Category: Medicare Drug Plan

10 Terms to Beef Up Your Medicare Literacy

Posted on November 8, 2018 by - Medicare, Medicare Annual Enrollment, Medicare Drug Plan, Medicare Supplement, Retirement Planning

10 Terms to Beef Up Your Medicare Literacy

In this day and age, you have a vast pool of knowledge available to you. But none of that matters if you can’t understand any of it. If you’ve done any researching on the Internet about Medicare, you know what I mean. To help you out, I compiled a list of important terms that often catch retirees unaware.

 

  1. Annual Enrollment Period (AEP)

The AEP is the busy time of year for Insurance companies such as ours. You can think of it as the black Friday of Medicare. It is the time of year (October 15—December 7) when Medicare beneficiaries can switch plans, drop plans, and join new ones. It is an open market, a bustling time for anyone involved with the Medicare industry.

 

  1. Open Enrollment Period

The day you turn 65 and are signed up for Medicare Part B is the first day of your open enrollment. This 6-month long time frame is the window in which you can get on ANY Medicare Supplement plan, regardless of health! You will want to take advantage of this…your options narrow significantly outside of open enrollment.

 

  1. Deductible

A deductible is the money you have to pay upfront before the benefits of a plan begin. For example, Part A of Medicare has a $1340 deductible. They will not cover anything until you reach it.

 

  1. Copayments

Copays are a set dollar amount you pay in addition to the payment made by the insurer (whether it be Medicare or a private insurance company). Think of the $10-50 fees when you visit the doctor’s office or buy a certain prescription drug.

 

  1. Coinsurance

This is very similar to copayments, but it is a set percentage instead of a dollar amount. For example, the Medicare Part B coinsurance is 20%. This means you pay 20% of the total bill, not a set dollar amount.

 

  1. Out-of-pocket Costs

All three of the previous terms (deductibles, copays, and coinsurance) are all a part of a much larger concept of out-of-pocket costs. In other words, your out-of-pocket costs are everything you pay for your healthcare beyond your premium. One warning you will receive a lot is this: With only traditional Medicare (parts A and B), there is no limit to your out-of-pocket spending. Yes, I am low-key warning you again, but hopefully you fully understand it now.

 

  1. Donut Hole

Speaking of out-of-pocket costs, for a Part D drug plan, they are highest in the donut hole, a gap in prescription drug coverage. You enter the donut hole when you reach $3750 in total costs and exit it once you reach $5000 in out-of-pocket costs.

 

  1. Drug Tiers

Drug plan companies often organize the medications they cover into levels. They call these levels—you guessed it—tiers. Drugs on a lower tier (often generic brands) have lower copays and coinsurance. Drug on a higher tier (such as brand name or specialty drugs) often have higher associated costs.

 

  1. PPO

PPO stands for Preferred Provider Organization. So a PPO is a health plan that has a network of “preferred” doctors and hospitals. If you use those doctors and hospitals, they reward you will lower out-of-pocket costs.

 

  1. HMO

HMOs (Health Maintenance Plans) are a little bit more intense than PPOs. It is the same idea, but HMO plans won’t cover you at all if you don’t use their network of hospitals and doctors.

 

That brings this list to close. If you are still confused about a term on this list, ask us for help in the comments section. Have you come across another difficult word on your Medicare planning journey that you think we should add? Let us know. We want to hear from you!

 

Annual Enrollment is the only time of year you can switch your Medicare Advantage Plan or Part D Drug Plan! Looking to review your plans with a Certified Senior Advisor this open enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

Drug Plan Check Up: Is your Drug Plan Still the Best Plan for You?

Posted on October 4, 2018 by - Medicare Annual Enrollment, Medicare Drug Plan, Uncategorized

It’s annual enrollment…is your Part D drug plan still the best plan for you?

As most of us remember, there are some VERY important dates associated with Annual Enrollment.  As we discussed earlier in “Don’t set it and forget it” we don’t want to miss these dates.  There are several things that need to be done during annual enrollment but for now let’s focus on the Part D drug plan.  DON’T ASSUME THAT SINCE YOUR PLAN COVERED YOUR MEDICATIONS LAST YEAR THAT YOUR MEDICATIONS WILL BE COVERED THIS YEAR.  Yes, I know, it isn’t convenient that things change, but they do.  So please make sure you review your part D plan this annual enrollment.

