Category: Medicare Drug Plan

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

I know you’ve got a lot of dates to juggle: birthdays, anniversaries, holiday get togethers, or departure dates for long awaited travel plans. But you have to leave some empty space—in your memory and on your calendar—to add these 6 dates.

 

Why?

 

Because the Medicare Annual Enrollment Period is upon us, a time when the Medicare marketplace is bustling with transactions. Beneficiaries such as yourself are switching Drug Plans, Advantage Plans, or transitioning from an Advantage Plan to a Medicare Supplement or vice versa. These are strategic moves you can only make during Annual Enrollment!

 

Now, if you are thinking, “I’m perfectly fine with my health insurance. I’ll just let it go this year,” I’d like to offer a word of warning: Not reviewing your Medicare health insurance plans this Annual Enrollment Period could cost you thousands. You see, Benefits and premiums change from year to year, so you have to review your plans with a professional to ensure you are still in the best-valued plan for your needs.

 

It doesn’t seem like letting it slide just one year could end up being so costly, but I’ve seen it happen again and again. In fact, I recently had a man come into my office in January, confused about why his approximately $190 per month prescription wasn’t covered anymore. As it turns out, he missed Annual Enrollment. The insurance company dropped his prescription from their formulary (list of covered drugs) for the new year. Unfortunately, I had to tell him, he was stuck in the ill-fitting Drug Plan for the whole year, the consequences of a mistake that would (by the end of the year) cost him $2,280. Ouch.

 

So, if you are a current Medicare beneficiary, get your pen ready and calendar ready. Annual Enrollment (October 15—December 7) is chock full of clear-cut deadlines. Don’t find yourself locked into a financially draining health insurance plan! You (quite literally) can’t afford to miss these 6 dates:

1. October 1st

This is the day we, as an insurance agency, receive all of the new information regarding plan changes.

  • Did your Drug Plan drop your most expensive prescription from its formulary?
  • Was there a premium hike?
  • If you have an Advantage Plan, is your doctor still considered “in-network?”

October 1st is the day we have all these answers and can speak to you about the possibility of switching to save you money and hassle.

 

Note: You can call about your options anytime during Annual Enrollment, but the earlier is truly the better. This time of year is quite busy!

2.October 15

The marketplace is open!  Annual enrollment has officially begun, and you can now enroll in a new plan.

3.December 7

I hope you have made all the necessary changes, because—at this date—you are locked into your plans for another year. Annual enrollment is closed.

4.January 1

It’s a new year, a new resolution, and—quite possibly—new insurance. This is the date any changes you made during the open enrollment period go into effect.

5.January 1

Nope, you didn’t just read the same line twice, and you are not seeing double! I know this is a repeat, but I want to clarify why this date is worth the extra mention: It is also the first day of the Advantage Plan disenrollment period. Just in case you’re second-guessing your decision, Medicare set up a disenrollment period where you can get out of your Advantage Plan with no penalties.

6.February 14

Finally, this is the last day of Medicare’s disenrollment period. If you are in an Advantage Plan and don’t like it, this is your last chance to drop it!

BONUS: February 14th is also Valentine’s Day. You’re welcome.

 

Looking to Review Your Plans With a Medicare Expert?

Even if you are not yet sure if you want to switch, I recommend giving Seniormark a call at 937-492-8800! Our friendly and caring staff is more than willing to be a resource during this bustling Annual Enrollment season. We will help ensure you meet all the deadlines and end up in a great plan for your needs and pocketbook as the New Year rolls around.

How Much Does Medicare Cost in 2017?

How Much Does Medicare Cost in 2017?

The cost of health care is a big question mark for soon-to-be retirees. Perhaps you’ve been on a trusty employer plan for the last few decades or have come to know and love a private insurance plan that fits your needs and budget.

But now you’ve got to switch to Medicare. And although you’ve always been able to pay your premiums, the cost of Medicare is an unknown number among a sea of unknowns associated with health care in retirement (or retirement in general, for that matter).

