Tag: Medicare Advantage Ohio

Prescription Drug Assistance: Where to Get Help

Posted on August 10, 2015 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

Here is a Helpful article that was recently in the Dayton Daily News.

By Marci Vandersluis

Contributing Writer

I recently visited with a couple that shared that they were having difficulty paying for some of their prescription medications. One spouse stated that some of their medications had very high out of pocket costs. These co-pays were affecting their ability to pay for some needed home repairs along with food purchases. While this article has no magic solutions on how to eliminate prescription drug costs, it should be of some relief to know that with a little perseverance, along with some web “surfing”, there are programs and services available directed towards providing prescription assistance to lower income older adults.

Since 2006, those eligible for Medicare have been encouraged to enroll in a Medicare Part D plan, which provides prescription drug coverage. The two ways to get coverage are either through adding drug coverage to original Medicare, or to enroll in a Medicare advantage plan that offers Medicare prescription drug coverage. Beneficiaries must first have Medicare A and/or B to enroll in a drug plan and must have Medicare A and B to qualify for enrollment in a Medicare Advantage Prescription Drug plan. It is important to note that while enrolling in a Medicare D plan, is voluntary, not signing soon after eligible or when other medical coverage (such as an employer sponsored plan) ceaseD-resized-600s will result in a monthly financial penalty that will continue through the duration of coverage.

Most have found that while the implementation Part “D” has provided significant cost saving, it continues to present some challenges for beneficiaries. One such frustration is the feared coverage gap or “doughnut hole.” In 2015, once the beneficiary and drug plan have spent $2960, the person is responsible for much higher of pocket costs for prescriptions. Once these costs reach $4,700 the beneficiary is only responsible for 5 percemt of prescription costs, for the remainder of the year. While Medicare is working on more discounts for those in the coverage gap with the ultimate goal of closing the gap in 2020, there are still significant costs while in the “ doughnut hole.” Monthly statements from your drug plan will outline explanation how much has been spent on medication and if you have reached the coverage gap.

Co-pays for some medications can be very expensive even when not in the coverage gap. Fortunately, for those who meet certain financial guidelines there are some programs to help with prescription drug costs. One such program is the Chubby Checker, Patty Duke, endorsed Medicare Extra-Help program. Individuals with income of approximately $17,655 yearly income ($23,895 for married couples), with resources of approximately $13,640 ($27,250 for married couples) should consider applying for this program as it can offer considerable savings. See below for the link to apply online. If there are additional circumstances, if only marginally above these guidelines, or even if in doubt regarding eligibility, it is encouraged to apply. The Medicare website also advises contacting and your specific drug plan to see if eligible for any type of extra help.

Resources

Ohio Benefit Bank-Consumer Hotline: 800-648-1176 or www.ohiobenefits.org

United Health Solutions: 937 220-6600 or www.uhs-dayton.org

Partnership for Prescription Assistance: 888-477-2669 or https://www.pparx.org

Needymeds: Helpline 800-503-6897 or http://www.needymeds.org/newuser

Ohio’s Best Rx: 866-923-7879 or http://www.ohiobestrx.org/en/index.aspx

Good RX-drug discount card: 888-799-2553 or https://www.goodrx.com

Drug companies that offer assistance:http://www.needhelppayingbills.com/html/get_free_prescription_drugs.html

Medicare information on lowering drug costs: 800-633-4227 or https://www.medicare.gov/part-d/costs/coverage-gap/ways-to-lower-drug-costs.html

Ohio Senior Health Insurance Information Program (OSHIIP): 800-686-1578 orhttp://www.insurance.ohio.gov/Consumer/OSHIIP/Documents/whatisoshiip.pdf

Medicare Extra Help: 800-772-1213 or www.socialsecurity.gov/extrahelp (Online application)

Medicare Supplement Policyholder Alert!

Posted on March 10, 2015 by - Uncategorized

postcard33Have you received this postcard in the mail?  Is it coming from Medicare?  Is it important information?  It does say, “REGISTERED DOCUMENT – DO NOT DESTROY.”  The truth is this is just a solicitation for insurance, and if you mail in the return postcard you are sure to get a call from an insurance agent, or worse yet a knock on your front door.  The unfortunate truth is we now live in a world of information overload and everyone is vying for your attention…yes, even me.  And in the world of Medicare, some lead companies resort to making the older population believe their mailing is more than it is.

