Category: Medicare Advantage

2020 AEP Checklist

Annual Enrollment Period (AEP) To-Do List

  1. Write the important Annual Enrollment dates to remember on your Calendar, and clip your calendar on your fridge.
  2. Don’t eat that midnight snack until you’ve read the dates at least once.
    1. October 1st— we can talk about your options!
    2. October 15th— The AEP games begins.
    3. December 7th—AEP comes to exhausting close.
    4. January 1st— Plan changes go into effect.
  3. Compare your medications to the formulary (drug list) mailed to you by your drug plan company.
  4. Consider changing your drug plan if some of your medications are no longer covered or if the premium is too high (call OSHIIP at 800-686-1578 to reshop your plan).
  5. Call us and set up an appointment to have a good chat about your Advantage plan.
    • Consider switching Advantage Plans if:
    • Your hospital or doctor went out-of-network
    • Plan changes for the following year result in jaw-dropping out-of-pocket spending or a high premium.
    • Your medications are no longer covered or are costing a lot.
    • Your Advantage plan is (all around) a bit of a drag.

6.  Remember — you can change your Medicare Supplement any day of the year.  If you currently have a supplement, you are not bound by AEP in order to switch companies.  However, if you want to switch from a Medicare Supplement to a Medicare Advantage plan or if you want to switch from a Medicare Advantage plan to a Medicare Supplement, you must do that during this time.

7.  As a golden rule, your ultimate to-do list item is …plan ahead!

Still confused about what to do?  Give our office a call at 937-492-8800.  We are here to help!

 

Why You Should Consider Working In Retirement

Why You Should Consider Working In Retirement

(Even If You Don’t Need the Money)

Work? Retirement? The two words don’t even sound like they belong in the same sentence. After all, retirement is for relaxation. Retirement is for grandkids. Retirement is for vacations and bucketlisting.

 

But wait just a minute.

 

Although all of those things are true, studies show that regular work is also on the agenda, nestled in-between the couch sitting as well as babysitting. According to a Merill Lynch Retirement Study, 72% of pre-retirees age 50 and up will work in some capacity during their retirement.

 

This raises the question: Why are so many soon-to-be retirees planning to spend time working, the same thing they’ve likely been doing for the last 40 years?

 

It’s Not All About the Dollar Signs

As it turns out, there are a lot of reasons, and not all of them are financially related. Participants of the Merrill Lynch Study reported working in order to

  • Stay mentally active
  • Stay socially connected
  • Maintain a sense of identity and self worth

…as well as many other valid reasons. Surprisingly, staying mentally active was the number one cited reason. Money was still a consideration, especially considering that many retirees have not saved enough for a 20-year-or-more retirement, but those other motives definitely pulled their weight in the statistics.

 

And, fortunately, these desires were not left unfulfilled. The study also indicated that retirees who are working in retirement get out what they put in. As it turns out, working retirees reported feeling 10% prouder, 17% more connected to others, and 17% more stimulated than their non-working counterparts! It seems the sense of accomplishment, social interactions, and work environment provided a sense of overall well-being.

 

The Bottom Line

The point is today’s retirees and pre-retirees refuse to see retirement as the end. They are, instead, viewing it as a new horizon, a new beginning, a springboard instead of a landing pad. According to the study, many do take a 2.5 year break from work after retiring, but they are using that rest to recharge rather than wind down.

 

From working with my clients, I’ve heard some of their ideas for work. One client of mine does woodworking projects for people. Others give private music lessons. I even know a couple that travels down the east coast, selling kettle corn at local festivals during the summer. I remember them telling me all about the fun of traveling from year to year and the relationships they’ve built with some of the locals. Doesn’t that sound like fun?

 

You see, work and retirement only sound like they don’t belong in the same sentence if you consider work to be stressful or boring. However, if you can make money doing what you like, working will turn into a passion rather than a drag. In fact, you just might find that work and retirement is a match made in heaven.

 

Do You Have Retirement Questions?

