Will your Drugs cost more in 2015?

If you’re currently enrolled in Medicare, what you do or don’t do over the next few weeks could determine whether you can get the best, most affordable coverage next year.  Hear’s why:

Medicare Part D prescription plans frequently change premiums, drug formularies, deductibles and co-payment amounts for specific drugs from year to year.  Medicare Advantage plans often make similar changes; plus doctors, hospitals and pharmacies may drop out of their preferred provider networks.

Thus, by simply choosing the same options for 2015 without investigating alternatives, you could wind up paying hundreds or thousands of dollars more for similar healthcare services.

Medicare’s annual election period ends Dec. 7. 

For most people, this is the best — and sometimes only — opportunity to make coverage changes. (Exceptions are made for people who qualify for special enrollment periods.)

If you already have traditional Medicare Parts A and B and a Medigap plan, you don’t need to make any changes; however, if you also have a Part D plan, you must either accept your current plan’s changes or choose another plan.

When choosing next year’s Part D plan:

  • Carefully review your plan’s “Annual Notice of Change” for any changes to premiums, deductibles, co-payments, covered drugs, participating pharmacies, etc.
  • Notice whether they’ve changed co-payments or co-insurance for your medications or possibly dropped some altogether.  (Yes, this does happen!) Ask your doctor whether comparable, covered drugs will work; otherwise you could pay much more next year.
  • Even if your plan hasn’t changed substantially, it’s still wise to sit down with someone like myself who can help you compare all available plans.  Each year I am trained and tested on the new plans by each of the insurance companies and I have the experience and knowledge to help you make the best choice.

IMPORTANT NOTE:  The lowest monthly premium may not be your best bet — sometimes plans with higher monthly premiums have a lower overall cost due to their more favorable deductible, co-payment and coinsurance amounts.  Also each company negotiates individual drug prices so a drug that costs $400 per month with one company may put you in the Coverage gap sooner than one that only costs $80 with another company.  This is an important piece of your plan review.

Medicare Advantage plans are HMO or PPO type Managed care plans.  They are alternatives to Traditional Medicare Parts A and B with a Medigap Supplement. Most cover drugs and some include extra benefits like vision and dental coverage or reimbursement for gym memberships.  They usually have lower deductibles and co-payments but require you to use the plan’s provider network.

If your Part C, Medicare Advantage plan includes drug coverage you should also carefully review the “Annual Notice of Change” from your plan for any changes that could cost you more money in 2015.

Bottom line: Reviewing your Medicare options each year is complicated and time-consuming.  But if you don’t and your plans change significantly, it could cost you a bundle next year.  

Call Todd today for a no-cost plan review, toll free: (866) 976-9038


When do I enroll in Medicare?

When you're approaching age 65, it's important to thoroughly research the benefits and costs of each different Medicare insurance plan in your area.  But it's even more important to make sure you enroll at the right time.

Missing an enrollment date could cost you higher premiums down the line or it could cost you coverage entirely. 

If you are already receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare you won't have to worry about your enrollment date, since the government automatically enrolls you in both Part A and Part B at age 65. (Three months prior to your 65th birthday, your Medicare card will arrive in the mail.) Your only concern of timing would be if you declined Medicare Part B (and missed the initial enrollment window). If you do decline Part B, you will pay higher Part B premiums if you enroll later on. For each year that you don't enroll your premium will be 10 percent higher, unless you're insured by an employer-sponsored health insurance through either you or your spouse. 

If you are not receiving Social Security or Railroad Retirement Benefits when you become eligible for Medicare you won't be automatically enrolled in Original Medicare. Instead, you'll be able to enroll during one of three enrollment periods.

  • Initial Enrollment Period – a seven-month window of time that begins three months prior to the month of your 65th birthday. The date your Part B coverage starts depends upon how early in the IEP you enroll. If you wait until the last four months of the IEP, the start date of your coverage will be later.

  • General Enrollment Period – January 1 to March 31 of each year. Your coverage will begin on July 1 of the year you enroll.