Although I can’t grant you any magical, one-size-fits-all answer, I can give you some solid estimations based on my experience working as a local Medicare expert to help you compare what Medicare costs with your current plan.

I always like to start with some good news…

 

  • Medicare Part A (Inpatient Care) Is Free

Have you paid into Social Security for at least 10 years (40 quarters)? Then your premiums for Part A are paid for!

Unfortunately, though, it can’t all be free…

 

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

This figure is adjusted for high income, but that is not a concern for most people. $134.00 will be your monthly premium unless your income exceeds $85,000 per year or more as an individual or $170,000 filing jointly with your spouse.

This is where there is a fork in the road. 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 (“Swamped with mail? Here’s what it all means”): Medicare Advantage or Original (traditional) Medicare.

 

The Traditional Medicare Route

If you take this path, I always suggest picking up a Medicare Supplement Plan. It might seem unnecessary (“Do I Really Need a Medicare Supplement?”) to some, but without the extra coverage, there is no limit to your out-of-pocket spending.

A Supplement’s price range is anywhere from $50-150, but a standard, middle of the road Plan G usually costs about $110 per month. This is the typical plan I recommend to my clients.

Then, since a Supplement does not cover those sky-high prescription drug costs, the vast majority of retirees purchase a Part D Drug Plan. Although the prices span anywhere from $14.60 to $157.40 per month, the average cost for a drug plan is $35.63 as of 2017. The out-of-pocket costs associated with Part D vary greatly depending on your medications. Just keep in mind that there will likely be copays and coinsurance regardless of which plan you choose.

 

The Medicare Advantage Route

The other choice is the less beaten path. From my experience, most people feel very cozy in the stability of a Medicare Supplement. However, an Advantage Plan often appeals to the more cost-conscious, risk-taking retirees. Offered as an alternative to Traditional Medicare, Advantage plans range from $0-179 per month with most settling in around $70. To make them even more attractive, a Drug Plan is almost always included as a part of the package.

Caution: Check For Possible Out-of-pocket Costs
At first glance, it looks like choosing a Medicare Advantage is a no-brainer, but there is a reason it appeals to risk-takers. With a Medicare Supplement (only available with Original Medicare), the maximum out-of-pocket is only $183 annually for Plan G (not including prescription drug costs). However, in an Advantage Plan, the coverage is a bit spottier. You pay less in 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! Some years you will save money because of the cheaper premium, but one year of bad health can turn that around really quickly.

The Costs At a Glance For a 65-Year-Old

Original Medicare
Free Part A
+
$134 per month Part B
+
$110 per month for Medicare Supplement Insurance
+
$35.63 for Part D Drug Plan
= $279.63 monthly
(with LOW out-of-pocket spending limit)

Medicare Advantage
Free Part A
+
$134 per month Part B
+
$70 per month for an Advantage Plan (Part D included)
= $204 monthly
(with HIGH out-of-pocket spending limit)

 

Interested In A More Personalized Analysis?

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 interested in more personalized figures, call us at 937-492-8800 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 will always be some unknowns when it comes to health care costs in retirement, but sitting down with a professional in order to assess your situation can diminish even the biggest question marks and settle your deepest concerns.

Disclaimer: Numbers are based on Sidney, Ohio.

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7 Reasons Why You Should Choose a Retirement Advisor (Instead of a Salesperson)

7 Reasons Why You Should Choose a Retirement Advisor (Instead of a Salesperson)

Are you turning 65 soon and thinking about retirement? Then buckle up. An onslaught of sales mail is coming your way. You might even get a few sales calls and knocks on your door as well. Salespeople are definitely assertive. And once you are between 3-6 months of your 65th birthday, hundreds of them will be vying for your attention, Medicare Advantage Plans and Supplement insurance extended in hand.

 

But I don’t think you should buy from them.

