2019 Medicare Costs

Medicare Part A

Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”).  If you paid Medicare taxes for 40 or more quarters and you have earned your Social Security Benefit then you will not pay the Part A premium.  You have earned it through your taxes.

However, if you paid Medicare taxes for less than 30 quarters, the standard Part A premium you will pay is $437.  

If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240. 

Medicare Part B

The standard Part B premium amount for 2019 will increase by $1.50. The premium will increase from $134 to $135.50.

Medicare Deductibles

The annual deductible for all Part B beneficiaries will be $185.00 in 2019.  However, depending on the insurance plan you choose, this deductible may be covered by your supplmental insurance plan.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,364.00 in 2019.. The Part A deductible covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care per stay in the hospital. After this 60 day period the daily coinsurance amount will be $341 for days 61 through 90 and $682 for each lifetime reserve day used.  Again, depending on the insurance plan you choose, these deductibles and some coinsurance amounts may be covered by your insurance plan.

Higher income households will pay more.

If your household income is more than $85,000 and you are single or more than $170,000 and married you will pay a higher monthly premium for Part B that will be between $189.60 to $460.50 depending on your income.  Click here to download a pamphlet from Social Security titled, “Medicare Premiums: Rules for Higher-Income Beneficiaries for more information.”

Your income is based on your tax return from 2 years prior.  Meaning for 2019 Social Security will use your tax return from 2017 to determine your household income.  But you may be able to get the high-income surcharge reduced or eliminated if your income has decreased since then because of certain life-changing events, such as the death of a spouse, divorce, retirement or reduced work hours.  In that case, you can ask Social Security to use your more recent income instead.  Contact the Social Security Administration, estimate your 2019 income, and provide evidence of the change, such as a marriage or death certificate, a signed statement of retirement from your employer, or pay stubs showing your reduced income.nk is external)

Are you retiring in 2019?

There is no cost or obligation for you to talk to me and get the answers to your questions.  I welcome all questions and it is my goal to be the single best resource in the state for such questions. And when the time comes for you to enroll in a Medicare Supplement and Prescription Drug Plan, I will help you with that too.

I am a licensed insurance agent working in Maine and New Hampshire.  I have contracts with the top health insurance companies available in the area.  I am able to help you via email, on the phone, or in person.

If you would like to review your options over the phone or schedule a meeting at your home or office you can reach me at 207-370-0143 or schedule an appointment on my booking website here.(link is external)

“The best part about working with me is that it costs you nothing and you benefit from my full knowledge and experience.”

That’s right.  You pay nothing to meet with me.  I am paid by the insurance companies in the form of a commission when you enroll in a plan. You pay the same price for the insurance whether you go direct to the insurance company or take advantage of working with someone who has experience and knowledge to help guide you. My goal is to help people and I have found great joy in being able to offer my services to people who need my help.

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

2019 Part D Costs

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 costs for a standard Part D prescription drug plans.

Here are the highlights for the CMS defined Standard Benefit Plan changes from 2018 to 2019. This “Standard Benefit Plan” is the minimum allowable plan to be offered by insurance company who has a contract with Medicare to offer Part D prescription drug insurance.

  • Initial Deductible:
    will be increased by $10 to $415 in 2019.
  • Initial Coverage Limit (ICL):
    will increase from $3,750 in 2018 to $3,820 in 2019.
  • Out-of-Pocket Threshold:
    will increase from $5,000 in 2018 to $5,100 in 2019.
  • Coverage Gap (donut hole):
    begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 in 2019.
    In 2019, Part D enrollees will receive a 75% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 70% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP (True Out Of Pocket).
    For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2019 total out-of-pocket spending limit.
    Enrollees will pay a maximum of 37% co-pay on generic drugs purchased while in the coverage gap (a 63% discount). For example: If you reach the 2019 Donut Hole, and your generic medication has a retail cost of $100, you will pay $37. The $37 that you spend will count toward your TrOOP (True Out Of Pocket).
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**:
    will increase to greater of 5% or $3.40 for generic or preferred drug that is a multi-source drug and the greater of 5% or $8.50 for all other drugs in 2019.
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    will increase to $3.40 for generic or preferred drug that is a multi-source drug and $8.50 for all other drugs in 2019. 