  • Special Enrollment Period – You can wait to enroll in Part B and not incur a premium hike if you had coverage through your job or your spouse's job at the time you became eligible for Medicare. While you're still covered, you can enroll in Medicare at any time – and for another eight months after you lose your group coverage or you (or your spouse) stop working.

For more information about signing up in Parts A and B you can contact your local Social Security office or call 1-800-772-1213. If you would like to know more or talk about your options and what plans are available for you, call me at (207) 370-0143. There is never any cost or obligation to discuss your options.

Once you have enrolled in Parts A & B you may need to enroll in a Medicare Part D prescription drug plan – even if you do not take any medications!


With Medicare's prescription drug coverage, your first opportunity to enroll is when you're first eligible for Medicare (during the seven-month period beginning three months before your 65th birthday).  It's important to note that if you don't enroll during the seven-month period when you're first eligible, you may pay a late-enrollment penalty that will raise your Part D premium when you do decide to purchase coverage. 

During the Open Enrollment Period mentioned above, you can also enroll in a Medicare Part D plan, switch to another Part D plan or leave Part D entirely. Again, pay close attention to the dates as they affect your options.

  • Between October 15 and December 7 – You can join a Part D plan, switch between Part D plans or drop your Part D coverage.

  • Between January 1 and February 14 – You can leave Original Medicare for an Advantage plan that offers prescription drug coverage. You can not switch from one Part D plan to another.

There is still much more you should know but these are some important dates to keep in mind.  For more information about late enrollment penalties or to ask some specific questions you can call me anytime toll free at (866) 976-9038 or use my Contact Me form on this website to email me. 🙂


6 Reasons To Change Your Medicare Plan.

6 Reasons To Change Your Medicare Plan.


1. Has your health situation changed? 

Perhaps you have developed a health condition in the previous 12 months that requires a new prescription drug or ongoing visits to a specialist. It’s important to know whether the plan you have, or decide to purchase, covers these health needs.

2. Have you changed doctors?

Physicians may retire or relocate, and medical facilities may change their terms. A number of developments could lead your plans to no longer include the doctors you see or the medical center you visit. If your doctor is important to you, this is a good reason to study your options and possibly switch Medicare plans.

3. Has your coverage changed? 

Plans can alter the drugs, procedures and conditions they cover. For example, your prescription drug Part D plan may no longer cover the prescription drugs you need to purchase in the coming year, or put restrictions on how and where you purchase them. Questions about prescription drug costs are one of the top concerns I encounter.  This is especially critical for those who fall into the prescription drug donut hole.  The donut hole is the gap of coverage in which the individual pays a greater percentage of the drug cost.

4. Have your plan premiums, co-pays or deductibles increased? 

Price changes occur year to year, so examine the prices you have been paying and what you can expect to pay in the coming year. There may be alternative plans with lower costs available in your area that an experienced Agent like myself can help you review.

5. Have you moved or are you planning to move? 

It’s important to consider your Medicare plans when moving because you may leave the plan’s service area and be disenrolled or have new options available to you.

6. Has your current plan changed dramatically or will it no longer be available next year? 

In these instances, beneficiaries should take the time to talk with an agent to review their options. Sometimes plans are eliminated because the provider offers a similar plan, but it’s still important to compare that coverage to what you actually need in the coming year.

The Bottom Line.

It is always a good idea to call your agent and have a brief conversation to discuss how your current plan is meeting your needs.   If you are happy with your current plan and all your doctors and medications are covered by the plan that’s great.  But if a new doctor you want to see does not accept your plan or the plan will not pay for those visits or if you are prescribed a new medication that is not covered then you should most certainly check to see if there is another plan available that will give you the coverage you need.  Maine has a lot of Medicare Supplement and Medicare Advantage plans available to choose from.  I talk to every one of my clients each year to review any plan changes and to make sure they are receiving the coverage they need.
Each year, Medicare open enrollment brings with it changes that can affect you. The limited enrollment timeframe of just 54 days – Oct. 15 to Dec. 7 – gives all Medicare beneficiaries the opportunity to change their Medicare plans for the coming year to better match their needs and potentially save on health care costs. This includes anyone using original Medicare, Medicare Advantage or Part D prescription drug plans.
In the fall, Medicare participants receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their current Medicare Advantage and Part D providers. It’s important you read this information.  Take time to review your current health care needs, and then compare this to the plan’s coverage for the coming year.   Reviewing your Medicare plan options earlier rather than later will put you in a better position to make changes during the annual enrollment window.
I hope you found this information helpful.