 

It’s not that I have a special vendetta against salespeople. You just have a better choice available: the reserved, resourceful guys on the fringes of the chaos, just waiting for you to come to them. That’s right, I recommend seeing a retirement advisor, and here’s why:

 

Advisors Have More Certification

I’m not saying there aren’t well-studied salespeople, but it isn’t the norm. An advisor, on the other hand, will almost always have some form of certification. They have to. Because they aren’t just sweet talking you into a healthcare plan, they are working with you to develop a comprehensive retirement strategy based on your unique situation. You need skill to do this. You need to know your industry backwards and forwards. This takes reading the right books and completing the right classes. It takes a certain level of certified expertise.

But be careful: Not all certifications are equal.  Here is a link to some of the most significant certifications.

 

They Specialize

Be leery of those who “specialize” in Medicare Supplements, Long-term care insurance, home and auto, life insurance, annuities, rollovers, and pet insurance. If their list is long and their Santa bag of products is larger, there is a good chance they’re the proverbial Jack-of-all trades who is—unfortunately—a master at none. Typically, an advisor isn’t like this. They will pick a few areas of finance or insurance and specialize. Their specialization leads to mastery. And their mastery leads to good advice and service.

 

They Are Accessible

They have an office space, so you know where to find them. They have office hours, so you know when they are available. When you call, they pick up. When you email, they respond. Predictability is the key. This is because their job isn’t just to sell (although they do this as well); it is to service their products afterwards. Claim issues? Questions? Concerns? An advisor sticks around long enough to tackle them.

 

They Educate You

The goal of an advisor is not to decide for you. It is to educate you, so you can make a decision for yourself. They will give you recommendations, of course. They aren’t just going to slap down 11 supplements, 24 drug plans, and several dozen Advantage Plans and say, “Choose!” But the point is, you make the choice to buy. You know the advantages and disadvantages of different options (because they taught you).  And you become the driving force of your own fate. So when plans go well, you don’t just have an advisor to thank; you can also thank yourself.

 

They Challenge You

Advisors aren’t just “yes men”. They are straight up with you. When you wander onto a questionable path, they care enough to stop you. I remember when a client of ours stormed in, fighting mad about the weak points of his employer plan. He wanted to get off it immediately and onto Medicare. But I knew this was an emotionally charged decision. Sometimes employer plans can be frustrating, but it was going to be way more expensive for him to get on Medicare. It took quite a bit of convincing, but I challenged him. It’s what an advisor does. Your first instincts are not always the best ones.

 

They Give You Time to Process

A lot of salespeople try to communicate something called “urgency”. This isn’t always a bad thing. Some situations are just urgent! For instance, I almost always recommend getting on Medicare when you are first eligible because not doing so can result in life long penalties. But a lot of this communicated “urgency” is just to rush you into buying a product. But advisors give you time to think things over. They realize that you want a methodical approach, a framework for weighing all your options.

 

They Are Client-Centered

 An advisor focuses on you, not the product. The whole process starts with an analysis of your situation and ends with your decision. Advisors advise people that buy products. Salesmen sell products that people buy.  This seems like splitting hairs, but listen to the people around you. Have you ever heard someone say, “Yeah, this guy came by my house and sold me this?” Notice the lack of agency. They didn’t buy it. Someone sold it to them. That is a sure sign of a product-centered approach: a sense of buyer’s guilt and a subtle, underlying regret.

 

Before I end this post, I want to make something very clear. I am not saying that salesmen are bad people. And I am not saying that all advisors are these haloed angels in disguise. But I know what it is like to be on both sides. I’ve worked for a large brokerage firm, a large insurance company, and a large bank. And in all 3, I had the same problem: I felt bound by the ever-present pressure of sales quotas. I tried to advise and do what was best for the client, but—for all intents and purposes—I was a salesperson. My job was to sell products that people buy.

 

Now that I’ve switched sides, I will never go back. The advising side is just better. It is better for clients. And it’s better for everyone, really.

 

But enough about me. Now back to you. You are approaching retirement, readying yourself to leave that stressful job behind and explore new hobbies, new places, and new experiences. Or maybe you just want to stay local and spend more time with family.

But whatever your situation, I want to make a suggestion. As an advisor, I want to advise. Whoever you choose to help you with retirement, makes sure it is someone you can absolutely trust. Makes sure it is a person who is knowledgeable in the area you need the most help. And make sure they aren’t just there to sell products to people, but rather to invest in people who buy products.