If you live in Maine or New Hampshire and would like to learn more about the new Medicare plans for 2019 or to go over the changes in your plan, you can call me at (207) 370-0143 or CLICK HERE to send me an email message.

You can also use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information in the mail if you choose. 
Have a question that needs to be answered right away?  You can talk to a licensed insurance agent by calling (207) 370-0143 or toll free 866-976-9038.
Book an appointment with Maine Medicare Options using SetMore

C.O.B.R.A.

Everything you need to know about COBRA

COBRA provides the ability for you and the dependents covered on your health plan to keep coverage after you lose your job or lose coverage for other reasons.

You are eligible for COBRA if your employer’s health plan covers at least 20 employees and you have had an acceptable “qualifying event.”   

A qualifying event is something that causes you or your dependents to lost health coverage, such as termination of employment, loss of full-time status, divorce or legal separation, or turning 26 (in the case of your children.)

If you have one of these events, your employer will notify you of your option to enroll in COBRA coverage within 14 days of the plan ending.  You will then have 60 days to decide if you want to enroll.

You can keep COBRA coverage for 18 or 36 months, depending on the qualifying event.

In general, COBRA only applies to employers with 20 or more employees. 

But, some states require employers covering employers with fewer than 20 employees to let you keep your coverage for a limited time.  This is often referred to as “Mini-COBRA” and you can read more about how Maine handles this here:  https://www.maine.gov/pfr/insurance/faq/cobra_faqs.html
 

Your Employer’s Responsibility:

The employer must tell the plan administrator if you qualify for COBRA because of one of these reason:

  • The covered employee dies
  • The covered employee lost her/her job
  • The covered employee becomes entitled to Medicare
Once the plan administrator is notified they must let you know you have the right to choose COBRA coverage.
 

Your Responsibility:

You or the covered employee are responsible to notify the plan administrator if you qualify because of on of the following reasons:
  • You’ve divorced or legally separated from the covered employee
  • You were a dependent child or dependent adult who is no longer a dependent.
You will need to tell the plan administrator about your change in situation within 60 days of the change in order to qualify for COBRA.
 
 

COBRA and MEDICARE:

Something really great about COBRA that is not widely known is that if the covered employee becomes entitled to Medicare and the spouse is a few years younger, you do not have to keep working to keep your spouse insured.   Your spouse and dependents may keep COBRA for up to 36 months if you lost coverage due to enrolling in Medicare!
 
You may also keep COBRA coverage for services that Medicare does not cover, such as vision and dental. 
 
You may – for example – if you have COBRA dental insurance, the insurance company that provides your COBRA coverage may allow you to drop your medical coverage but keep paying the premium for the dental coverage as long as you are entitled to COBRA coverage.
 
If you have Medicare Part A or Part B when you become eligible for COBRA, you must be allowed to enroll in COBRA if you choose.   Medicare will be the primary insurance and COBRA will be secondary.  You should keep Medicare because it is responsible for paying the majority of your health care costs.
 
NOTE:  COBRA is typically much more expensive than the most expensive Medicare plans so it makes sense to talk to an agent or broker like myself to know your options before you decide to go with COBRA and compare costs.

 

Read more about working with an agent.

 

 
If you have questions about Medicare or COBRA, you can reach out to me using the CONTACT button on the menu at the top of this website or by calling (207) 370-0143.  You can also reach out to the government agencies below.
 
If you are leaving a government employer contact:
The Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627.
 
If you are leaving a private employer contact:
The US Department of Labor at 1-866-487-2365
Maine DOL: (207) 623-7900
New Hampshire DOL: (603) 271-3176
 
 
If your employer group health plan coverage was from a state or local government employer then call
The Centers or Medicare and Medicaid Services (CMS) at 1-877-267-2323 extension 61565.
 