Deciding whether or not to work is just one of many decisions you will have to make as you transition to retirement. Luckily, our Life After Work series of workshops seeks to cover the three critical areas of a successful retirement transition: Medicare, Social Security, and 401(k) planning. You can sign up for just one or all three. No high-pressure sales pitches here, just in-depth discussion about what you need to know as you approach retirement.   Our Welcome to Medicare workshop is Thursday, June 25, beginning at 5:30 on Zoom.  Call our office at 937-492-8800 or head on over to our web page and sign up for a free workshop today!

Will I Be Able to Afford Medicare?

Will I Be Able to Afford Medicare?

The shortest and most honest answer is “I don’t know”. But I know this doesn’t help you answer the most pressing questions weighing on your mind as you approach retirement age. Am I ready? Or Should I delay my retirement? And most of all—how am I going to afford health care without my employer insurance?

 

So here’s what I am going to do. Using my 20+ years of experience working with retirees, I am going to lay out a framework for what to expect when it comes to Medicare expenses. These will just be “in-the-ballpark” figures, but I believe they will help you come to a decision. You just might find that Medicare falls squarely into your budget.

 

So let’s get started with some good news.

 

Medicare Part A (Inpatient Care) Is Free

As long as you’ve paid into Social Security for at least 10 years, social security will return the favor with no associated Part A premium.

 

The Associated Part B (Outpatient Care) Monthly Premium is $134.00

This figure is adjusted for high income, but most people don’t fall into the high-income category. $144.60 will be your monthly premium unless you make $87,000 per year or more as an individual or $174,000 filing jointly.

 

From this point, the cost of Medicare is heavily affected by which path you take. You can boil down all the madness into two basic choices: Medicare Advantage or Original (traditional) Medicare.

 

The Traditional Medicare Route

If you choose the Traditional Medicare route, you will want Medicare Supplement Insurance to fill in the gaps of what Medicare doesn’t cover. Otherwise, there will be no limit to your out-of-pocket spending. The premiums for a Medicare Supplement range from $45-146 per month. However, we often recommend a plan G, which typically costs $110 per month. This is a fairly standard premium. It puts into perspective what you can expect a Medicare Supplement Plan to cost.

 

To cover your medications, you will also need a Part D prescription drug plan, which will cost in additional premium anywhere between $14 to $128 monthly. The average cost for a drug plan is $42 in 2020. The out-of-pocket costs associated with Part D vary greatly depending on your medications. It is impossible to estimate without knowing your specific situation.

 

The Medicare Advantage Route

Offered as an alternative to Traditional Medicare, Medicare Advantage is often the cheaper option when it comes to premiums. They are offered for prices within the range of $0-163 monthly with the average premium being approximately $23 per month. The Part D prescription drug plan is almost always rolled into the plan.

 

Caution: Check For Possible Out-of-pocket Costs

At first glance, it looks like the Medicare Advantage route is the obvious choice. But this fails to take into account the risk of out-of-pocket costs. With a Medicare Supplement (only available with Original Medicare), the maximum out-of-pocket (for Medicare approved expenses) is only $198 annually for Plan G. However, in an advantage plan, it is more of a pay-as-you-go approach. There are less monthly premiums; but copays, coinsurance, and deductibles are much higher. The potential out-of-pocket for an advantage plan can be as a high as $3500-6000 per year or more!

 

The Costs At a Glance


So there you have it! This should give you a good idea of what Medicare costs for the average 65-year old. But—as I said before—the cost of Medicare is different for every person. If you are still concerned about being able to afford Medicare, contact us for a free consultation. We will assess your financial and health situation to find an overall plan that meets your needs, concerns, and pocketbook. Ensuring you a successful and secure transition into retirement is our number one priority.

 

There are a lot circumstances that may prevent you from retiring. But I believe that the affordability of health insurance shouldn’t be one.

 

Disclaimer: Numbers are based on Ohio 45365.

 

Turning 65 soon and not sure what to do?  Our next workshop is quickly approaching on June 25.  Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

How to Lower Health Care Costs in Retirement—The 4 Best Ways

How to Lower Health Care Costs in Retirement—The 4 Best Ways

Did you know that a recent Fidelity study shows that the average couple can expect to spend $260,000 on health care expenses in retirement? Well, unfortunately, that is the current figure circling around the retirement blogosphere. And that isn’t even taking into account the possibility of long term care such as an extended nursing home stay, a consideration which escalates the estimation well into the three hundred thousands.

 

It can’t be true, can it?

