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

Annual Notice of Changes (2018)

3 things to know about the Annual Notice of Change (ANOC)

 

Avoid surprises – Review your Annual Notice of Change each fall!

If you have a Medicare Advantage plan (Part C) you will receive an Annual Notice of Change (ANOC) from your health insurance company at the end of September. If you are new to Medicare, then you may not know what this is.

Who gets one and what should you do with it?

The ANOC is an important notice sent each year to people who have a Medicare Advantage (MA) Plan or a Medicare Part D Prescription Drug Plan.

The health insurance companies that administer these plans are required to send notices to you each year to notify you of cost and/or benefit changes that will take effect starting January 1, 2018.

When should you expect it?

You should receive this notice by September 30th of this year. If you haven’t received it by then, you should contact your plan to ask for it or call your agent to learn about what is changing. Your agent will know everything that is changing and can explain how it will effect you.

If there are changes to your costs and benefits that could raise your costs or get in the way of getting the health care you need, you may want to think about making changes to your Medicare coverage during Medicare’s Fall Open Enrollment Period.

When can you make changes?

Fall Open Enrollment runs from October 15 to December 7 every year. If you make changes to your Medicare coverage during Fall Open Enrollment this year, they will go into effect on January 1, 2018.

Even if you review these notices and decide that there won’t be any major changes to your Medicare coverage in 2018, it still might be helpful to look at other Medicare options and compare them to your current plan.

Another plan in your area might offer health and/or drug coverage at a better price than what you currently pay. To learn more about different Medicare coverage options, call 1-800-MEDICARE or use the Plan Finder tool at medicare.gov or click this link.

Still have questions?

If you would like help comparing your needs against the many Medicare plans out there or if you 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

 

Top 5 Medicare Myths

Educate yourself on these common Medicare myths — both your health and your wallet will thank you.

Medicare is a great program. I know because I meet with people every day who are turning 65 and entering the Medicare system and looking for help and advice on where to start and what to look for.  Medicare saves you from having to pay enormously high private health-insurance premiums, and it protects you from catastrophic medical expenses. But if you’ve heard one of these common misunderstandings about Medicare, you will be glad you found this website.

1. Medicare enrollment happens automatically at 65

Everyone becomes eligible for Medicare at age 65, but actually enrolling in the program is up to you. The only way you’ll be automatically enrolled in Medicare is if you’re already receiving Social Security benefits when you hit your 65th birthday or if you are collecting Social Security Disability payments. In either of these cases, you’ll be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) as soon as you become eligible, although it’s still up to you to sign up for any prescription drug coverage, Medigap, or a Medicare Advantage plan. — That’s where I come in! smiley

Read more about How and When to Enroll.

2. You can enroll any time after age 65

This is not quite accurate. Your initial enrollment period for Medicare begins three months prior to your 65th birthday and ends three months after the month which you turned 65. If you don’t enroll during this seven-month period, you’ll have to wait for the next Medicare open enrollment period which happens between January 1 and March 31 and your Medicare benefit will begin on July 1st. And if you are enrolling in a Medicare plan it must be done prior to July 1st!

There are also penalties for late enrollment. If you don’t sign up for Part A during your initial enrollment window, then your monthly premium will go up by 10% for twice the number of years you could have been enrolled but were not. For example, if you file for Medicare Part A three years after you become eligible, then you’ll have to pay a higher premium for six years.

You should also sign up for Part B as soon as you’re eligible. If you don’t, your premium will go up 10% for every year you delayed — permanently.

Read more about How to Correctly Plan Your Enrollment.

3. Medicare is free

This is a big one! Especially with all the advertisements out there saying that plans have no cost or $0 monthly premiums.

Some parts of Medicare and some covered services are indeed free, but there are certainly some costs involved. Medicare Part A, which covers in-patient hospital stays, has no monthly premium if you worked (and paid Medicare taxes) for at least 40 calendar quarters (or 10 years) by the time you enroll. Medicare Part B, which covers outpatient doctor visits, routine bloodwork and similar expenses, has a premium of $134 per month in 2017, although high-income enrollees may pay higher premiums.