 
 

Would you like my help?

If you would like help finding the right plan or just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

Vitamins and Supplements

More and more of my clients are asking about coverage for vitamins and dietary supplements because their doctors are recommending vitamins and nutritional supplements, such as vitamin D and calcium.

Original Medicare doesn’t cover vitamins and supplements. However some of the insurance plans do offer coverage for them.

If you have a Medigap and a Stand-alone Part D Prescription Drug Plan

Some Medicare Prescription Drug Plans will cover certain vitamins and supplements. Every Medicare Prescription Drug Plan has its own list of covered drugs called a formulary. Check your plans formulary to see what is covered.

In general, Medicare Prescrption Drug Plans will not cover vitamin supplements.  But Part D plans that have “enhanced alternative coverage” included in their benefits may include coverage for some vitamins and supplements. Enhanced alternative coverage means the plan’s formulary contains additional items that go beyond the standard Medicare Part D coverage.

You should contact the agent who helped you find your plan to find out if it offers enhanced alternative coverage and what, if any, prescription vitamins and supplements are covered.

A plan’s formulary may change from year to year. Each year you will receive notice of plan changes and it’s a good idea to review those changes and talk to your agent if you have any questions or concerns.

Feel free to contact me if you would like to learn more about your Medicare coverage and options.  I am always happy to answer questions.

If you have a Medicare Advantage Plan (MA-PD)

Sometimes referred to as a Part C plan, Medicare Advantage plans have your prescription drug coverage built into the plan.  These all-in-one plans also sometimes offer other the counter drug benefits as well as enhanced alternative coverage.  To access the over-the-counter (OTC) benefit you usually have a cataloge of covered items, such as vitains, aspirin, cough syrup, antacidis, bandages, cotton swaps and more expensive things like heating pads or incontience supplies.

Generally the plans that offer this type of coverage give you a set dollar amount ($200 per year, $50 per quarter or $25 or $40 per month) and you simply order each month from the catalog and they ship it to free of charge.

If you would like to know if your plan includes these benefits you can give me a call at (207) 370-0143 or reach out to me via email using the CONTACT button on the menu at the top of this webpage.

And if you have any questions about this topic or need help finding a better plan or making a change, I will be happy to help you.

And it won’t cost you anything!

I do not charge anyone the assistance that I provide. I am an independent agent so I don’t work for the insurance company. I work for you. Just like your car insurance agent – I help you search all the different compaies to find the best price and the best coverage. I help you fill out the application and then turn it into the insurance company and follow up on it for you. If there are any difficulties I help you thtough them. Working with me makes Medicare easy!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
 
Book an appointment with Maine Medicare Options using SetMore

 

 
Have a question that needs to be answered right away?
 
Just give me a call at your convenience.  
 
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form –> https://www.mainemedicareoptions.com/contact
 
 
 

Are you turning 65 and still working?  Read this.

 

Need to Change Plans?

If you need to change your Medicare Advantage plan or want to leave your Medicare Supplement or Medigap plan but are worried that you missed the December 7th deadline you can stop worrying right now!

You still have time to make a change!

Medicare’s Annual Election Period (AEP) ended on December 7th – that’s true – but there are some other less commonly known Election Periods or Enrollment Periods during the year that can help you!

This is why I tell all my clients to call me if they need to make a change – no matter what time of year – because there are many opportunities within the Medicare rules and Congress changes these rules every year.

I joke with my clients that, “You don’t have to remember everything I tell you, just remember my phone number!”  That usually gets a laugh but it’s absolutely true.  

So, how do you keep up with the changes?

You don’t have to. That’s what your insurance agent does!

Each year in the fall Medicare will mail you a copy of the Medicare and You Handbook but some of the information is a year behind because they print it before all of next year’s changes are known.

As part of my job, I keep current on all the changes within the Medicare system and the changes that effect my clients and the Medicare insurance plans and prescription drug plans.  I am always reading and researching ways to help people compare and get the coverage they need and find the best plans and best prices. 