 

I know, when I saw that figure in print for the first time, I was surprised as well. But as I begin adding up all of the possible costs—really crunching the numbers—I found out it was a lot more probable than I originally thought.

 

So what are you to do? If you are still working, the answer is common sense: save more to cover the costs. But if you are beginning the retirement transition right now, it’s too late for that strategy. You need something to lessen the burden—and fast!

 

Although these four ways won’t slash that number in half by any means, they can certainly help keep your health care costs in check:

 

1.  Sign Up For Medicare On Time To Avoid Penalties

You must sign up during the six-month period surrounding your 65th birthday or else pay hefty penalties that continue for your entire life! Unless you have a qualifying reason, everyone should sign up for Medicare parts A and B. And unless you are on an Advantage plan with a drug plan rolled into the deal, you should sign up for Part D. Because, if you miss it by just one year, you will accrue $4,248 worth of penalties over your lifetime, assuming you live 20 years after 65.

 

2.  Take Advantage of the Preventive Services Provided by Medicare

Like the old saying goes, an ounce of prevention is worth a pound of cure, and Medicare agrees. While Medicare covers very few things in full, the program covers every penny of many preventive services including (but not limited to) the following:

  • Flu Shots
  • Various cancer screenings
  • Obesity screenings and counseling
  • Annual “wellness” visits
  • Tobacco use cessation counseling

Now I am not saying you should spend all of your golden years sitting in cold waiting rooms. Rather, the core of this advice is simple: take care of yourself. Take the tiny steps now, so you can avoid the big health issues later. Catch the problems in their inception, so what could have been a free office visit and quick fix doesn’t end up costing you an arm and a leg in hospital bills.

 

According to a study conducted by Age Wave, pre-retirees and retirees say the two most important ingredients to a happy retirement are health (81% of respondents) and financial security (58% of respondents). The funny thing is that taking preventive measures often helps both.

 

3.  Cut Prescription Drug Costs

It is not difficult to see that the cost of drugs, especially for those with chronic illness, contributes its fair share to that $260,000 figure in health care expenses. Sure, you have a Part D Drug Plan, but there are still expensive coverage gaps.

 

But the good news is there are a few things you can do to lessen the burden. You can switch to generics. You can try mail order. Some people are even splitting pills to split the bill with certain medications.

 

For more specific details to help you cut drug costs, read this:  “How to afford meds in the donut hole”.

 

4.  Beat the Medicare Supplement Creep by Shopping Around!

If you don’t have a Medicare Supplement, I would strongly recommend getting one. And if you do and you’ve been in the same one for 3-5 years, I strongly recommend that you shop around.

 

Why?

 

Because Medicare Supplement premiums naturally creep up year-by-year, and they rarely come back down. The best news is you don’t even have to change coverage when you switch. Because of standardization, any and all of Medicare’s 11 lettered plans (A-N) offer the same exact benefits no matter which company you purchase it from. It is not uncommon for people to save $40-50 per month by switching. I’ve even seen savings as high as $100 per month or more.

 

The point is it pays to bargain shop! And it will pay to put some or all of these health care cost cutting ideas to the test.

 

Want to check and see what you could save by switching? Use our free Medicare Supplement quoting tool.   No contact information required.   Or call our office and we can give you a free quote over the phone!  937-492-8800

Do I Need To Do Anything To Enroll in Medicare?

Do I Need To Do Anything To Enroll in Medicare?

This is a question I get quite frequently at my offices in Sidney and Vandalia, Ohio. When it comes to Medicare, soon-to-be retirees know that they’ve been paying for it since they started working through Social Security. However, they often don’t know how they collect the benefit they’ve worked so hard to earn.

 

Does it just happen automatically? Or do soon-to-be retirees like you need to do something?

 

Well, that depends on one thing…

 

Are You Already Receiving Your Social Security Benefit?

If you decided to claim your Social Security benefit before 65, then you don’t have to sign up. Your Medicare card will arrive in the mail around your 65th birthday and you will be automatically signed up for Medicare Parts A and B.

 

If Not, Make Sure You Sign Up!