Other Medicare parts and plans have a wider range of premiums, often based on the type of plan and where you go for care. As for services, different Medicare parts and plans offer different levels of coverage for various medical expenses. Some expenses may be completely covered by Medicare, such as an annual wellness exam, while others require you to pay a co-pay or meet an annual deductible.

Read more about How can insurance can have a $0 premium?

4. Medicare covers all types of healthcare expenses

The different parts of Medicare cover different types of healthcare. Medicare Part A covers only hospital-related services, while Part B covers other types of medical expenses such as doctors’ visits and lab tests. Part D covers prescription expenses.

Part C, also known as Medicare Advantage, can cover additional services such as vision and dental care. Medigap plans help cover some of the costs that Medicare Part A and Part B don’t cover, but it doesn’t include prescription coverage, dental, vision, and so on. So the exact coverage you have will depend on which parts of Medicare and which specific plans you sign up for.

5. You may not qualify for Medicare

Happily, you cannot be rejected from Medicare coverage just for being sick or having a pre-existing condition. For that matter, pre-existing conditions won’t raise your premiums, either. This should continue to be the case for Medicare even if Congress repeals the Affordable Care Act’s pre-existing condition clause.

Still have questions or want help comparing the different health insurance plans?  I can help you!

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 a licensed insurance agent 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.

There is no obligation to you and no cost to meet with someone.

Popular Donut Hole Questions

Popular Donut Hole Questions

During this time of year, many people will begin to enter the Coverage Gap or “Donut Hole” portion of their Medicare Part D coverage and find their coverage costs changing. 

If you have already purchased medications with a retail value of $3,700 you are in the 2017 Donut Hole.

Question:  I have purchased medications worth $3,390 toward my 2017 Donut Hole, my next brand-name drug purchase has a retail cost of $400, bringing me into the Coverage Gap.  Will I get a Donut Hole discount on the full $400 retail price or just the $90 that falls into the gap?

Your Donut Hole discount (which is 60% in 2017) only applies to the $90 portion of the retail drug price that falls into the Coverage Gap.  Since your purchase “straddles” two phases of coverage, you pay your cost-sharing for the Initial Coverage phase (for example, $40 for a Tier 3 brand drug) and the brand-name Donut Hole discount applies to the remainder of the retail price falling into the Donut Hole. 

Therefore, your total drug cost is the cost-sharing you paid in the Initial Coverage phase plus the discounted cost in Donut Hole. (Note: The combined cost of the Initial Coverage phase and the Donut Hole phase will never exceed your drugs total retail cost.) 

Question:  If I use only one brand drug that costs $347 and have a $47 co-pay, will I enter the 2017 Donut Hole?

Yes. If your retail drug costs average $347 you will exceed your Medicare plan’s Initial Coverage Limit of $3,700 and enter the 2017 Coverage Gap or Donut Hole in early-November. 

Only your plan’s retail drug costs count toward entering the Donut Hole. Your co-pay has no impact on entering the Donut Hole, but will impact when you exit the Donut Hole.  

Question:  I am in the Donut Hole and now have a new prescription that is not on my plan’s list of covered drugs.  Do I get a discount on my new medication and will my costs count toward getting out of the Donut Hole?

No. Only Medicare Part D prescription medications found on your plan’s formulary receive the 60% brand-name discount or 49% generic drug discount. Non-formulary medications and medications excluded from the Medicare Part D program, do not qualify for the Donut Hole discount and your non-formulary drug purchases do not count toward meeting your 2017 total out-of-pocket drug spending (TrOOP) limit of $4,950 — the amount you need to spend to exit the Donut Hole.

If you are using a non-formulary medication, you can ask your Medicare plan for a Formulary Exception which is a type of Coverage Determination. 

If your Medicare Part D plan denies your request, you have the right to appeal your plan’s decision.  For more information, you can click here to read about Formulary Exceptions. https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Exceptions.html

Do you have a question not answered here?

Click here to ask a question.