 

Your retirement decisions are just that important.

 

If you are confused and interested in some Medicare planning help, click here to sign up for our free workshop! No high-pressure sales pitches here, just in-depth discussion and Q and A about Medicare.

 

A Side-by-Side Comparison of Medicare Advantage and Medicare Supplements

A Side-by-Side Comparison of Medicare Advantage and Medicare Supplements

When it comes to Medicare, you only have two big options. That’s it.

The piles of mail you’ve been receiving from various agents as you approach 65 do not represent hundreds of choices. There are only 2 ways to get your Medicare coverage.

First, I hope you have already signed up for Medicare (If not, hop on over to our blog titled “What Is the Fastest Way to Sign Up For Medicare? to take care of that, then come back and read the rest of this!).

The first way is just to stick with original Medicare—Parts A and B. Then you need what is known as Medicare Supplement Insurance, named as such because it “supplements” Medicare, filling in the gaps of what Medicare doesn’t cover.

The other option, however, is to get a Medicare Advantage Plan. This is an alternative to Original Medicare provided through private insurance companies that have contracted with Medicare. Although you still have to sign up for Parts A and B to be eligible, this replaces Medicare as the primary payer of your claims.

Choosing one or the other comes down to what’s most important to you. You can’t have both! What I am going to do is hold both of these options up to the light, side-by-side, so you can see clearly the strengths and weaknesses of each.

Check it out:

Medicare Supplement

 

PROS  

  1. Minimal Out-of-Pocket Spending

You won’t have much coinsurance or copays with a Supplement. Most of it is covered.

 

  1. Predictability

They are also fairly consistent from year to year. They do creep up in premium (see our blog “Beat the Medicare Supplement Creep”, but they rarely leap! The benefits are guaranteed to stay the same.

 

  1. Out-of-State Coverage

Supplements cover you the same whether you are in your home state or out. Vacation homes? Extensive trips? No big deal. You’re covered.

 

  1. No Networks

You are free to use any doctor or hospital that accepts Medicare without sacrificing your coverage.

 

 

CONS

  1. Higher Premium

An in-the-ballpark average Supplement price is about $110 per month premium. This is higher than most Advantage Plans.

 

  1. No Drug Plan

Drug plans are not built in. You have to get a stand-alone drug plan, which cost an average of $34.10 per month in 2016.

 

Medicare Advantage

 

CONS

  1. High Out-of-Pocket Spending

Advantage plans have more of a pay-as-you-go approach. Higher copays, coinsurance, and unexpected costs are common.

 

  1. Unpredictability

Since Advantage plans are funded by government subsidy, benefits and premium costs tend to vary from year to year as a result.

 

 

 

 

  1. Out-of-State Coverage…Sometimes

Only in the case of emergency will you receive coverage out of your home state. Other than that, you’re on your own.

 

  1. Networks

They have them…networks of preferred hospitals and doctors. If you don’t use those preferred providers, you might have less coverage or—depending on the plan—no coverage at all.

 

PROS

  1. Low to No Premium

The average premium is somewhere around 60 dollars a month. Some are even free!

 

  1. Built-in Drug Plan

The vast majority of Advantage plans include a drug plan. No hassle or extra premium for you!

As you can see, the Medicare Supplement route is more costly, but there are a lot of benefits that give you more peace of mind and—all in all—less hassle.

On the other hand, the Medicare Advantage route is more economic, but it has fewer benefits, leading to unexpected costs and stress.

But both do their jobs. They both limit the potentially high out-of-pocket spending that is left by Medicare alone. Whatever you choose, don’t leave yourself vulnerable. Medicare alone is never a good idea!

Turning 65 soon and not sure what to do? 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!

Workshops

10 Medicare Terms To Get You Started

10 Medicare Terms To Get You Started

If you’ve ever done research in your life, you know that knowledgeable people sometimes overdo it. They use words that only other life-long Medicare experts would know.