Starting January 1, 2019 you have a new opportunity to make one change.

If you have a Medicare Advantage plan and need to change to a different plan or if you want to leave your Medicare Advantage plan and return to Original Medicare and get a Medigap plan with a new Part D prescription drug plan you can do this at the beginning of the year.

That’s right. You can still make the changes you need. But you must act quickly because each different plan has a different timeline on when the changes can be made.

The rules and deadlines are different depending on the type of plan you currently have so if you want to call me we can discuss your specific options. My number is (207) 370-0143.

If you want to read more on your own before we talk you can review these new rules on Medicare.gov.

If you would like to talk to me or schedule a meeting at your home of in my office come to my office, you can reach me at 207-370-0143 or use my simple form on the CONTACT page of this site to send me an email message.

The best part about working with me is that it will not cost you anything to meet with me or to discuss your options or to review the plans that are available. I am paid by the insurance companies in the form of a commission – just like your car insurance agent. I get paid by the insurance companies to help you!

My goal is to help people and I have found great joy in being able to offer my expertiese and knowlege to people who need my help.

You can call me at 207-370-0143 or you can book an appointment online – it’s quick and easy!

 

2019 Part D Changes

Here are the Part D changes for 2019 that you need to know!

If your plan has a deductible it may go up. The initial Part D deductible will increase by $10.00 to $415 for 2019.

What does this mean to you?

If your Medicare Part D Rx drug plan has a deductible, you may pay more out-of-pocket in 2019 before your insurance plan begins covering your medications. For example, if you are taking Xarelto which costs about $500 and your plan has a $47 copay then the first refill will cost $462 ($415+$47) and then will be $47 each month after that until you reach the Initial Coverage Limit and enter the “Donut Hole.”

Not all Part D Prescription Drug Plans have a deductible and many plans exclude lower-cost generic drugs from the deductible, giving you coverage for these Tier 1 or Tier 2 drugs before you need to pay your deductible.

Beginning January 1, 2019 your Initial Coverage Limit (ICL) will increase from $3,750 to $3,820.

This means that you will be able to buy slightly more medications before reaching the 2019 Donut Hole or Coverage Gap.  A good rule of thumb is that if the full retail cost of your medications is less than $320 per month, you will not enter the Donut Hole before the end of the year.

Good news! The Donut Hole discount will increase 10% in 2019!

The discount you get on brand-name drugs will increase from 65% to 75%. So, if you are using a brand-name medication such as Advair which has a retail cost of around $400, you will pay $100 for your medication or if you take Lantus which has around a $300 price tag, you will pay $75 while in the Donut Hole.

What is the end result?

In 2019 you will have to spend only about $25 more to get out of the Donut Hole than you did in 2018.  The Out of Pocket Threshold (or TrOOP) has increased from $5,000 to $5,100 which will trigger entry into the Catastrophic Coverage Phase where you will remain for the rest of the year.

While in the Catastrophic Coverage Phase you will pay either 5% of the total retail cost of the drug OR $8.50 for brand-names and $3.40 for generics, whichever is higher.

If you need a more in-depth explanation of how Part D works or want to review what plans have the lowest costs and will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.

Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2019 to cover the costs of coverage. [READ MORE …]

If you would like to ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available.  My services are free to you. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You pay nothing for my help!

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

How To Pay Your Medicare Bill

Do you receive a bill labeled Notice of Medicare Premium Payment Due?

If you did then keep reading to understand what this is and how you can pay it.

NOTE: If you receive benefits from Social Security, Railroad Retirement Board, or Civil Service your Medicare Part B premium will be automatically deducted from your benefit each month.

But …what if you have postponed your Social Security?

If you are not collecting your Social Security, Railroad Retirement Board, or Civil Service benefits, but you have enrolled in Medicare Part B, or if you owe a Part D Income-Related Adjustment (IRMA) then you will receive a notice from Medicare called “Notice of Medicare Premium Payment Due”.