If you would like help comparing your needs against the many Medicare plans out there or if you 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

 

 
 

Medicare Advantage (Part C)

Medicare Part C is available through Medicare Advantage plans, and is an alternative to Original Medicare (Parts A and Part B). Medicare Advantage plans are health insurance plans offered by private health insurance companies approved by Medicare. Medicare Advantage health plans (such as HMO, PPO or PFFS plans) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.

One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan. These plans give you the convenience of having your Medicare Part A, Part B, and Part D coverage through a single plan.

Medicare Advantage plan costs and coverage details can vary depending on the insurance company and county that you live in.

What are the different types of Medicare Advantage plans?

As mentioned, Medicare Part C coverage details can vary depending on the insurance company, so it’s always a good idea to compare the Medicare Advantage plan options in your specific location. The following are types of Medicare Advantage plans that may be available in your location:

Health Maintenance Organization (HMO) plans: These plans offer a network of doctors and hospitals that members are generally required to use to be covered. Because of this, HMOs tend to have strict guidelines, meaning that any visits and prescriptions are subject to the plan approval. If you use providers outside of the plan network, you may need to pay the full cost out of pocket (with the exception of emergency or urgent care). You generally need to get a referral from your primary care doctor to see a specialist.

Preferred Provider Organization (PPO) plans: Medicare Advantage PPO plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from health-care providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.

Private Fee-for-Service (PFFS) plans: This type of plan allows visits to any Medicare-approved doctor or hospital, as long as the plan’s terms and conditions of payment are accepted by the provider. Keep in mind that you’ll need to find providers that contract with the plan each time you are receiving treatment.

Special Needs Plans (SNPs): These plans limit enrollment to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and state Medicaid (also known as dual eligibles). Benefits, provider options, and prescription drugs are tailored to meet the needs of the plan’s enrollees.

How do I know if I am eligible for a Medicare Advantage plan?

In order to be eligible for Medicare Part C, you must be enrolled in both parts of Original Medicare (Part A and Part B). Once you have Medicare Part A and Part B, you are generally able to enroll in a Medicare Advantage plan, provided you live in the plan’s service area and do not have end-stage renal disease (ESRD).

There are some exceptions where you may be able to enroll in a Medicare Advantage plan even if you have end-stage renal disease. For example, if you’re enrolling in a Special Needs Plan that targets beneficiaries with end-stage renal disease, you may be eligible to enroll in this type of Medicare Advantage plan.

To learn more about other situations where you may be eligible for Medicare Part C if you have end-stage renal disease, you can contact us using the contact page on this site. You can also contact Medicare at 1-800-MEDICARE (633-4227); 24 hours a day, seven days a week.

Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind. It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.

If you’d like to learn more about Medicare Advantage plan options or if you’d like help finding coverage that may fit your needs, 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. 

“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

Read more about other types of plans and options …

49 New Generic drugs

2017 Medicare Part D drug lists updated with 283 new drugs!

Medicare Part D rules allow insurance companies to update their prescription drug lists throughout the plan year and in the past few months, 283 new medications have been added to many drug plans. The April 2017 formulary data released by the Centers for Medicare and Medicaid Services (CMS) included 380 new national drug codes representing 250 drugs. The May 2017 CMS formulary data included 43 new drug codes representing 33 drugs.

Medicare’s Formulary Browser, located at Medicare.gov has also been updated with the April and May 2017 Medicare Part D formulary data.

49 New Generic drugs added!

These additions to the Medicare Part D insurance plans included a total of 25 new generic equivalent medications that represent 48 generic drug combinations. Some interesting additions to the 2017 drug lists include:

GLYBURIDE 1.25 MG / METFORMIN HYDROCHLORIDE 250 MG ORAL TABLET [Glucovance]

LOPINAVIR-RITONAVIR 80-20MG/ML [Kaletra] 

ABACAVIR-LAMIVUDINE 600-300 MG [Epzicom] 

AMLODIPINE-OLMESARTAN 10-20 MG [Azor] 

APREPITANT 125 MG CAPSULE [Emend] 