 

And when you ask them to explain, what do they do? Use even bigger and scarier words to describe the ones you didn’t understand in the first place. Our philosophy: Never use a big word, when a singularly un-loquacious and diminutive linguistic expression will do the trick.

 

Over our 19 years of helping retirees, it has served us well. Now we are here to pass our knowledge onto you in words you understand. To get started, here are 10 commonly used terms:

1. Medicare

At the top of the list, I like to kick-it-off with the basics. Medicare is a government-run health care program for those over 65. It is also for younger people with disabilities or kidney failure, but its primary concern is to serve the older generation.

2. Medicaid

This is often confused with Medicare, but they are completely different programs. Although they both serve the same purpose (to provide health insurance), Medicaid is for people with low income. There is a chance that you might be eligible for both programs at the same time.

3. Medicare Beneficiary

This is you. Or if you haven’t signed up yet, it will be you very soon. A Medicare beneficiary is a person enrolled in Medicare, receiving Medicare benefits.

4. Initial Enrollment Period (IEP)

The IEP is made up of 3 parts: the 3 months before you turn 65, your 65th birthday month, and the 3 months after. This 7-month window is the time that most people should sign up for Medicare. If you miss your IEP, it could lead to costly penalties. So pay attention. Like all time, those 7 months will fly by!

5. Part A

Medicare is divided up into 4 parts (A, B, C, and D). And Part A is your inpatient care. It includes nursing care, hospice, and some home health services. But—for the most part—it is coverage for when you are officially checked-in at a hospital.

6. Part B

Part B is exactly the opposite of Part A. It is your outpatient care, including lab tests, medically necessary supplies, and various screenings. To keep simple, Part B is care received while checked-out of the hospital.

7. Original (Traditional) Medicare

This one is simple. Whenever someone refers to original (or traditional) Medicare, they are referring to Parts A and B together.

8. Part C (Medicare Advantage)

Medicare Advantage is an alternative to original Medicare offered through private insurance companies that have contracted with Medicare. In other words, they replace Medicare as your health insurance provider. About 1 in 4 people choose Medicare Advantage, according to the Reader’s Digest. To find out the advantages and disadvantages of Part C, click here.

NOTE: You still have to sign up for Parts A and B to be eligible for Part C.

9. Part D

Part D is your drug plan. It covers your prescription medications. Also offered through private insurance companies, almost everyone signs up for Part D in addition to original Medicare (Parts A and B).

10. Medicare Supplement Insurance

A supplement is fondly nicknamed a “Medigap plan.” It is referred to this way because it “fills in the gaps” of what Medicare Parts A and B doesn’t cover on its own. Without it, you leave yourself quite vulnerable. There is no limit to what you could spend in uncovered health care costs!

That should be enough to get you started on this often-overwhelming journey of Medicare planning. As you continue to learn more and plan your retirement, we are committed to keeping you up-to date and informed…in words you can understand. How did we do? Leave us a comment below to pose any questions or concerns!

 

Turning 65 soon and confused about Medicare? 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! We put it into words you can understand.

 

Workshops

Attention Retirees: Premiums Shouldn’t Rule Your Healthcare Plan Decisions

Attention Retirees: Premiums Shouldn’t Rule Your Healthcare Plan Decisions

It is easy to do. If you’ve got a tight budget to think about, a drug plan with a low monthly premium is appealing. And if your past is fraught with health scares, it feels more secure to go with a high premium Medicare Supplement for “more comprehensive coverage”.

But you’ve got a lot more to consider when it comes to healthcare decisions: deductibles, coinsurance, copays, and medications, just to name a few. “Tunnel vision” focus on premiums will not help you make a smart decision.

 

Here are two examples why:

 

Lower Does Not Mean Better.

For a drug plan, people get in big trouble choosing a low premium drug plan hastily. Just because your friend or neighbor has an $18 per month drug plan that works for them, doesn’t mean it will work for you.