You can expect to receive this bill around the 10th of the month. 

Here is a sample of what the bill will look like:

You can download this official brochure here:  https://medicare.gov/pubs/pdf/11659-Understanding-CMS-500.pdf

 

How Can I Set up Payment for My Medicare Premiums?

By mail

Follow the instructions on your Medicare premium bill and mail your payment to the address listed on the form.

Pay Online, through your bank

  • Contact your bank, or go to your bank’s website, to set up automatic payments.  Here is the Payee information you’ll need:
  • Your Medicare Number (It’s the combination of letters and numbers on your red, white and blue Medicare card.
  • The payee name: CMS Medicare Insurance
  • The remittance address:  Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355

Pay By Credit or Debit Card

  • Refer to the bottom portion of your Medicare bill and complete the instructions for paying by credit or debit card.
  • You’ll need your credit or debit card handy so you can fill in the account number and other information.
  • Mail your payment to the address above.

Sign up for “Medicare Easy Pay”

This is a free electronic payment option that auotmatically deducts monthly Part B premium payments from your savings or checking account each month.

To sign up go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4727.)  They are available 24 hours a day, seven days a week.

If you have questions about your bill or the status of your coverage call Social Security at 1-800-772-1213.

If your bill comes from the Railroad Retirement Board

The payee’s mailing address is: Railroad Retirement Board, Medicare Premium Payments, P.O. Box 979024, St. Louis, MO 63197-9000.

If you receive Civil Service retiree benefits

Contact the Center for Medicare & Medicaid Services (CMS) via e-mail at OPMMailbox@cms.hhs.gov or Call Medicare at 1-800-MEDICARE (1-800633-4227), 24 hours a day, 7 days a week.

Need Local Help? Have Medicare Questions?

I can help you!

Just give me a call at your convenience. My cell number is (207) 370-0143
or call toll free 866-976-9038.  Or send me an email using this online form;
 

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

Moving to Maine?

Are you moving to Maine or another state, and enrolled in Medicare?

Moving can be a stressful time and you have a lot of things to change and update. You will want to make sure your Medicare and Social Security benefits continue smoothly so here is some important information that I hope will help make it easier.

First, what kind of Medicare plan do you have?

 

Lettered Plans (Plan G, Plan F, Plan N, etc…)

If you have a Medicare Part D Prescription Drug Plan, with a Medicare Supplement plan that is a “lettered plan” which works in combination with Original Medicare and you move to another state, you will most likely be able to keep the same supplement policy but you will have to change your Part D plan.

When to start shopping for a new plan.

If you’re enrolled in a Medicare Advantage plan under Part C of Medicare, a change in residence, such as moving to another state, could qualify you for a Special Election Period (SEP). During this period of time, you are able to find a new plan that is offered in your new home.

If you permanently move somewhere that your current Medicare plan does not cover (outside the service area), you should call your insurance company immediately and begin looking for a new plan. The phone number for customer service is located on the back of your insurance card.

If you call your insurance company before you move and tell them you are moving, you will have one month before the month you move and three more months after you move to find a new plan but your insurance company may end your coverage at the end of the month that you move. So be sure to ask when your plan will end.

If you notify your plan after you move, you can switch plans the month you provided notice of the move and up to two months after that. Again, your insurance company may end your coverage at the end of the month, so it’s important to ask when it will end.

Medicare Advantage or Part C

If your current insurance plan is not offered in the new area, your plan is required by Medicare to dis-enroll you.  If you don’t enroll in a new Medicare Advantage plan during your SEP, you’ll return to Original Medicare (Part A and Part B).

If you miss this window and do not choose a new plan before it ends you may have to wait for the Annual Election Period (October 15 – December 7) and your coverage will begin January 1st.

Medicare Part D Prescription Drug Plan

The same rules for the Medicare Advantage plans above apply to your Part D plan. If you don’t enroll in a new Medicare Prescription Drug Plan during your enrollment window, you might find yourself without Medicare prescription drug coverage, and you could face a Medicare Part D late-enrollment penalty if you pick up this coverage later on.