CLINDAMYCIN PHOSPHATE-BENZOYL PEROXIDE 1.2-5% [Benzaclin] 

CLINDAMYCIN-TRETINOIN 1.2%-0.025%

[Veltin, Ziana] 

DAPTOMYCIN 500 MG VIAL [Cubicin] 

DROSP-EE-LEVOMEF 3-0.02-0.451 [Beyaz, Safyral] 

ETHACRYNIC ACID 25 MG TABLET [Edecrin] 

ETHYNODIOL-ETH ESTRA 1MG-50MCG [ZOVIA] 

EZETIMIBE 10 MG TABLET [Zetia] 

FENOFIBRATE 150 MG CAPSULE [LIPOFEN] 

FLURANDRENOLIDE 0.05% LOTION [Cordran] 

IRBESARTAN 150 MG TABLET [Avapro] 

NILUTAMIDE 150 MG TABLET [Nilandron] 

OLMESARTAN MEDOXOMIL 20 MG TAB [Benicar] 

OLMSRTN-AMLDPN-HCTZ 20-5-12.5 [TRIBENZOR] 

OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu] 

PARICALCITOL 1 MCG CAPSULE [Zemplar]

QUETIAPINE ER 150 MG TABLET [Seroquel] 

RASAGILINE MESYLATE 0.5 MG TABLET [Azilect] 

TELMISARTAN-HCTZ 40-12.5 MG TB [Micardis] 

TOBRAMYCIN 10 MG/ML VIAL 

[Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] 

VALGANCICLOVIR HCL 50 MG/ML [Valcyte] 

Check with your plan to find out what has changed or you can use the assistance tool below to get your free report.

Free Rx Review:

Name:

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Having trouble using the form?  Click here.

Still have questions?

If you would like help comparing your needs against the many Medicare plans out there or if you 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.”

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What is a Special Needs Plan (SNP)?

Special Needs Plans are a type of Medicare Advantage plan that is specifically designed for people who meet certain eligibility criteria. These plans cater their benefits to serve the unique needs of its members.

There are three types of Special Needs Plans (SNPs) available:

Dual-Eligible Special Needs Plans (D-SNP) for individuals who are entitled to Medicare and who are also eligible for some level of assistance from a state Medicaid program or MaineCare.

Chronic-Condition Special Needs Plans (C-SNP) for individuals with one or more of the following conditions: diabetes, cardiovascular disorders, chronic heart failure and chronic lung disorders such as COPD.

Institutional Special Needs Plans (I-SNP): These plans serve those living in an institution (such as a nursing home) or who need nursing care at home.

If you fall into any of the categories above, you may have unique health-care needs that a Special Needs Plan may be better equipped to address.

For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition or lower costs for the prescription drugs typically prescribed for your particular illness.

Special Needs Plans benefits

Like other Medicare Advantage plans, Special Needs Plans are available through private insurance companies that are approved by Medicare. All Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare, Part A and Part B. Some Medicare Advantage plans may also cover benefits beyond what Original Medicare covers, and your Medicare plan options and benefits can vary, depending on where you live. You can read more about Medicare Advantage plans here.

Some Special Needs Plans include care-coordination services to help you better understand your condition and stick to your doctor’s treatment regimen. Or you might have access to wellness programs to help with a special diet or other lifestyle activities that can help improve your condition.

Chronic-Condition Special Needs Plans may include provider networks with physicians and hospitals that specialize in treating the specific condition of its members, or they may have drug coverage that is tailored to include the prescription drugs that treat your illness.

If you’re enrolled in a Special Needs Plan for dual eligibles, there may be certain social services available to help you coordinate your Medicare and Medicaid benefits.

It’s important to note that you still get all the coverage that is otherwise included with Original Medicare, Part A and Part B, and Medicare Part D. The Special Needs Plan simply offers extra coverage to help you better manage your particular situation, whether that’s living in a nursing home; coordinating your Medicare and Medicaid benefits; or treating a serious chronic illness.