If you look closely at the small print at the bottom you will read, “This information is not affiliated or endorsed by government agencies or the federal Medicare program.  You may be contacted by an insurance licensed representative.”  This disclaimer language is a sure sign that the mailing is a solicitation as it is required by Medicare.  I am not judging those who use these postcards to drum up business, in fact these cards are completely compliant with current regulations.  I just believe there is a better way…honesty!

Why can’t we replace the words, “REGISTERED DOCUMENT – DO NOT DESTROY” with, “THIS IS NOT A REGISTERED DOCUMENT – DESTROY IF YOU WANT…BUT IF YOU DO, OUR AGENCY WON’T BE ABLE TO HELP YOU!”  Why can’t we just get back to letting people know we are here to help when they need it.

Here is a great example:

https://www.youtube.com/watch?v=FrmYLo3tMA8

Medicare Solicitation

Posted on October 7, 2014 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

knockingIt has been brought to our attention (thanks to our clients) that several medicare supplement/medicare advantage agents in the area have been going door to door soliciting new business.

If you don’t know, it is illegal for an agent to stop at your door, or call you on the phone, without an existing business relationship.

If this happens to you, please do us and yourself a favor and let them know they are not allowed to solicit door to door. If they don’t agree, direct them to Ohio Administrative Code 3901-8-09, Section (D)(2)(a).

At Seniormark, we work diligently to follow the rules put before us.  If you are considering making any changes to your existing plans, give us a call before you do — we are happy to help!!!  (937) 492-8800.

 

 

Medicare Supplement policyholders are paying too much for their coverage!

Posted on July 21, 2014 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Social Security, State Teachers Retirement

If your parents were like mine, they probably taught you to spend your money wisely. Let me use a story here to make a point. Suppose you are shopping for a new refridgerator. Your first stop is at Sears where you find the perfect Frigidaire XL2014, and at a great price, $2100. But because your parents told you to shop before you buy, you decide to check a few more places. The last stop you make is at Lowes, where you find the same Frigidaire XL2014. Same make, same model, same features…they are IDENTICAL! Only the one at Lowes costs $1500. Do you go back to Sears and buy the one for $2100? Unless you own stock in Sears, or your son is the sales rep, I hope your response is…Absolutely not! Why would you spend $600 more on the same thing. But Retirees are doing that very thing with their Medicare Supplement insurance.

 

But you may ask, “How do I know I’m getting the same benefits?” The answer is simple, our government did something right. Prior to 1992, Medicare Supplement insurance plans were not standardized. What this meant was that each insurance company’s Medicare supplement plans offered different benefits. This made it almost impossible for the Retiree to shop their coverage from company to company. Compare it to shopping for a car today. You can’t really compare cost from one dealer to another because the options are completely different. This one has leather seats, but the other one has On-Star. This one has a DVD player, but the other one has alloy wheels. It is impossible to truly compare cost because you are never comparing “apples to apples.” The same was true with Medicare Supplement insurance prior to 1992. But in 1992 the federal government stepped in and “standardized” Medicare Supplement insurance.

 

They did this because prior to 1992, unethical salespeople were taking coverage away from Retirees in order to save them money, and they weren’t disclosing the fact that they reduced their coverage. So the government stepped in and standardized the plans so this couldn’t happen anymore. They did this by offering 11 plans and giving them the letter names of A through N. In other words, it means you can compare a Plan F with one company to a Plan F with another company and know that the benefits are IDENTICAL. So you no longer have to say, “I know my supplement is expensive, but I don’t want to change it because it pays so well.” As long as you stick with the same Plan letter name, the new company is legally obligated to pay the same benefits as your old one.

 

So what does this mean for you? It means it would be a good idea to know what premium you pay compared to what others your age and in your area are paying for the same plan. This is important because you may be paying hundreds if not thousands of dollars more per year in premium and not be getting any better benefits. For example, the premiums for a Plan F for a 70 year old female range from $130/month on the low end up to $276/month on the high end. That’s a difference of $1,752 per year. And worse yet, the person paying $276/month is not getting any better benefits than the person paying $130. And don’t forget, you can change your medicare supplement policy any time of the year…you don’t have to wait for the Annual Enrollment Period at the end of the year.

 

If you would like to see how your premium compares, you can go to our website at www.seniormark.com and click on the “Supplement Rates” tab. And don’t worry, you will get instant numbers and we won’t collect your personal information. If you are not tech savvy just call us at 877-492-8803 and we will provide you with a free comparison report.