For 2019 there will be more than 20 drug plans available in Ohio.  How in the world do you know which is best for you?  Well, there are several things to consider.  Your medications.  The plan’s formulary.  Your preferred pharmacy.  The plan’s preferred pharmacy.  The premium cost.  And so on…  You should have received the Annual Notice of Change for your current plan in late September so make sure you review it!   How do you know if your current plan is still the best plan for you in 2019?  Let’s face it, even if you try and do your homework this stuff is confusing!  As much as we would love to help everyone review their prescription drug plan for 2019, annual enrollment is just too busy for us.  We unfortunately can’t help with the Part D comparisons BUT there are people that can!    If you are still confused and unsure if you’re in the right plan for 2019, please call OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578.  OSHIIP trained volunteers are happy to help.  Make sure you have your Medicare card and list of prescription drugs handy.  If you don’t want to make a phone call, check with your pharmacy and see if they will help you re-shop your plan.  Some pharmacies will assist with this process.  And of course, if you are internet savvy and comfortable doing the comparisons on your own, visit www.medicare.gov and shop it yourself.  Please click here for more information on comparing your plan online.   No matter which way you choose – please make sure you review your Part D drug plan this annual enrollment period starting October 15th through December 7th!

And, as always, if you still have questions, do not hesitate to give our office a call at 937-492-8800.

Don’t “Set It and Forget It” This Annual Enrollment Season!

Posted on October 1, 2018 by - Medicare, Medicare Advantage, Medicare Annual Enrollment, Medicare Drug Plan, Medicare Supplement

Don’t “Set It and Forget It” This Annual Enrollment Season!

Does anyone remember Ron Popeil?  If you don’t, allow me to rephrase the question.  Does anyone remember the “set it and forget it” infomercial king?

 

I bet it’s ringing a bell now.

 

I, for one, can still see him in his green apron, armed with nothing but some well-seasoned meats and a fancy rotisserie cooker, taking the cheesy and overly scripted infomercial world by storm: “All you have to do is…”  The unrealistically enthused audience chants, “SET IT AND FORGET IT!”

 

He was like the Billy Mays of the 70s, but with food instead of cleaning products.

 

But I digress…back to the topic at hand.  The reason I retrieved this slogan from memory lane is to make a point: Many people have the “set it and forget it” mindset with their Medicare Health Insurance Plans.  They think that once they undergo the process of enrolling in Medicare, enrolling in supplemental coverage or an Advantage plan, and signing up for a drug plan that they never have to change anything again.  Happily ever after.

 

But this just isn’t true.  Yes, most of the work is done.  And you’ve definitely done the minimum to get by.  But there’s a good chance your situation will change over time.  And, even if your situation doesn’t change, there is a very good chance your health care plans will, oftentimes drastically.  This leaves you in an ill-fitting plan that doesn’t meet your needs or your budget.  You may need to switch!

 

When it comes to Medicare Annual Enrollment, there is a reason for the season.  From October 15—December 7, you have the opportunity to make strategic changes to your health care plans.

 

Here are 3 reasons you might need to make changes this year!

 

The Medicare Supplement Creep

Medicare Supplements are typically consistent from year to year.  The benefits are guaranteed to stay the same, and the premiums rarely increase drastically.  But the premium cost almost always creeps up, dollar by dollar, slowly but surely.

 

If you stay on that ride for too long, you could end up paying $100+ more a month than you should.  In fact, if you have been in the same Medicare Supplement Plan for 4-5 years, there’s a good chance you’re paying too much for it.  Shopping around for a better deal this year could save you hundreds…and all without reducing your coverage.

 

REMINDER:  You can change your Medicare Supplement any time of year (click here for related info), not just annual enrollment.

 

The Advantage Plan Leap

There are so many aspects of an Advantage Plan that can frog around over time.  The deductible may go up.  The premium may go down.  You might have higher copays.  Your coinsurance might drop.  And beyond benefits and price, doctors and hospitals may go in and out of your plan’s network.  A doctor available to you this year, may not be available the next.