Getting help with costs

If you have both Medicare and Medicaid or if you have limited income, Medicaid may be able to cover some or all of your Medicare Advantage Special Needs Plan’s premiums and/or out-of-pocket costs. Depending on your income levels, you may qualify for a Medicare Savings Program, which can help pay for costs like premiums, copayments, coinsurance, or deductibles.

Contact your state’s Medicaid office for more information, or call 1-800-MEDICARE (TTY users 1-877-486-2048), 24 hours a day, seven days a week. Or contact me directly at (207) 370-0143 for help understanding all the benefits that are available to you.

Medicare Advantage Special Needs Plans costs

Depending on the Special Needs Plan, you will typically have the following costs:

  • Medicare Part B premium
  • Monthly premium for your Special Needs Plan (if your SNP requires it)
  • Extra monthly premium for prescription drug coverage (if your SNP requires it)
  • Extra monthly premium for additional benefits (if your SNP requires it)
  • Cost-sharing expenses, such as copayments, coinsurance, or deductibles*

*Please note: If you are a dual eligible, your Special Needs Plan can’t have higher cost-sharing requirements than you’d normally pay in Medicaid or Original Medicare, Part A and Part B.

Keep in mind that your specific costs may vary, depending on if you qualify for financial assistance or get both Medicare and Medicaid benefits.

Your out-of-pocket costs will also depend on the type of health-care services you need and how often you need them. Each Special Needs Plan is different so you should review the specific plan materials for the plan you’re considering to see exactly how much you’ll have to pay.

Make sure you pay particular attention to the differences in your cost sharing when you use the plan’s in-network doctors versus out-of-network doctors (if the plan allows you to go outside it’s network).

Enrolling in a Medicare Advantage Special Needs Plan

You can enroll in a Special Needs Plan once you’re first eligible for Medicare if there is a Special Needs Plan in your service area for your target group and you meet the eligibility requirements of that plan.

Most people are first eligible for Medicare during their Initial Enrollment Period, the seven-month period that starts three months before your 65th birthday, includes your birthday month, and ends three months later. If you qualify for Medicare because of disability, your Initial Enrollment Period starts three months before the 25th month that you are receiving Social Security or Railroad Retirement Board disability benefits and lasts seven months.

You can also enroll in a Special Needs Plan during the Annual Election Period from October 15 to December 7 of every year. During this period, you can enroll in a Special Needs Plan for the first time, switch plans, or disenroll from your plan.

Outside of these periods, you may be able to join a Special Needs Plan with a Special Election Period in certain situations. Some situations that may qualify you for a Special Election Period to enroll in a Special Needs Plan or make coverage changes include:

  • You are diagnosed with a severe or disabling condition: You can enroll in a Chronic-Condition Special Needs Plan for beneficiaries with your illness at any time, and your Special Election Period ends once you enroll in the plan.
  • You move into, currently live in, or leave a nursing home: You can enroll in a Special Needs Plan or switch plans at any time.
  • You qualify for Medicaid: If you have Medicaid or are newly eligible for Medicaid, you can enroll in a Medicare Special Needs Plan at any time.
  • You move outside of your Special Needs Plan’s service area: You can use a Special Election Period to switch to a new plan, or you’ll be automatically returned to Original Medicare.
  • Your Special Needs Plan leaves the Medicare program: You can use a Special Election Period to switch to a different Special Needs Plan.

Still have more questions?

Contact me for answers using this form –> https://www.mainemedicareoptions.com/contact

Need more help comparing the different health insurance plans?  I can help you.

Have a question?  Need help understanding your options?  Call me.  I’m local and I can help you. 
Call (207) 370-0143 or call toll free 866-976-9038.
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 ahead of time to get you started.  It’s up to you!
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Do you need Dental or Vision Insurance?  Read this.

There is no obligation to you and no cost to meet with someone.

Having trouble paying for Medicare?

If you’re having trouble paying your Medicare Part B monthly premium then this article is for you.

If you are having trouble paying for your Medicare supplemental insurance or prescription drug costs then you need to read this article. –> Click here.