 

I bet your momma never thought shopping would be this easy!

Seniormark Alert: Observational Status could cost you tens of thousands of dollars

Posted on January 23, 2014 by - Medicare, Medicare Advantage, Medicare Supplement, Social Security

For the past year and a half I have been talking with clients about the difference between an “Inpatient” hospital stay vs. being in the hospital under “Observational Status” and why it matters.  If you missed my previous blog post on this issue you can read it HERE.

This information is finally getting media coverage which is good because what you don’t know can Hurt A Lot!  Here is NBC Nightly News’ coverage of the topic from a few weeks ago:

Capture

Feel free to comment below if you have any questions…

Can Medicare Advantage survive PPACA?

Posted on September 6, 2013 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Social Security, Uncategorized

Here is a great article about how the Patient Protection and Affordable Care Act (aka Obamacare) may affect the Medicare Advantage program…

Can Medicare Advantage survive PPACA? | BenefitsPro.

Attention Seniors…Beware of Sharks!

Posted on October 1, 2012 by - Medicare Advantage, Medicare Drug Plan

A feeding frenzy is about to begin.  No, I am not talking about real sharks.  I am referring to the Medicare Annual Enrollment Period (AEP).  The Annual Enrollment Period is the time of year, set aside by Medicare, during which Medicare beneficiaries can enroll in or change their Medicare Advantage or Prescription drug plans.  The AEP runs from October 15 to December 7, although insurance companies and agents can begin marketing to you beginning October 1st.

The problem arises due to the fact that this is the only time of the year that insurance companies and agents can market their Medicare Advantage and Prescription Drug plans to you – unless you are new to Medicare.  In my opinion, this leads to very aggressive marketing behavior.  Now don’t get me wrong, just like every shark in the ocean is not out to bite you, not every agent and insurance company is out to take advantage of you, but you do need to be aware.

So what steps can you take to protect yourself?

Know what you have.  It is extremely important to know what type of plan you have.  Do you have Traditional Medicare Parts A&B paired with a Medicare Supplement policy, or do you have Part C of Medicare which is a Medicare Advantage plan?  If you have a Medicare Supplement policy, what plan do you have (A – N)?  If you have a Medicare Advantage plan, do you have a HMO, PPO or PFFS plan?  Do you have a stand-alone Part D prescription drug plan or is it part of your Medicare Advantage plan?  These are all important questions to ask yourself.

Know what you should do.  The first thing you should know is that you don’t have to do anything, unless your plan is terminated for some reason.  If that is not the case, and you are completely happy with your plan, you can just leave everything “as is.”  With that said, it is important to review any benefit, premium or formulary changes to your plan.  If you have a Medicare Advantage or Prescription Drug plan, your plan will send you an “Annual Notice of Change” packet explaining any changes to your plan for 2013.  Don’t assume that because your medication was covered this year that it will automatically be covered next year.  Finally, don’t let any agent or insurance company lead you to believe that you have to make any changes.

Know what you can/can’t do.  There are a lot of rules surrounding Medicare, so be careful when you do make any changes.  Some changes could get you disenrolled from a plan you didn’t intend to get disenrolled from.  Don’t assume all agents know these rules.

Know what agents can/can’t do.  It is important to know that agents cannot cold call you in any way, meaning that if you didn’t invite them, they can’t contact you – except by mail.  Be careful when requesting free information whether by mail or on the internet.  Many times when you request this free information, you have just given an agent permission to contact you.  If you have made this mistake in the past, you know how many phone calls you can get.  The Ohio Department of Insurance put out an excellent flyer called, “Medicare & You: Understanding & Protecting Yourself from Predatory Sales practices.”  You can view this form on their website.

Work with a trusted advisor.  When you do have questions or need to make changes to your plan, make sure you work with a trusted advisor.  An advisor is someone who listens to you and helps you find a plan that is right for you based on all the options available.  A salesperson is someone who will tell you what you want to hear so they can sell you a product.  Sometimes it’s hard to tell the difference, so do your homework on this one.  How long have they been in the business?  Are they a jack of all trades or do they focus on senior insurance?  Do they have a local office?  Do they have a website to help you research your options?  Do they work with someone you know who can vouch for them?  Are they available during working hours to help you, or do you just get their voicemail?

If you will do your homework and become knowledgeable in these five areas, you will have come a long way in protecting yourself and making sure you don’t get bitten when the feeding frenzy begins October 1st.