But if you are not receiving your Social Security benefit, you need to sign up during your open enrollment period, the seven-month period surrounding your 65th birthday. You will be doing yourself a big favor by signing up on time because there are many late enrollment fees. For example, the Part B penalty is 10% for every year you are late. Unfortunately, this penalty will continue for the rest of your life.

 

So take the time amidst retirement planning and birthday celebrations to sign up. You can sign up online at ssa.gov or you can call or stop by your local Social Security office. If you live near Sidney, that office is in Piqua, 227 Looney Rd.  If you live somewhere else in Ohio, find your closest location here:  Ohio Social Security office locations.

 

Everyone’s Got a Lot More to Consider!

But whether or not you have to sign up for Medicare, you are far from done. It is a big misconception (see our blog on this here) to think that original Medicare alone is enough to cover all your health care expenses. There are two things you should do. Firstly, it is almost always a good idea to pick up a stand-alone prescription drug plan through Part D of Medicare. Otherwise, you will have no coverage for your medications. In addition, I also recommend finding some way to supplement Medicare with additional insurance. You can get a Medicare Supplement plan, or—for those who are more cost-conscious—a low to no cost Advantage plan.

 

As you can see, even though you may not have to do anything to sign up for Medicare, signing up is just the first step before you have your health insurance in order. I recommend seeing an advisor to help guide you through this complex process.

 

Need help navigating Medicare? Want personal help to find a plan that is right for your needs and pocketbook? Call Seniormark at 937-492-8800 for a free consultation!

 

Half-Truths And Medicare Advantage Commercials

Half-Truths And Medicare Advantage Commercials

Weekly, we receive phone calls from people asking about something they saw on their tv and wondering if their insurance covers whatever they are seeing advertised.  This is more prevalant in the fall of each year, when Medicare Advantage companies ramp up their advertising during annual enrollment.  As an office, we offer both Medicare Supplements and Medicare Advantage plans to our clients.  We try to help people figure out what is best for their situation, budget, and lifestyle.  Our end goal is to help people avoid costly Medicare mistakes.  Sometimes, what is portrayed on tv is only half of the story, as you will see below.  This is an article recently published online at Forbes magazine, but echoes our thoughts so we wanted to share.  Source:  https://www.forbes.com/sites/dianeomdahl/2020/02/11/half-truths-and-medicare-advantage-commercials/#3d223f8c42ff

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If you watched any television in the last several months, you probably saw a slew of commercials for Medicare Advantage plans. One that pops up frequently features a former professional football player who once did a commercial wearing pantyhose. His commercials must be working so well that another former NFL star has also started promoting Advantage plans.

All the commercials, no matter the narrator, talk about the Medicare benefits you deserve, that you should be getting. They list those benefits in a very big and bold font, and encourage you to call the free number and sign up today.

According to Federal law, whatever we see or hear in an advertisement must be truthful and not misleading. I spent some time the last few days closely watching several different commercials. Everything that was said about the cost and benefits was true, to the extent that it was said. But there was much left unsaid and that’s the important information you need to make a smart decision.

First, the benefits

Get the benefits you deserve, including rides to medical appointments, private home aides, nurse and doctor visits by telephone.

Medicare describes these as benefits for daily maintenance and doesn’t cover them. However, because of policy changes, Medicare Advantage plans can now provide them. The plan, not Medicare, must cover the costs. This is a new program and not that many plans offer these benefits.

Based on my preliminary plan research, here are some important points not mentioned in the commercials:

  • These benefits appear to be more common in health maintenance organization (HMO) plans. Except for an emergency, the benefits are only available through a network of selected providers, which can limit the individual’s choice.
  • The plan likely will require prior approval or authorization. Before receiving care, the plan must review and approve the physician’s order.
  • There are limits on these benefits. For example, two meals a day for five days after hospitalization with a limit of four hospitalizations, and a private home aide four hours a day for no more than 31 days in a year.
  • And, most important, the plans we researched require members to select only one benefit per calendar year.

In some of the commercials, there were two more benefits that require clarification.

Free preventive screenings

Medicare covers a long list of preventive and screening services. You don’t need to enroll in one of these plans to get preventive services.

A 75% discount on prescription medications in the Coverage Gap

You see this and think, “Wow! A big discount on drugs! Where do I sign?” However, as with preventive services, this benefit is not unique to Medicare Advantage plans.