Does Open Enrollment matter to me if I am happy with my current Medicare plan?

You are happy with the plan you have today….

However, as of January 1, a new plan will take effect that you’ll have to live with in 2015.  Here are some of the things that may change:
  • Your monthly premium
  • Your annual deductible
  • Your annual out-of-pocket spending limit
  • Your out-of-pocket costs (co-payments or coinsurance)
  • The network of providers and pharmacies
  • The drug formulary (list of medications the plan covers)
  • Coverage rule for medications (quantity limits, step therapy, prior authorization requirements)

How will I know what is changing?

Prior to October 1st your Medicare Advantage or your Part D drug plan must send information about changes in benefits and costs for the upcoming calendar year.  You will be receiving this Annual Notice of Change (ANOC) in the next few weeks.  Take time to study it. 
If you have concerns, you can use the Medicare Plan Finder at www.Medicare.gov to compare plans in your area or by talking to an insurance broker or agent who is contracted with your plan and can help you understand all the changes.  If you don’t like what you find, use the Plan Finder to check out other plans and if your agent is contracted with those other plans he/she will be able to help you change to the new plan that better suits your needs for the coming year.  The new plan will take effect January 1st.

Do ALL agents and brokers know about ALL the plans available?

If your agent is not contracted with one of the plans you are interested in this means they have not been trained by the insurance company and may give you wrong information about the plan based on rumors or out-dated information which could end up costing you.
I am a licensed insurance agent in Maine and New Hampshire. I specialize in educating people on all the Medicare supplements and Medicare Advantage Plans offered in Maine and New Hampshire.  I am an independent agent which means I do not work for one specific insurance company.  I have contracts with many different insurance companies and I am trained annually and have passed exams to be able to offer those plans to my clients.   The benefit to you is that I am a “one stop shop.”   When my clients sit down with me, I review their needs and match them up with all the plans available and then I am able to help them narrow down those choices to one plan.  I will help you enroll in the plan that is best for you and I will be there for you during the year if you have any questions or need help.  I also meet with my clients each year before the plans change to review those changes and when necessary help them to find a plan that suits their needs better at that time.
I am currently contracted with the following insurance carriers;
  • Aetna
  • Anthem/Blue Cross Blue Shield
  • Harvard Pilgrim Health Care
  • Humana
  • Martin’s Point Generations Advantage
  • Maine Community Health Options
  • Todays Options
  • Universal American (Today’s Options)
  • Wellcare
  • and Delta Dental
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 here to send me an email message.  It will cost you nothing to meet with me to discuss your options or the plans that are available.  I am paid a commission by the insurance company when you enroll in the plan.  I am looking forward to helping you find the plan that right for you.  Please contact me today to set up a time to talk.
Thank you.

How to Sign Up for Medicare

So you’re turning 65? Congratulations! 

It’s time to start taking advantage of your Medicare benefits. And just how do you do that?

First, here’s a quick overview of what Medicare offers:

Medicare has 4 parts; A, B, C, & D. Part A pays for hospitalization, and most eligible people do not pay premiums for Part A. Part B covers doctor fees, outpatient care, home health care, and preventive screenings for Cancer, Glaucoma, Diabetes, and other diseases. Part B has a monthly premium, which for most beneficiaries is $104.90 this year.  Part C is Medicare managed care and Part D is prescription drug coverage.  Both of these options are available through private insurance companies.
If you already get benefits from Social Security or the Railroad Retirement Board(RRB), you will automatically be enrolled in Part A and Part B starting the first day of the month you turn 65.  You’ll get your red, white, and blue Medicare card in the mail about three months before your 65th birthday. If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you’ll keep Part B and pay your Part B premiums which will be deducted from your Social Security Check each month.
If you are not currently receiving Social Security or RRB benefits (because, for instance, you’re still working), you need to sign up for Part A and/or Part B.  It’s easy to do. You can sign up by calling Social Security at 1-800-772-1213 or by calling your local Social Security Office. You can also apply online for Part A (if you don’t have to pay premiums) and Part B at www.socialsecurity.gov/medicare. The whole process can take less than 15 minutes for most people.
If you’re eligible for Part B when you turn 65, you have a seven-month window that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.  Sign up early! That way you’ll avoid any delay in getting your benefits. If you sign up during the first three months of your Initial Enrollment Period, in most cases your coverage starts the first day of your birth month. (If your birthday is on the first day of the month, your coverage starts on the first day of the month before.)
If you didn’t enroll in Part A and/or Part B when you were first eligible because you were working and covered under a group health insurance, you have a Special Enrollment Period (SEP). This means you can sign up any time while you or your spouse are working and you have employer or union group coverage. Or you can enroll during the eight-month period that begins after your employment ends or your group health coverage ends, whichever happens first.  With part C Medicare Advantage plans you only have the 3 months prior to when your Part B starts.  For example, if your Part B Medicare benefit starts on January 1 then you can enroll starting October 1.
Generally, you won’t pay the Late Enrollment Penalty if you sign up during your a Special Enrollment Period.
But here’s an important caveat: If you have COBRA coverage or a retiree health plan, you don’t have coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends AND you may be subject to the Late Enrollment Penalty.
For more information about enrolling in Medicare, visit www.medicare.gov or my calling 1-800-MEDICARE (1-800-633-4227). 

I am a licensed insurance agent in Maine and I am happy to help explain this process and answer any of your questions.  I can also help you review the many supplemental insurance plans available in your area and give you the advice that you should have to choose the right plan for you and your spouse.   Call me anytime.  My number is 207-370-0143 or send me a message using my contact page and I will respond by email or call you, which ever you prefer.  Good luck and welcome to Medicare!

No Increase for Medicare Part B Premiums. It will stay at $104.90 for 2014.

You may remember that last year I wrote about some very scary rumors that Obamacare was going to cause Medicare premiums to double or triple by 2014.   It started with an email circulating that stated as part of Obamacare (known more formally as the Patient Protection and Affordable Care Act, or PPACA) the Medicare premium will increase to $247 by 2014.

The Good News…

That's right.  The good news is that yesterday the Department of Health and Human Services announced that the premiums for Medicare Part B will not increase in 2014 and remain at $104.90 per month.  The deductible will also remain at $147. I agree with CMS Administrator Marilyn Tavenner when she said, "This is good news for Medicare beneficiaries and for American taxpayers."
In addition to the Medicare Part B premium remaining the same, they also said the Medicare Part A premium will drop $15 in 2014 to $426.  Part A pays for inpatient hospital care, skilled nursing facilities and some home health care services, but 99% of Medicare users do not pay premiums for Part A.  (To learn more about Part A click here.)
New Medicare premium rates come out each fall and take effect in January.  Medicare laws dictate that beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue.  In other words, Medicare beneficiaries receive a 75% subsidy for Part B, so every $1 in Part B premiums for enrollees is matched by $3 in general revenues.

The Not-so-Good News…

Even though the Part B premium that is taken from your Social Security Check each month is not going to increase, this does not mean that your insurance supplement premiums will not go up.  Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. 
You need to be aware of how your plan may change, and prepare accordingly.   Medicare Open Enrollment is October 15 to December 7 and it is your only opportunity to review your plan and change to the better plan of your choice.  Right now there are several plans that have made some changes to their plans that will take effect on January 1, 2014.  You should have received an Annual Notice of Changes at the end of September listing any changes to your current plan.  You can find out about all of the plans in your area by using the Plan Finder tool at Medicare.gov
If you would like a personalized, in-depth review of the changes to your current plan or the new plans available this year I am here to work as your guide.   I can help you review any changes and answer any and all questions you may have about your plan or another.  And if you find a better one I will help you through the process of changing. The best part is there is no cost to meet with me to review your choices.  The decision whether or not to change is entirely up to you.  If your health plan gives you the coverage you need and the costs to you are low I will encourage you to stay with it.
If you live in Maine or New Hampshire and would like someone with my knowledge and experience to help you review your health insurance then give me a call and we can talk.  My phone number is (207) 370-0143 or you can contact me via email through my Contact page.  I specialize in Medicare Supplements but I also help people under 65 find and compare plans on the new Federal Health Insurance Marketplace.
Take care,

Medicare Open Enrollment starts tomorrow. Are you ready?