You may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan, or to get your Medicare coverage through a Medicare Advantage Prescription Drug plan – but if you don’t do it within a couple months of your move, you may miss your opportunity to change and would have to wait for the Annual Election Period (October 15 – December 7). Again, if you enroll in a new plan during this period your coverage will not begin until January 1st.

What if you move to an address that’s still within your plan’s service area, but where new Medicare Advantage or Medicare Prescription Drug Plan options are available to you?

This will also qualify you for a Special Election Period. You may use this SEP to enroll into the new plan that is offered in your new service area or do nothing and remain on your current plan.

When should I notify Social Security about my address change?

Make sure you notify Social Security of your change of address. The Social Security Administration handles Medicare enrollment. You can change your address by calling the Social Security Administration at 1-800-772-1213 (TTY users 1-800-325-0778) and speak to one of their representatives from Monday through Friday, from 7AM to 7PM. You can also visit the Social Security office nearest you and fill out a change of address form or visit them online at www.ssa.gov

How do I find a new plan?

You can use the Planfinder tool on the Medicare.gov website and put in your new zipcode and list out all your medications and the tool will give you a list of plans in that area that cover your drugs. This is just very basic information based strictly on the financial costs.

To find out the details on how the plans work and what doctors and hospitals accept the plan you will have to call each insurance company directly and ask the right questions.

Or …

You can call me and save yourself the time and headache. I will help you review all the plans available to you and I will explain each one and how it works. I have many clients who are using the different plans out there and I know from talking to them which plans have the best customer service and which are easiest to use. I can help you like I have helped all of them. Give me a call today. I will be happy to help you. My number is 207-370-0173.

Best of all – it does not cost you anything!

I do not charge anyone for my help, whether you enroll with me or not.  I get paid by the insurance company when I deliver your application so once we pick the right plan I will help you fill out the application and I will turn it into the insurance company for you. I get paid for helping you and it does not cost you anything. You do not pay higher rates or any additional costs. You pay the same rate as everyone else whether I help you or not. So, why not get some great advice and benefit from my experience?

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
 
Book an appointment with Maine Medicare Options using SetMore
 
 
 
Have a question that needs to be answered right away?  Call me!
 
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form: https://www.mainemedicareoptions.com/contact
 
 
 

Are you turning 65 and still working?  Read this.

 

SSA not Deducting Premiums?

If you changed Medicare plans this year and received a letter from Social Security saying they will no longer deduct your Medicare prescription drug plan premiums from your monthly benefit, then this blog is for you.

So, What’s going on?

It’s January and if you changed your Medicare Part D prescription drug plan or your Medicare Advantage plan during open enrollment then you may have received a bill from the insurance company instead of having the monthly premium deducted automatically from your monthly Social Security check as it had been in the past.

What do you have to do?

When you changed your Medicare Part D prescription drug plan or changed your Medicare Advantage (Part C) plan you may have chosen to have the monthly premiums automatically deducted from your Social Security check.

But now you have received a letter from Social Security saying: “We will no longer deduct money for your Medicare prescription drug plan costs from your monthly benefits.”

This letter also says, “If you have any questions about your Medicare prescription drug plan costs, please contact your Medicare prescription drug plan.”

You should do just that!

Call the insurance company’s Member Services phone number (usually found on the back of your new insurance card) and they will instruct you to either pay your monthly premium by sending in a check (possibly with a coupon book) or set up automatic electronic funds transfer from your bank account (or a debit card).

This is because your new Medicare plan may not have had time to organize the automatic Social Security deductions and so you will be asked to use another form of premium payment.

But don’t worry. You can have it deducted from your Social Security payment. All you have to do is ask them to start having your monthly premiums deducted automatically from your Social Security check.

Please note: It can take up to three months to coordinate these automatic deductions with Social Security so you will need to continue paying your monthly premiums until then to avoid any lapses in coverage.

Want to know more?