Medicare Savings Programs

Here is some information on Medicare Savings Programs, which can help you with the costs of both your Part B premium and your Part D prescription drug costs. These programs do not reduce the costs of your insurance premiums but may reduce some of the out of pocket costs such as co-pays to doctors, hospitals and ambulance as well as reduce your prescription drug costs.

Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs, are state programs that assist you with paying your Medicare costs. The names of these programs may vary by state. In Maine the programs are often referred to as “Quimby” or “Slimby”.

These programs can pay up to 100% of your premiums, deductibles, coinsurance charges, and copayments.

There are three MSPs, (https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html#collapse-2625) each with different federal income and asset eligibility limits.

States can raise these limits to be more generous, which allows more people to qualify for the benefits.

All three MSPs cover your Part B premium, which means your monthly Social Security check will increase by the amount you currently pay for your Part B premium if you qualify for and enroll in one of these programs.

Qualifying Individual (QI)

QI pays for your Part B premium and provides three months retroactive Part B premium reimbursement from the month of application. Note: you cannot have Medicaid and QI.

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB (“Slimby”) pays for your Part B premium and provides three month retroactive Part B premium reimbursement from the month of application. Note: you can have Medicaid and SLMB.

Qualified Medicare Beneficiary (QMB)

QMB (“Quimby”) pays for your Part B premium and Medicare deductibles, coinsurance charges, and copayments. If you have a Medicare Advantage Plan, QMB pays for your plan’s cost sharing.

The program also pays for your Part A premium if you do not qualify for premium-free Part A. It does not provide three months retroactive Part B premium reimbursements; benefits start the first of the month after the month you are approved for the program.

Note: you can have Medicaid and QMB, but you cannot buy a Medigap plan once you are enrolled in QMB. You can however enroll in a Medicare Advantage plan and take advantage of the additional benefits offered on those plans, such as Dental, vision and gym membership reimbursements.

To verify your eligibility, you need to verify that you meet the income and asset limits in your state.

In Maine

  • If you are single and your income is less than $1759 a month you may get help.
  • If you are married and your income is less than $2369 a month then you may get help.
  • If only one person in a couple wants the help, then the income limit may be as high as $2837 per month.
  • If you have earned income, the income limits may be higher.
  • Most assets do not Count. However, Liquid or cash assets greater than $58,000 for an individual and $87,000 for a couple will count. Liquid assets are those that are easy to convert to cash, such as checking/savings accounts, most retirement accounts, some annuities, etc.

You will apply at the Maine Department of Health and Human Services (DHHS).

In New Hampshire

See if you qualify: https://nheasy.nh.gov/#/screening

Apply online: https://nheasy.nh.gov/#/services/Medicare%20Beneficiary

For all Other States

To apply for an MSP, you will need to apply to your local Medicaid office or other state agency that receives MSP applications. You or a SHIP counselor can contact the local Medicaid office to learn how to apply. Many states allow you to submit your application online, through the mail, and/or through community-based organizations. Some states may require that you schedule an appointment and go in person to the Medicaid office to apply.  (https://www.medicare.gov/Contacts/)

What will you need to apply?

You will need to gather documentation for the application. The list of needed documents varies by state. Some examples of required documentation are:

  • Social Security card and/or Medicare card
  • Birth certificate or passport and driver’s license
  • Proof of address, such as a utility bill
  • Proof of income, such as a Social Security Administration award letter, pay stub, or income tax return
  • Information about assets, such as bank statements or life insurance policies

You should make a copy of any application before submitting it. Once you have applied, your state Medicaid program should send you a notice within about 45 days to let you know if your application was approved or denied.

If you are approved for the MSP, you should begin to receive benefits on the date listed on the notice you receive. If there are any issues with your benefit, or if you have not received any decision from your state within 45 days, you should contact the Medicaid office where you applied.

If you have any questions about how to apply or if you might qualify please contact us for help using this form –> https://www.mainemedicareoptions.com/contact

Need more help comparing the different health insurance plans?  I can help you.

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. 
Have a question that needs to be answered right away? Just give me a call at your convenience.  You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038.
Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

There is no obligation to you and no cost to meet with someone.

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