The Coverage Gap is more commonly known as the donut hole. In 2020, the donut hole closed. Beneficiaries are responsible for 25% of the cost of medications in this payment stage. Or, in other words, they get a 75% discount. Anyone with Part D prescription drug coverage will qualify automatically for this discount when their total drug costs hit $4,080. This benefit comes with the plans in the commercials, some other Advantage plan with drug coverage, or a stand-alone Part D drug plan.

Second, the costs

All these benefits may be available at no additional cost to you.

The commercials focus on zero-premium plans and benefits available for no added cost. However, at the moment the narrator says this, a line of small type appears on the bottom of the screen. It’s there for only four seconds, while the list of benefits continues. The small type reads, “Plan premiums, copayments, and coinsurance can apply.”

Not all Medicare Advantage plans are zero-premium. And for those that are, it’s important to know that zero-premium does not mean zero costs. There are out-of-pocket costs for most services. Plan members will pay their share of costs until they reach the plan’s out-of-pocket maximum limit. That’s how much a person could write in checks when something happens, like a cancer diagnosis or a major car crash. In 2019, the average limit was $5,059.

Third, the call

The narrators talk about the help you will get when you call the toll-free number. But, once again, the small print is revealing.

Dial the number and you’ll be transferred to a licensed insurance agent. One commercial noted that the agent may or may not offer Medicare Advantage plans. Another said the person you talk with may not offer plans in your area.

A question

The facts, as presented, are true but then the question becomes, “Are these commercials misleading?” According to the Macmillan dictionary, misleading means something that is intended or likely to make someone believe something that is incorrect or not true.

In fall 2019, the American Medical Association (AMA) passed a resolution.

“Whereas, Medicare Advantage plans are heavily marketed to seniors by insurance companies, with less than ideal transparency in advertising; … and

“Whereas, Presentations by insurance company officials to seniors can overemphasize the value of different options and can create confusion; therefore be it

“RESOLVED, That our American Medical Association encourage AARP, insurance companies and other vested parties to develop simplified tools and guidelines for comparing and contrasting Medicare Advantage plans.”

The AMA identified the need for tools to help individuals go beyond the TV commercials and get the information they need to make a smart decision.

The Centers for Medicare and Medicaid Services redid its tool for comparing plans. The Medicare Plan Finder shows the premium in a large font. Then, you can check out the plan’s out-of-pocket costs for medical benefits on the details page. Beyond that, as pointed out in a past post, most of the essential information has disappeared. The Plan Finder no longer has links to networks, a list of preferred pharmacies, and most important, complete information about coverage rules like prior authorization.

The best way to get all the facts is to check the plan’s Evidence of Coverage. This document describes in detail the plan’s benefits, how much you will pay, and how the plan works, including authorization rules, limits, networks, and more. To find it, go to the plan’s website, look for the Evidence of Coverage link. This may take some searching but you’ll get the information you need on available benefits, limits, approval, and more.

Keep in mind that these Medicare Advantage plans are offered by for-profit entities, corporations not unlike your cable provider, department store, or neighborhood used car lot. The purpose of the TV commercials is to get you to act, to call the number on your screen, to make a purchase. First, do your research. Be an informed shopper. Go beyond the commercials to the whole truth. Your Medicare coverage is too important.

If you would like help muddling through all of this confusing information, please give our office a call.  We are happy to help you sort through the complicated Medicare alphabet and choices!  Call our office at 937-492-8800 and schedule a free, no obligation consultation.

Source:  Diane Omdahl for Forbes Magazine

Know Your Rights! (Your Medicare Supplement Guaranteed Issue Rights)

Know Your Rights! (Your Medicare Supplement Guaranteed Issue Rights)

Everyone knows that they have the right to remain silent and the right to an attorney, but few retirees know their rights to a Medicare Supplement policy. For this reason, many people believe that if they missed their Open Enrollment Period and have health problems, they will be unable to get insurance.

 

This is not so. Thanks to guarantee issue periods, retirees like you have rights. During guaranteed issue periods, insurance companies are obligated to offer you a policy at the normal rate and cover your pre-existing conditions. All of this with no pesky medical questioning whatsoever!