According to Medicare, each year, health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether.

If you have a Medicare Advantage or a Part D prescription drug plan then there may be important changes that will occur at the end of the year.  And if you don’t understand those changes you may be stuck with a plan that does not work the way you think.  Your opportunity to change plans ends December 7th of this year.

This is a short list of some of the things that may change at the end of this year with your plan.

  • The drug formulary (listing of medications the plan covers)
  • The network of providers and pharmacies
  • Your out-of-pocket costs (co-payments, coinsurance)
  • The annual out-of-pocket maximum spending limit
  • The annual deductible
  • The monthly premium

Each year these drug lists are reviewed and some drugs are removed from the plan and sometimes others are added.  Also they can be moved to a higher or lower tier meaning your co-payment could increase or decrease so it really is wise to check to make sure your medications are not effected.  Coverage rules for medications (quantity limits, step therapy, prior authorizations) can also change.

The other and more important answer is to be a wise shopper.  If you are currently on a Medigap plan or Medicare Supplement plan you most likely pay a larger monthly premium than you would with a typical Medicare Advantage plan so it would be wise to at least exam these plans and see what the cost savings might be.   Medicare Advantage plans also sometimes have additional benefits beyond what Medicare offers such as dental, vision and hearing coverage and also money to pay for your vitamins.

Prior to the Annual Open Enrollment Period, your Part C Medicare Advantage or your Part D drug plan must send information about changes in benefits and costs for the upcoming calendar year.  It is very important to take the time to study that information.  If you have concerns I suggest you call the Member Services number on the back of your insurance card and a representative there can answer your questions.  It may also behoove you to meet with a licensed health insurance agent if you have someone that you know and trust to see what other plans are available.  I suggest meeting with an agent because agents are trained and tested on these plans before they can talk about them so they may be able to offer you additional insight on some benefits you could overlook when shopping alone.

If you are the independent sort, as are most folks from New England, than you can find all the Medicare Advantage plans for the 2014 year listed in an easy to compare format at the back of your Medicare & You Handbook.  Medicare sends these out to beneficiaries every year so if you did not get your copy just call 1-800-MEDICARE and they will send it out to you.  You can also use the Planfinder Tool on the Medicare.gov website to compare plans.

You can make a change anytime between October 15 and December 7 each year.

If you live in Maine or New Hampshire I would be more than happy to meet with you and help you find a plan that may cost less or offer you better coverage than your current plan.   And if you have any questions you can reach me by telephone at (207) 370-0143 or you may contact me through my website at http://www.mainemedicareoptions.com/contact

Medicare Releases 2014 Part D Costs

The Centers for Medicare and Medicaid Services (CMS) has released the 2014 costs for a standard Part D prescription drug plan.

  • The deductible will drop from $325 to $310.  
  • The average monthly premium remains stable and is projected to be $31. 
  • The discount in the donut hole for brand-name medications will remain at 52.5%. The discount for generic drugs will increase to 28% from 21%. 
  • Medicare has dropped the limit for entering the donut hole (Coverage Gap) from $2,970 to $2,850 and the threshold for getting out of the donut hole is $4,550, down from $4,750.  (The Coverage Gap limits are set by a formula established in the 2003 drug plan law involving the negotiated value of prescription drug costs.)
  • The beneficiary’s cost sharing in the Catastrophic Coverage phase drops from $2.65 to $2.55 for generic drugs and from $6.60 to $6.35 for brand-name medications, or 5% whichever is higher.

If you live in Maine or New Hampshire, and would like to learn more about the new plans available in your area you can use the Contact Me page or call me directly at (207) 370-0143. 

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