Category: Medicare Drug Plan

Announcing……our next Medicare Workshop!

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Are you turning 65 and wondering what the next step is?

We will be holding our next Medicare Solving The Medicare Puzzle Workshop:

Tuesday, May 15 @ 5:30 pm – Location: Sidney office — 1602 Wapakoneta Avenue.

This is an introductory session explaining the 4 parts of Medicare and what an individual’s options are when they turn 65 or retire and go on Medicare.  We have had an excellent response to these workshops, so if you know of someone who could benefit, please let them know.

Seating is limited, so please RSVP:  Toll Free – 877-492-8803, or comment on this post!

State Teachers Retirement…To Save or Not To Save

I am often asked about the health insurance coverage offered by the State Teachers Retirement System (STRS) of Ohio and whether a retired teacher should stay on the STRS coverage once they turn 65 and go on Medicare.  I will be assuming here that the retiree had 30+ years of service with STRS.

As with all situations there is never a hard fast rule for everyone, but in most cases for the employee it is what I call a “no brainer.”  The current premium in Ohio for the employee is $81/month.  The plan offered by STRS is the Aetna Medicare Plan (PPO) which is a group Medicare Advantage Plan.  The plan has a $500 deductible and a $1500 annual out of pocket maximum (which includes the deductible).  More importantly, the prescription drug plan does not have the infamous donut hole like Medicare Part D has.  So if you are a retired teacher, be very wary of “advisors” recommending you leave STRS to go on a Medicare Advantage plan on your own.  If you have already made this mistake, don’t worry because you may be able to get back on your STRS plan.  Just give them a call to find out what to do.  You may have to wait until the Annual Enrollment Period (AEP) before you can get out of your current plan.

For the spouse of a retired teacher the story is much different.  The current premium for the spouse is $290/month for the same Aetna Medicare Plan (PPO).  On the surface it may seem like the answer is cut and dry, but not so quick.  There is no doubt that you can get much better medical coverage for a much lower premium.  But like I tell all of my clients, premium doesn’t tell the whole story.  We can’t forget about the prescription drug coverage.  Like I said above, you have to deal with the donut hole when you leave STRS and go with the Medicare Drug Plan.  So whether it makes sense to leave STRS and go out on your own will depend on your medications.  This is where you would be wise to contact a professional who can analyze the costs for you.  Here are two clients I have worked with in the past, with two very different outcomes:

 

Client 1:

This gentleman was in good health and only on three generic medications.  We were able to put him on a Medicare Supplement Plan G for $106/month and a Part D prescription drug plan for $25/month for a total of $131/month.  He wasn’t even close to having to worry about his donut hole.  With Plan G his annual out of pocket maximum on medical expenses is $140.  So for this gentleman he saved $159/month and now has much better medical coverage.

Client 2:

This lady was in fair health but had a very long list of medications including several brand name meds.  We could have put her on the same Plan G for $106/month and given her better medical coverage, but the real story was her medications.  With her meds she was going to go WAY into her donut hole.  This seriously raised her cost.  The premium for her drug plan was only $25/month, but because of the donut hole her total cost was going to average $333/month.  This combined with his $106 for Plan G made it a total monthly cost of $439/month, which would be $149/month more than she was currently paying.  We obviously told her to stay on STRS.

As you can see, you can’t just look at premiums when you are making a decision on the best plan for you.  Looking at the two examples above, the premium was the same for both clients, $131/month.  But the expenses were VERY different.  So before you make a decision you may regret contact a professional (not a salesperson) who can help.

 If you know a retired teacher, please pass this article along (just click the SHARE button below).  I’m sure they would appreciate it!

An Extra Alphabet Soup Seminar

Are you turning 65 and wondering what the next step is? 

Due to an overwhelming response to tonight’s Alphabet Soup Seminar, we have added another one next week.  We still have a few open spots.

Thursday, March 22 @ 5:30 pm – Location: Troy office — 1385 Stonycreek Road.

This is an introductory session explaining the 4 parts of Medicare and what an individual’s options are when they turn 65 or retire and go on Medicare.  We have had an excellent response to these meetings, so if you know of someone who could benefit, please let them know.

Seating is limited, so please RSVP:  Toll Free – 877-492-8803, or comment on this post!

Next Alphabet Soup Seminar

Are you turning 65 and wondering what the next step is? 

We will be holding our next Medicare Alphabet Soup Seminar:

Thursday, March 15 @ 5:30 pm – Location: Troy office — 1385 Stonycreek Road.

This is an introductory session explaining the 4 parts of Medicare and what an individual’s options are when they turn 65 or retire and go on Medicare.  We have had an excellent response to these meetings, so if you know of someone who could benefit, please let them know.

Seating is limited, so please RSVP:  Toll Free – 877-492-8803, or comment on this post!

Donut Holes Aren’t Always Tasty!

If your brain works like mine, it thinks about food a lot more than it should.  And it’s always food that’s not good for me, like donut holes.  Nothing beats a donut hole.  It’s like eating a whole donut in one bite…AWESOME!