 

The following circumstances spur a guaranteed issue period. In other words, you have the right to a Medicare Supplement policy if:

  • Your Medicare Advantage Plan is going out of service or you are moving out of the service area.
  • Your employer health insurance is ending.
  • You’ve been enrolled in an Advantage Plan for less than one year and want to switch back to a Medicare Supplement plan.
  • You lose your coverage without fault (i.e. your insurance company goes bankrupt).
  • Your insurance company misled you or doesn’t follow the rules.

(For a more comprehensive chart of potential situations, click here to visit Medicare.gov).

 

From the day any one of these events happen to you, you have 63 days of guaranteed issue to get into a new Medicare Supplement Plan.

 

Do not take this newfound information lightly, and keep any proofs of the previously mentioned events at your disposal such as:

  • Claim denials
  • Letters from employers
  • Official notifications

 

Insurance companies will ask for these items to prove your right to a policy. Then they will have no choice but to insure you. This is why it is so important to educate yourself on your rights. It allows you to take advantage of what has been made available to you.

 

If you want to find out more about guaranteed issue rights or need help shopping a Medicare Supplement Plan for your needs, Call Seniormark at 937-492-8800 for a free consultation from licensed experts.

What Is My Full Retirement Age? (And Why Does It Matter to My Social Security Check)

What Is My Full Retirement Age?

(And Why Does It Matter to My Social Security Check?)

 

Laws, guidelines, tax codes, regulation, health care—pretty much everything involved with the government—is constantly evolving. And the full retirement age is no different.

 

Life expectancy has been rising. So that means that retirees are drawing on their Social Security for much longer than they used to. Couple this with shockingly high spending for other programs, and you’ve got yourself a little budget problem on your hands. Social Security has to remain solvent somehow!

 

This is why the full retirement age is creeping up. Ever since Ronald Reagan signed the 1983 Social Security Act amendments, the government has been inching its way to a full retirement age of 67, like peeling off a Band-Aid nice and slow.

 

But What’s My Full Retirement Age?

Your full retirement age depends on when you were born. The younger you are, the closer your full retirement age will be to 67. But if you’re retiring soon, your full retirement age is likely 66. Check out this chart from SSA.gov to find out for sure:

 

Why Does it Matter to My Social Security Check?

Your full retirement age is when you qualify for full Social Security benefits (not to be confused with your Medicare eligibility)[LINK TO WARNING: CONFUSING MEDICARE AND SOCIAL SECURITY ELIGIBILITY]. You can apply as early as age 62, but you will receive reduced benefits, only 75% of what you would’ve received had you waited until your full retirement age.

 

But there’s another side to this coin. You can also delay your benefits, leading to bigger benefits. For every year you delay beyond your full retirement age, you get an extra 8% tacked onto your Social Security check every month.

 

These options leave a lot up to you, and I wouldn’t take them lightly. Deciding when to start your Social Security takes a lot more than just understanding your full retirement age; it calls for a carefully planned strategy, another step along the way to a successful retirement.

 

Looking for some strategies to help you get the most out of Social Security? Click here.

3 Reasons to Start Medicare Planning NOW!

3 Reasons to Start Medicare Planning NOW!

Every last one of us is pretty much the same in this respect: we don’t take now for an answer. When the task is daunting, overwhelming, or complex, we always manage to escape doing it now by putting it off for tomorrow. We’re like a gaggle of Houdinis. Just when you think time constraints have us trapped, we magically free ourselves into an enchanted tomorrow land of channel flipping, Internet surfing, and power naps.

 

But some things are just too important to put off. Even for one more day, one more catnap, one more rerun of I Love Lucy. Medicare planning is one of these things. Not convinced? Here are three reasons why you should start the Medicare planning process now:

 

Reason #1 Mistakes Happen

Glitches. Mistakes. Goofs. If there is a way something can go wrong, Lord knows it probably will. Just like a customer service call can turn into several hours of God-awful hold music, a small slip-up in the Medicare process can turn a five minute solution into a month long ordeal.

 

This is because you are just one of the 10,000 people turning 65 everyday. Medicare has a lot to handle; little things can slip through the cracks. Even if you are fortunate enough to not make any mistakes, you still have to plan in advance for theirs.

