email medicare@paulbinsurance.com or call my office 631-358-5793
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How to pick a Medicare Part D plan

1/12/2021

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See tips to help you select a prescription drug plan—and learn what to avoid.
Key takeaways

Never pick a Medicare Part D prescription drug plan just because it has a low monthly premium. Instead, pick a plan based on how the prescription drugs you're taking are covered.
Pay attention to Medicare Part D plans with special rules that may limit prescription usage or force you to satisfy requirements before you can have a prescription drug.
Typically, you can switch Medicare Part D plans each year during open enrollment (October 15–December 7), but some states may have more switching options available.

For most retirees, health care—especially prescription drugs—can be a significant expense. The average annual cost of therapy for widely used generic drug products was $365 in 2019 and $6,798 for widely used brand name drug products.1
Whether or not you need coverage when you first sign up for Medicare, it's critical to plan ahead. Most people will need coverage at some point in retirement. If you're uncovered and need prescription drugs, the costs can be crippling. And if you wait to sign up for drug coverage until you need it, you will likely need to pay a much higher insurance premium.
Those eligible for Medicare have 2 options: A stand-alone Medicare Part D prescription drug plan or an "all-in-one" approach with a Medicare Advantage plan. Here we will focus on Medicare Part D.
Either way, it's crucial to consider Medicare drug coverage options carefully.
Your Medicare Part D checklistNot all Part D plans are created equal. Each plan varies in terms of cost, the drugs covered, special rules, and so on. Just because a friend or family member's Part D plan works for their needs doesn't mean it will work for yours. Instead, do some homework. Here are 5 simple steps to get started.

Make a list of your current prescription drugs, including the dosage, quantity (30-day supply, 60-day supply, etc.) and frequency (how often you take them).
Take your list to the Medicare Plan Finder at Medicare.gov. It can show you which Part D drug plans are available in your area and which of those plans cover your drugs. (You can also use the Plan Finder each year to check your current Part D plan and see if better options are available.)
Once you find plans that cover your prescriptions, see how much they will cost you. Costs are typically your monthly premium (what you pay to have the Part D plan) and any out-of-pocket amount you pay for a drug. While a Part D plan may cover your prescriptions, you may wind up paying more compared to other plans, depending on which pricing tier the plan places your prescriptions (referred to as a drug formulary).
Your share of the prescription drug costs can fluctuate based on your drug's category (generic or brand). Part D plans usually spell out this information in their plan details. If you want to choose a plan with a low monthly premium, make sure to consider the plan's total cost (premium plus out-of-pocket costs) per year.
Check out the Part D plan's ratings. Medicare gives Part D plans a rating of 1 start (poor) to 5 star (excellent) based on customer service, customer experience and complaints, performance, drug safety, and pricing accuracy. These ratings can help you know how good a job the plan is doing in providing coverage. Keep in mind new plans might not have a rating.

What if I'm not taking prescription drugs?No one can predict the future. Even if you're a super fit 65-year-old and you're not taking any prescription drugs, you could need a prescription because of a sudden illness or accident. Without prescription drug coverage, you could wind up paying the full cost, which could be hundreds or thousands of dollars.
Even if you don't take prescription drugs currently, if you need them later and you try signing up for a Part D plan late, you could face a penalty of 1% for each month you went without coverage. Not having Part D coverage could be a costly—and long-term—mistake.
You should consider enrolling in a Part D prescription drug plan as soon as you become eligible for Medicare (unless you have creditable drug coverage such as from an employer health plan), regardless of your current prescription drug needs.
Navigating Part D restrictions
A Part D plan may also feature restrictions around certain prescriptions. These restrictions are intended to address drug safety and manage prescription drug costs. You'll usually see these drug restrictions on the higher pricing tiers in a drug plan. Here are some common ones:

Prior authorization: A plan can require you to get physician authorization and/or insurance company approval before your prescription is covered.
Quantity/dosage limits: If your doctor prescribes a prescription drug at a certain dosage or for a certain period that a plan considers outside the range necessary to treat your condition, the plan may not cover the drug. Or, the plan may ask that it be prescribed at a lower dosage or for a shorter period.
Step therapy: If your doctor prescribes an expensive drug, the plan may require you to try a similar but lower-priced drug first.

While not every Part D prescription drug plan includes these restrictions, there are steps you can take to avoid them in plans that do. The 2 biggest actions you can take are:

Try a different drug. Ask your doctor if there's a more affordable alternative to a restricted drug or a generic version of the drug. Try a different Part D plan. You can switch Part D plans during open enrollment.

Yes, you can switch plans as your needs changeIf your Part D plan isn't working for you, there's hope. Each September, plans send out an Annual Notice of Change letter. This letter lets you know about plan changes for the upcoming year, such as cost increases or drugs being added or removed from the plan (or switched to a different pricing tier). Read the Annual Notice of Change letter carefully to see if it makes sense to keep or switch your plan. You can change plans during open enrollment.
Get readyBefore you enroll in a Part D prescription drug plan, find out which plans are available in your area and whether they cover your prescriptions. Compare their overall cost and look for a plan that:

Features the lowest overall cost
Has either no restrictions or minimal restrictions
Best meets your health and financial needs

If the costs to cover your drugs are too high for your budget, contact your local State Health Insurance Assistance Program (SHIP) office about programs available in your state that help with costs. These services are provided at no extra charge to you. (You can also check with your state's SHIP representatives to see when you are allowed to change Part D plans.)
Choosing Medicare prescription drug coverage is a decision you'll have to make throughout your retirement.
If you have questions we are here to help 631-358-5793 or email medicare@paulbinsurnace.com

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The Modern Medicare Agency Blog

Medicare Advantage Plans Are the BEST?

Medicare Part D Insulin Savings Program

How to pick a Medicare Part D plan

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