But when it comes to the Medicare Prescription Drug Plan, donut holes lose their luster.  Don’t ask me why Medicare decided to give it the name donut hole, maybe it was to take the edge off its bite (no pun intended, unless you think it’s funny).  The Donut Hole, otherwise known as the coverage gap, is exactly what it sounds like.  It is a hole in your coverage.  Here’s how it works according to the Medicare guidelines:

Stage 1: The plans start off with a “Deductible Period.”  This is the amount you must pay for out of your pocket before the plan will pay anything.  Not all plans have a deductible.  The plans cannot have a deductible higher than $320.

Stage 2: After you have met your deductible (if you have one) you go into what is called the “Initial Coverage Level.”  During this stage you will pay approximately 25% of the cost of the medication.  Most drug plans set up copays during this stage based on the medication which they assign to a Tier.  For instance, you might pay a copay of $5 for generics (Tier 1), $25 for formulary brand names (Tier 2) and $45 for nonformulary brand names (Tier 3).

Stage 3:  Once you have had $2930 in total drug costs, you will go into the “Donut Hole.”  Notice I said “total drug costs.”  This means what you paid for the medications plus what the plan paid.  For example, if the total cost of a medication is $100 and you only had to pay a copay of $25, it’s the entire $100 that goes toward the donut hole number.  Once in the donut hole you will pay 50% of the full cost of any brand name medications and 86% of the full cost of any generics.  Due to the new healthcare reform, these percentages will continue to decrease each year until they reach 25% in the year 2020.

Stage 4:  Once you have paid a total of $4700 in out-of-pocket costs (not including the premium for the plan), you enter the “Catastrophic Coverage Level.”  Notice that this amount is out-of-pocket meaning that you would have to pay a total of $4700 before you entered this next level.  Once you hit this level you would only pay approximately 5% of the cost of the medication for the rest of the calendar year.

Once you reach the end of the calendar year, all plans start back at Stage 1 on January 1st.

According to a report from the Kaiser Family Foundation, approximately 19% of Medicare beneficiaries reach the donut hole at some point during the year.  So not everyone has to worry about hitting the donut hole, but if you do your expenses can add up in a hurry.  For those of you who are in this situation, maybe you can ease the pain with a box of donut holes (the good kind from the local bakery).

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Next Medicare Alphabet Soup Seminar

We will be holding our next Medicare Alphabet Soup Seminar:

Thursday, February 16 @ 5:30 pm – Location: Sidney Office – 1602 Wapkoneta Ave.

This is an introductory session explaining the 4 parts of Medicare and what an individual’s options are when they turn 65 or retire and go on Medicare.  We have had an excellent response to these meetings, so if you know of someone who could benefit, please let them know.

RSVP:  Toll Free – 877-492-8803

Bullies Ain’t Just in Elementary School

Everyone remembers the bully from their elementary and high school days.  In most cases it was the stronger picking on the weaker.  You would think that 30, 40, or 50 years later things would be different, but it seems nothing has changed.  Not a month goes by that I don’t hear a story from one of my clients about an insurance agent bullying them or someone they know.  Bullying in the insurance industry comes in many different sizes and colors.  A few of them come to mind based on recent events…

1.  They prey on your fears!  I just received a call today from a new client of ours who we saved money by switching her from her existing medicare supplement policy to a policy with one of the companies we represent.  She had called very upset because she had just received a phone call from her previous agent.  He had called to tell her about all the coverages she would be losing by switching to the new supplement company.  He had proceeded to tell her that she would no longer be covered for preventative services (not true), that she would be responsible for a $155 deductible (this was the deductible amount for 2010, he was off a couple of years) and that one of her routine tests would no longer be covered (also not true).  If this agent was sincerely looking out for his client, then I apologize.  But at the least, he should know the plans he is representing.  If he was only concerned with the loss of his commission, then SHAME ON HIM!

2.  They prey on your good will!  No one “likes” to tell someone NO, or hurt someone’s feelings.  Pushy agents know this, that’s why they continue to push.  If they push long and hard enough they know that you will give in and buy, you don’t want to hurt their feelings, right.  You would recognize these agents if you ever told them NO, because many times they will get angry and rude when they don’t get the sale.  I recently met with a woman who was TOLD by an agent that the agents plan was much better than what she had and the agent proceeded to fill out an application without asking the woman if she wanted to move forward.  Not really knowing if the plan was better or not, and not wanting the uncomfortable feeling of saying NO, she proceeded to sign the paperwork and complete the sale.  She had told me afterward that she felt very uncomfortable with the agent.

3.  They just plain bully you!  Another recent experience I was told was from a woman we had switched from her current policy to a new policy with us.  She ended up cancelling the new policy because her existing agent had called her and TOLD her that she couldn’t switch because HE was her agent and HE was the one she had to work with.  Worse yet he told her that he was on vacation and that he would deal with it when he got back.

Now don’t get me wrong, there are a lot of agents out there who really do care about you and are doing their best to help.  I also know that the above examples are just one side of the story, so if I was getting the wrong side I apologize.  But I hear stories like this more frequently than I should, which tells me that many of them are, unfortunately, probably true.  When did money become more important than people?  To the agents who are bullying, KNOCK IT OFF!  To those of you who are being bullied, STAND UP AND SAY NO!