 

Reason #2 You’ve Got a Ton of Decisions to Make

Do you need a med sup? Or should you go the Medicare Advantage route? Should you sign up now? Or wait until you are done working? When are the deadlines? What are the penalties? What is a donut hole and how do I navigate it?

 

Take these questions along with deciding between 24 drug plans, 11 supplement plans and a legion of Medicare Advantage options, and you’ve got yourself a to-do list you can’t leave until the last minute.

 

Reason #3 Your Hairdresser Is Not a Retirement Advisor

Getting advice from your family or friends over coffee at church or in-between hands of euchre won’t cut it.  And no, your all-knowing hairdresser won’t do either.   Although your loved ones and acquaintances may have your best interests at heart, they simply do not know the ins and outs of Medicare. What was right for them may not be right for you. And what they overheard at the grocery store is (gasp) probably not watertight advice.

 

This is why seeing an expert is a great (dare I say the only) way to make sure you are on the right track, ensuring you a smooth, penalty-free transition to retirement. But you may find it difficult to schedule an appointment if you wait last minute. We will still help you out, of course, but it will save you a lot of stress to plan an appointment weeks or months ahead.

 

So—when should you start the Medicare Planning process? If you are within 6 months of turning 65, the answer is…you guessed it…Now!

 

Well……

Maybe not now, right?

 

Not sure what to do next? Give us a call at 937-492-8800 for a free consultation!

The Part D “Donut Hole” Is Not as Tasty as You Might Think

The Part D “Donut Hole” Is Not as Tasty as You Might Think

 

Apple is a 605 billion dollar company. Blackberry is a pocket-sized desktop computer. Yes, it’s true. You can now add one more item to your list of foods the 21st century has complicated. You may be used to eating a donut hole with your cup of joe in the morning, but keep in mind that the Part D “donut hole” is not nearly as powdery, chocolately or delicious. In fact, it could be costing you on your prescription drug plan.

To clarify, The Part D donut hole is a gap in your prescription drug coverage. In the donut hole, you continue to pay normal premiums but Part D covers less. This means higher drug costs and less expendable income for you.

 

There are 5 main things you need to know about this mysterious pseudo-food:

 

1. The Donut Hole Starts When You Reach $3,820 in Total Prescription Drug Costs.

The key word here is total. $3,820 is not what you pay for drugs. It is not what Part D pays. It is the sum of both. The only cost not included in the $3,820 threshold is your monthly premium.

 

2. Once You Are In the Donut Hole, You Will Pay 30% For Brand Name Drugs and 37% For Generic Drugs.

 

3. The Donut Hole Ends When You Reach $5,100 in Out-of-Pocket Prescription Drug Costs

 Again, this tidbit of info has a keyword. In this case, it is “out-of-pocket”. The amount of money Part D pays is irrelevant. The $5,100 figure only includes what you pay for prescription drugs, minus the monthly premium, of course! Once you exceed $5,100 for out-of-pocket costs, you enter into what is known as “catastrophic coverage”. At this point, you only pay 5% of your prescription drug costs.

4. Medication Costs are Rising.

This might seem obvious. But what might not be obvious is the effect it can have on your entry into the donut hole. The higher the cost of drugs, the sooner you pay the higher 30 or 37 percent coinsurance rate. For example, in the Pittsburgh Post Gazette’s article about rising drug costs, they tell the story of retiree Milly Scott. This seasoned Medicare beneficiary was used to her usual copays until the rising costs of drugs put her in the donut hole late in the year, October.  The very next year she entered the donut hole 3 months earlier, in July! Part D coverage gaps paired with higher costs can wreak havoc on your finances, so plan accordingly.

5. The Donut Hole Is Closing

 

 

I made sure to save the best news for last. Although the donut hole is not gone yet, it is on its way out the door. Regardless of your opinion of the Affordable Care Act, it is shrinking the coverage gap dramatically. Beneficiaries used to pay the full amount of their drugs in the donut hole, and now they only have to pay 30-37%. The plan is to close the coverage gap completely by 2020!

 

In light of this news, I suggest breaking out some Krispy Kremes to celebrate!

 

Have more questions about the donut hole?  Contact our office for a one-on-one appointment and we can tailor an appointment for you!  Call Seniormark at 937-492-8800.