 

You have to consider your medications. Different drug plans cover medications at varying levels. If you are on an expensive drug and it isn’t on that plan’s formulary, it isn’t covered. If it is on a different tier, it could affect the dollar amount of copays you spend. Saving $10-15 a month on premiums isn’t worth it if you are paying an extra $150 a month on copays, coinsurance, or uncovered drugs. Pay the extra in premium for a drug plan that is right for you. Lower isn’t always better!

 

Higher isn’t always better, either.

I find that perceptions sometimes flip when it comes to Medicare Supplement Insurance. Clients believe that the most expensive and comprehensive plan is right for them, employing “you get what you pay for” logic. This saying is true a lot of times, but not always.

For instance, you can save approximately $20 per month by switching from a plan G to a plan N. The only difference between these two is a couple copays: $20 for office visits and $50 for emergency room visits.

This is where I lose people. They just don’t want the copays. But take a closer look. Is the free doctor and emergency room visits worth the extra $240 a year in premium? If you’re in good health, you probably only go to the doctor a few times a year for a general wellness test. It might save you $200 per year to go with a lesser coverage plan. In this case, it’s not worth it. When you compare the most comprehensive Plan F with G (see our blog “Underrated Plan G” by clicking here), you have another example, and that one is a no-brainer!

Of course, these choices are still up to you and your preferences. All I am asking you to do is not let premiums rule your decisions.

I’ve seen it work. Free thought leads to better value, all the time!

Need help shopping a Medicare Supplement Plan? Call Seniormark at 937-492-8800 for a free consultation!

 

Attention Retirees: Don’t Fall For These 2 Medicare Sales Tactics

Attention Retirees: Don’t Fall For These 2 Medicare Sales Tactics

Before the Medicare Improvements for Patients and Providers Act passed in July of 2008, Medicare Supplement salespeople had the upper hand. They could call you as much as they wished and show up at your doorstep uninvited. Medicare sales were practically a warzone.

Now, however, they have to be a little bit more clever about their sales tactics. Since they can’t contact you (except by mail) without your consent, they have to find some way to get permission from you—whether you realize what you are asking for or not. Here are two key strategies they use.

Online Quote Generators

It seems like an easy way to shop and compare Medicare Supplement prices in your area, but it may lead to a bombardment of unwanted calls and emails. Here’s how it works: When you put in your personal information like phone number or email, you consent to being contacted. You are essentially (but unknowingly) saying “hit me with your best shot!”

This is when the owner of these quote generators can sell your information to as many agents who care to buy. If you are one of the unlucky few whose contact is sold widely, you are in for an Armageddon of sales calls just like the barrage a client of ours so nobly braved. He claimed that within one minute of plugging in his phone number, the calls stormed in. To spare you the details, let’s just say he stopped picking up after 30 calls.

Tear and Return Reply Cards

I’ll bet your mailbox is practically bursting with Medicare literature. And I’ll bet a lot of them have a tear off reply card that asks for your contact information. Although it may seem official with its big “Do Not Destroy” stamps or fancy seals, this can be a ploy as well. If you can’t tell by the other content, there is a dead give away at the bottom of the mail in fine print where it says that an insurance representative may contact you.

 

“No. I’m not interested.”

I hope you don’t read this as “everything I get in the mail is bad” or “I should never give anyone my contact information” because this is simply not the case. There are wonderfully helpful people in the Medicare business who ask for your personal information. In fact, although we don’t ask for personal information, we send out mailers every month and have a quoting tool on our website!

The purpose of this post is to help you understand the difference between someone who trying to assist you and someone who is trying to badger you. No one wants his inbox overrun with spam. No one wants to answer a firing squad of phone calls a day with a sighing “I’m not interested.”

We know you don’t either.

If you would like to shop Medicare Supplements safely, click here to access our quoting tool. We don’t ask for any personal information!

Know The Drug Plan Lingo! 5 Terms to Get You Started

Know The Drug Plan Lingo! 5 Terms to Get You Started

Every field or discipline has its own language. And to the undiscerning ear, it can all run together into nonsensical jargon. Mumbo jumbo. Gibberish. Flim flam. Drivel. You get the idea. But if you want to walk the walk and get ahead, you must first talk the talk. To get you started, you’ve probably come across these 6 terms in your Part D Drug Plan research.

