Insulin $35 copay in 2021

How to get your Insulin for only $35.

Do you use one of the insulins listed below?

  • Admelog – $35 copay in 2021
  • Apidra- $35 copay in 2021
  • Basaglar- $35 copay in 2021
  • Fiasp- $35 copay in 2021
  • Humulin- $35 copay in 2021
  • Humalog- $35 copay in 2021
  • Lantus- $35 copay in 2021
  • Levemir- $35 copay in 2021
  • Lispro- $35 copay in 2021
  • Lyumjev- $35 copay in 2021
  • Novolin- $35 copay in 2021
  • NovoLog- $35 copay in 2021
  • Toujeo- $35 copay in 2021
  • Tresiba- $35 copay in 2021
  • Soliqua- $35 copay in 2021
  • Xultophy- $35 copay in 2021

Then say “Good Bye” to the Donut Hole!

The opportunity to get insulin for $35 a month is a very good deal. However, this isn’t automatic and you may be stuck paying much higher copays in 2021 if you don’t have a plan that is participating in this new program.

That’s right. Not all Part D prescription drug plans will offer the $35 copay.

I reviewed the plans in Maine and New Hampshire and found that only half of plans available will offer these lower costs.

How to get these new Medicare savings?

This is the important part. Getting these savings is not automatic, it’s optional.

So you will need to research all the plans to find which standalone Part D prescription drug plans or Medicare Advantage plans will offer the lower costs. Start by calling your current plan and asking what your costs will be next year. If they do not say $35 then you may want to shop around for a better plan.

Would you like some help?

If you would like help searching for a new plan or just have a question, call us at (207) 370-0143 or use the button below to send an e-mail.

If you’re only paying $35 every month, who’s helping to pay the rest?

Currently, the insurance companies that offer Part D prescription drug coverage on their plans have the option to offer prescription drugs at lower copays during the donut hole coverage gap.

But the insurance companies have to pick up the costs that would normally be paid by the pharmaceutical companies. Often, they choose to pass these costs on to you, the Medicare beneficiaries in the form of much higher premiums.

This new program makes two significant changes:

  1. Pharma companies (specifically, Eli Lilly, Novo Nordisk, and Sanofi as the participating insulin makers) can continue paying their full coverage gap discount for products, even if a Part D plan offers lower cost-sharing.
  2. Participating Part C and Part D plans will be required to cap insulin costs at $35 for a month’s supply, by applying the manufacturer rebates. This will happen year-round, even if you enter the “donut hole.

How long will this program last?

This is a pilot program, in a sense. Medicare says it will watch how this works starting in 2021 and determine whether any changes are needed as time goes on. Expectations are from 3 to 5 years.

Medicare Administrator Seema Verma also said during the announcement: “If it goes well, we’ll extend this to other drugs. We’re starting with insulin, but depending on the progress, we will consider offering this flexibility to manufacturers and plans with other drugs, depending on the results. We think this creates a foundation and a platform to fix some of the problems that we have in Medicare Part D.”

The good news is that if Medicare does decide to continue with this low-cost insulin, other insurance companies may sign on in 2022 or later.

Todd Reagin Maine Medicare Insurance Agent Local Agent help with costs Medicare Advantage Medicare supplement costs compare prices in Maine

Would you like more info?

If you would like to talk about this program or schedule a meeting, 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 w not cost you anything 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, just like your car insurance agent.

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.

If you are diabetic and using insulin,
you may be able to save a lot of money.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a quick phone call today.

I can answer all your questions over the phone and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

Medicare IRMAA costs in 2021

Medicare Part B premiums will increase by about $4 per month next year and high-income surcharges will also rise modestly in 2021,

The standard Medicare Part B premium, which covers doctor’s visits and other outpatient services, will increase to $148.50 per month in 2021, up $3.90 from this year’s monthly premium of $144.60.

Medicare imposes surcharges on higher-income beneficiaries. The theory is that higher-income beneficiaries can afford to pay more for their healthcare. Instead of doing a 25:75 split with the government, you must pay a higher share of the program costs.

The surcharge is called IRMAA, which stands for Income-Related Monthly Adjustment Amount.

I haven’t seen any numbers that show how much collecting IRMAA really helps the government in the grand scheme. I’m guessing very little. One report says 7% of all Medicare beneficiaries pay IRMAA. Suppose the 7% pay double the standard premium, it changes the overall split between the beneficiaries and the government from 25:75 to 27:73. Big deal?