 

This is why it is important to review your plan.  Is your family doctor still within the plan’s network?  Is it still the best value for you?  If you simply set it, forget it and let it skate by another year, you’ll never know.

 

The Drug Plan Drop

A drug plan may vary in cost from year to year, but what you really need to check is the list of medications the policy covers, also known as the formulary.

 

Over the years, a drug plan may discontinue or reduce coverage on certain medications.  Imagine if the drug it discontinued was your most expensive one, and you didn’t realize it.  Yeah…it could be a financial disaster.

 

Review Your Plan This Year!

So make sure to take control of your health insurance options.  Review your plans, and take careful note of all the changes.  The “set it and forget it” philosophy might work well for cooking chickens, but it doesn’t work for this.

 

For your health insurance, I offer another slogan:  If you set it and forget it, you might regret it.

 

Maybe that will catch on…

 

Yeah…probably not.

 

Looking to review your plans with a Certified Senior Advisor? Call Seniormark at 937-492-8800 for a free consultation.

Take Advantage of What Medicare Covers in FULL

Posted on November 9, 2017 by - Medicare, Medicare Annual Enrollment, Medicare Drug Plan, Medicare Supplement

Take Advantage of What Medicare Covers in FULL

Medicare alone doesn’t cover very much in full. There’s almost always some sort of coinsurance or copayment or other out-of-pocket cost.  This is why many people purchase Medicare Supplement Insurance to fill in the gaps (I recommend that you do so as well).

 

But there is something that Medicare fully covers—and that is preventive services. This includes lab tests, screenings, vaccinations, virtually any service performed to ensure that health problems are caught early—before they become…well…even bigger and more threatening problems.

 

This means that—as long as you meet basic eligibility requirements—you won’t pay a dime for most preventive services. The only ones I found that required any out-of-pocket costs were glaucoma screenings, diabetes self-management training, digital rectal exams (to detect prostate cancer), and barium enema (to detect colon cancer).

 

To give you an idea of the scope of preventive services that Medicare offers, here is a quick list:

  • Colonoscopies
  • Mammograms
  • Annual Wellness Visits
  • Diabetes Screenings
  • Vaccinations
  • Blood Tests
  • Depression Screenings

And this is just scratching the surface.

For a more comprehensive list with all the details, click here to access the Medicare preventive services guide.

 

Keep Track of Preventive Services on mymedicare.gov!

Some of these services are offered every year, some every other year, and some less or more often. Your risk level for certain diseases (based on age, gender, or family history) can also play a factor in how often you are eligible for services. Needless to say, it can be a lot to manage, which is why I recommend using mymedicare.gov. This free online account (among other things) allows you to see which preventive services you are eligible for and when.  Sign up here:  MyMedicare.  You can also print off a personalized report to bring to your doctor. This will help the both of you plan out when and if you should receive the various services.

 

I hope you consider taking advantage of what Medicare has made available. The reason they made it free is because they know how important it is for retirees to take care of themselves in a proactive way. It is good for them, and it is good for you—money wise and otherwise.  No one likes to spend time at a cold doctor’s office, especially when getting a colonoscopy (geesh). But staying on top of your health now, can save you having to deal with major health issues later. It can keep you on the go and healthy during retirement, an era of life that I believe should be as (if not more) fulfilling and exciting as all the rest.

 

Have any questions or concerns about Medicare? Call Seniormark at 937-492-8800 for a free consultation.

Turning 65 and not sure what to do?  Consider signing up for one of our FREE workshops in Sidney or Vandalia, Ohio!  Sign up here:  Seniormark workshops.

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

Posted on October 16, 2017 by - Medicare, Medicare Advantage, Medicare Annual Enrollment, Medicare Drug Plan

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.

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

Posted on July 18, 2017 by - Health and wellbeing, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Uncategorized

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

Posted on July 12, 2017 by - Health and wellbeing, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Uncategorized

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.

 

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

Posted on June 13, 2017 by - Medicare, Medicare Drug Plan, Medicare Supplement

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!

 

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

Posted on April 26, 2017 by - Employer, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

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?

Posted on April 3, 2017 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

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!