 

Formulary

I’ll start with an easy one. The formulary is simply the list of drugs a particular plan covers. There are 24 drug plans at your disposal. Not all of them will cover the same medications. This is why it is important to check a plan’s formulary to find out if it’s right for you.

 

Prior Authorization

If a drug plan requires prior authorization, it means that they will not cover certain drugs unless your doctor or prescriber proves that the medication is medically necessary.

 

Step Therapy

Drug companies do not want you on an expensive drug when a less expensive one will be just as effective. For this reason, they will often make their beneficiaries start on a generic or cheaper drug as a trial to see if it works just as well. If it doesn’t, then the beneficiary can “step” up to the more expensive (often name brand) medication. This is called step therapy.

 

Quantity Limit

Quantity limit is exactly what it sounds like: a limit on the quantity of a specific drug that a plan will cover. Drug companies limit quantity to reduce waste, curb drug costs, and prevent unsafe use. For example, if someone is on a pain medication with a standard dosage of 2 per day, the quantity limit for a month will likely be 60 pills. They don’t want people getting addicted or wasting them through misuse or carelessness.

 

Tiers

Drug plan companies often organize the medications they cover into levels or “tiers”. Drugs on a lower tier (often generic brands) have lower associated costs such as copayments or coinsurance. Drugs on a higher tier (such as name brand or specialty drugs) often have higher costs.

 

The Donut Hole

The donut hole is a gap is prescription drug coverage. After you reach $3,310 in total drug costs, you enter the donut hole (resulting in higher out-of-pocket costs). After you reach 4,850 in out-pocket costs, you leave the donut hole and enter into what is known as “catastrophic” coverage where the plan will cover 95% of your drug costs.

 

All done! If you finished reading this, your Medicare literacy just increased. But if you have run into any more difficult terms, leave a comment. We are more than willing to answer your questions. Or visit Medicare Interactive’s glossary for additional Medicare vocabulary.

 

Have other Medicare questions? Turning 65 soon and not sure what to do? 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!

What Is the Fastest Way to Sign Up For Medicare?

What Is the Fastest Way to Sign Up For Medicare?

Once you’ve determined that it’s time to apply and have carefully considered all of your options, you are now ready to sign up for Medicare. You’ve got grandkids to get back to, family events to plan, and the world to explore, so you probably want to get this item off your to-do list as quickly as possible.

 

Fortunately, the federal government understands you in this respect. In response, they have designed a user-friendly website and an online enrollment process. It’s quick (taking only about 10 minutes). It’s easy (because you don’t have to leave the comfort of home). And the very fact that you are reading this blog proves you are tech-savvy enough to handle it.

 

To Apply Online, Just Follow These Few Simple Steps:

  1. Go to Social Security’s Website
  2. Click on the “Menu” Tab.
  3. In the “Benefits” section, choose “Medicare”.
  4. Scroll down and click the “Apply for Medicare Only” button.  (you will only be applying for medical coverage — not social security payments)
  5. In the “Apply and Complete” section, choose “Start a New Application”.
  6. The site will guide you from there.

 

Slow Down Partner!

But just wait! Before you start clicking away gung ho, I want you to consider how much thought you’ve put into your Medicare decisions. Not because I want to keep you from your grandkids, but because I know making mistakes in this process can result in unnecessary penalties and unexpected costs. If you haven’t sat down with a retirement expert in consultation, I strongly recommend doing so. It will take extra time, but—as the clichéd saying goes—sometimes slow and steady wins the race.

 

If you need someone to take this weight off your shoulders, give Seniormark a call at 937-492-8800. We make retirement decisions as quick and painless as possible!

 

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. $134.00 will be your monthly premium unless you make $85,000 per year or more as an individual or $170,000 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 $15 to $128 monthly. The average cost for a drug plan is $35.63 in 2017. 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 $60 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 is only $166-366 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? 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!

photo credit:  http://www.espace.cool/prudence-how-much-can-we-afford/