The income used to determine IRMAA is your AGI plus municipal bond interest from two years ago. Your 2019 income determines your IRMAA in 2021. Your 2020 income will determine your IRMAA in 2022 and so on.

As if it’s not complicated enough for not moving the needle much, IRMAA is divided into five income brackets. Depending on the income, higher-income beneficiaries pay 35%, 50%, 65%, 80%, or 85% of the program costs instead of 25%.

The lines drawn for each bracket can cause a sudden jump in the premiums you pay. If your income crosses over to the next bracket by $1, all of a sudden your Medicare premiums can jump by over $1,000/year. If you are married and both of you are on Medicare, $1 more in income can make the Medicare premiums jump by over $1,000/year for each of you.

So if your income is near a bracket cutoff, see if you can manage to keep it down and make it stay in a lower bracket. Using the income from two years ago makes a little harder. Now in 2020, you don’t know where exactly the brackets will be for 2022. Still, you can make reasonable estimates and give yourself some margin to stay clear of the cutoff points.

IRMAA Brackets

The IRMAA income brackets (except the very last one) started adjusting for inflation in 2020. Below are the IRMAA income brackets for 2020 coverage and the new brackets for 2021 coverage.

Before the government publishes the official numbers, I’m able to make projections based on the inflation numbers to date. Rounding rules make it such that the inflation numbers for the upcoming months are unlikely to affect the final results. For example, when a number is rounded to the nearest $1,000, it doesn’t matter whether the number is really $87,600 or $87,800 before rounding. Remember the income on your 2019 tax return (AGI plus muni interest) determines the IRMAA you pay in 2021. The income on your 2020 tax return (to be filed in 2021) determines the IRMAA you pay in 2022.

2021 Parts B and D Income-Related Premiums

Beneficiaries who file an individual tax return with income:Beneficiaries who file a joint tax return with income:Beneficiaries who are married, but file a separate tax return with income:2021
Total monthly Part B premium amount 
2021
Part D income-related monthly adjusted amount paid to Medicare (in addition to plan premiums)
Less than or equal to $88,000Less than or equal to $176,000Less than or equal to $88,000$148.50your plan premium
Greater than $88,000 and less than or equal to $111,000Greater than $176,000 and less than or equal to $222,000 $207.90$12.30 + your plan premium
Greater than $111,000 and less than or equal to $138,000Greater than $222,000 and less than or equal to $276,000 $297.00$31.80 + your plan premium
Greater than $138,000 and less than or equal to $165,000Greater than $276,000 and less than or equal to $330,000 $386.10$51.20 + your plan premium
Greater than $165,000 and less than $500,000Greater than $330,000 and less than $750,000Greater than $88,000 and less than $412,000$475.20$70.70 + your plan premium
Greater than or equal to $500,000Greater than or equal to $750,000Greater than or equal to $412,000$504.90$77.10 + your plan premium

Higher-income Medicare beneficiaries also pay a surcharge for Part D. The income brackets are the same. The surcharges are relatively smaller in dollars.

It’s too early to project the income brackets for 2022 coverage. Right now we only have one data point out of 12 to calculate the brackets for 2022. We’ll have three data points out of 12 by mid-December. If I must guess, the range for the first tier will be between $88,000/$176,000 (no change from 2021) and $90,000/$180,000, with the most likely scenario in the middle, i.e. $89,000/$178,000.

The standard Medicare Part B premium is $148.50/month in 2021. A 40% surcharge on the Medicare Part B premium is about $700/year per person or about $1,400/year for a married couple both on Medicare. In the grand scheme, when a couple on Medicare have over $174k in income, they are probably already paying a large amount in taxes. Does making them pay another $1,400/year make that much difference? Nickel-and-diming just annoys people. People caught by surprise when their income crosses over to a higher bracket by just a small amount get mad at the government. Rolling it all into the income tax would be much more effective.

Oh well, if you are on Medicare, watch your income and don’t accidentally cross a line for IRMAA.