The Centers for Medicare and Medicaid Services (CMS) has published a guide entitled, “Withholding Medicare Prescription Drug Premium from Your 2018 Social Security Payment” that outlines why some people are being denied automatic Social Security check deductions as their chosen form of premium payment.

You can download a copy of the document here: https://www.medicare.gov/Pubs/pdf/11400-Withholding-Medicare-Drug-Premium.pdf

This Medicare guide says that if you changed your Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans, “depending on when you made your enrollment decision, you may be asked to pay your new plan directly for a while. If that happens, you’ll get a bill or payment book from your new drug plan telling you the amount you owe. Your new plan will expect you to pay premiums directly until premium withhold is started with your new plan. You may need to contact the plan to let them know you still want to have premium withholding.”

They continues with the example: “You enrolled at the end of Open Enrollment and chose to have your premiums withheld from your Social Security payment. However, you just got a payment book from your drug plan saying you owe $36.50 each month, starting in January 2018.

You call the plan, and the plan says that it didn’t get your request for enrollment in time to arrange for your January premium to be withheld. The plan says it will request to have the premiums withheld from your Social Security payment starting in February. You’ll need to send your premium payment for January directly to your plan.”

So some Medicare plans may not allow Social Security check premium deduction at the start of this year, even though this was chosen by you as the payment method on your application.

Instead, you will be told to either send the first premium payment by check or submit the Electronic Funds Transfer request. When you call the Medicare plan Member Services representatives they will send you the forms necessary to request the Social Security payment option – as per the new rule.

If you live in Maine or New Hampshire and would like more answers or if you’re looking for help choosing a Medicare plan or just have some questions, I would be more than happy to help you.

You can fill out this form to send me an email message or call me.

Please note: We are only able to give general information about Medicare related issues. If you have questions about your Social Security Benefit, please contact your the Social Security Administration directly.

Still have questions or want help comparing Medicare Supplement plans?  I can help you!

Just give me a call at your convenience. My cell number is (207) 370-0143
or call toll free 866-976-9038.  Or send me an email using this online form;

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

2018 Part D Changes

These are some of the changes that you will see for Medicare Part D in 2018.

The standard Deductible will increase by $5.00. The standard Part D Deductible will be $405 for 2018.

What does this mean to you?

If your Medicare Part D Rx drug plan has a deductible, you may pay $5 more out-of-pocket in 2018 before you did in 2017. Most Part D plans exclude lower-cost Tier 1 and Tier 2 prescriptions from the deductible, giving you coverage for lower cost generic medications before you need to meet your deductible.

Beginning January 1, 2018 your Initial Coverage Limit (ICL) will increase $50 to $3,750.

This means that you will be able to buy slightly more medications before reaching the 2018 Donut Hole or Coverage Gap.  A good rule of thumb is that if the full retail cost of your medications is less than $312 per month, you will not enter the Donut Hole.

The Donut Hole discount will increase for both brand-name and generic drugs.

The generic drug discount you get while in the Donut Hole will increase from 49% to 56% and the discount for brand-name drugs will increase from 60% to 65%. So, if your brand-name medication has a retail cost of $400, you will pay $140 for your medication while in the Donut Hole.

Total Out-of-Pocket Costs will increase by $50.

The TrOOP or your total out-of-pocket cost is the dollar figure you must spend to get out of the Donut Hole or Coverage Gap, not including your monthly premium. The 2018 TrOOP will now be $5,000 in 2018.

What is the end result?

In 2018, you will have to spend only a little bit more to get out of the Donut Hole than you did in 2017.  So, to get out of the Donut Hole your total retail medication need to be over $702 per month. In which case you will enter the Catastrophic Coverage phase where you will remain for the rest of the year.

Once you enter the Catastrophic Coverage phase you will pay either 5% of the total retail cost of the drug OR $8.35 for brand-names and $3.35 for generics, whichever is higher.

If you need a more in-depth explanation of how Part D works or want to review what plans will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.

Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2018 to cover the costs of coverage. [READ MORE …]

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You pay nothing.

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

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