HOW TO APPEAL AN IRMAA SURCHARGE

If your income two years ago was higher because you were working at that time and now your income is significantly lower because you retired (“work reduction” or “work stoppage”), you can appeal the IRMAA assessment. The “life-changing events” that make you eligible for an appeal include:

  • Death of spouse
  • Marriage
  • Divorce or annulment
  • Work reduction
  • Work stoppage
  • Loss of income from income producing property
  • Loss or reduction of certain kinds of pension income

You file an appeal by filling out form SSA-44 to show that although your income was higher two years ago, you had a reduction in income now due to one of the life-changing events above.

For more information on the appeal, see Medicare Part B Premium Appeals.

You will not be penalized for life

If your income two years ago was higher and you don’t have a life-changing event that makes you qualify for an appeal, you will pay the higher Medicare premiums for one year. IRMAA is re-evaluated every year as your income changes.

If your higher income two years ago was due to a one-time event, such as realizing capital gains or taking a large withdrawal from your IRA, when your income comes down in the following year, your IRMAA will also come down. The change will take plans every year in January.

If you have any questions about this or anything related to Medicare, give me a call. I help people every day understand the complexities of Medicare. I’m happy to help.

Todd Reagin Maine Medicare Insurance Agent Local Agent help with costs Medicare Advantage Medicare supplement costs compare prices in Maine

Todd Reagin

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can call 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

Special Needs Plans (SNPs)

medicare advantage special needs plans snp d-snp c-snp dual eligible qmb slmb qi msp medicare savings program wellcare liberty dental vision hearing aids transportation humana food card

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that are 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 available in Maine:

Dual-Eligible Special Needs Plans (D-SNP)

D-SNP plans are 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)

C-SNP plans are 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

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 along with additional benefits like dental and vision coverage, help with over-the-counter items such as vitamins and toothpaste or allowances to purchase healthy foods.

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.

A 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

maine medicare part c martins point generations advantage eligible enroll qmb slmb qi msp medicare savings program medicare buy-in maine

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 you deductible.

Medicare Advantage Special Needs Plans costs

Depending on the Special Needs Plan, you will typically have help paying for the following:

  • Medicare Part B premium
  • Monthly premium for your Special Needs Plan (Up to a certain amount)
  • Cost-sharing expenses, such as copayments, coinsurance, and deductibles

Keep in mind that your specific costs may vary, depending on if you qualify for full or partial financial assistance or get both Medicare and MaineCare 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 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 Open Enrollment 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 to choose another 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?

If you need help comparing the different health insurance plans or understanding which plans will cover your doctors and prescriptions, I can help you.

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

Medicare Savings Programs

Maine Medicare Quimby QMB SLMB Mainecare help paying for Medicare LIS SNP application

Medicare Savings Programs, also known as the Medicare Buy-In or “Quimby” is a way to help reduce your costs with the Medicare Part B premium, copays and costs for prescription medications under Part D.

Depending on your income and assets, you may get help paying for Medicare co-pays, coinsurance, deductibles, premiums, and “extra help” with your Part D costs. There are two levels of MSP or Medicare Savings Program help that you may qualify for.

Level 1—The Qualified Medicare Beneficiary (QMB) level:

QMB pays ALL Medicare premiums, coinsurances, and deductibles, and lowers generic drug co-pays and eliminates the “donut hole.” There are also special plans with additional benefits like dental, vision, hearing and transportation that you will also qualify for. Click here to learn more.

Here are the income and asset guidelines for Maine:

Single

INCOME: $1,670 per month or less
ASSETS: Liquid assets at or below $58,000
Note: Liquid assets include cash or other resources that can be changed into cash on demand like cash value of life insurance.

Married

INCOME: $2,255 per month or less
ASSETS: Liquid assets at or below $87,000
Note: Liquid assets include cash or other resources that can be changed into cash on demand like cash value of life insurance.

Level 2—The SLMB or QI level with Maine Rx or DEL:

SLMB or QI pays Medicare Part B premium and Part D premium within a certain limit, pays your deductible, and lowers copays & eliminates the “donut hole.” It also lowers generic drug copays.

Here are the income and asset guidelines for Maine:

Single

INCOME: $2,042 per month or less
ASSETS: Liquid assets at or below $58,000
Note: Liquid assets include cash or other resources that can be changed into cash on demand.

Married

INCOME: $2,758 per month or less
ASSETS: Liquid assets at or below $87,000
Note: Liquid assets include cash or other resources that can be changed into cash on demand.

What Is Estate Recovery?

If you only have one of the MSP levels, QMB, SLMB or QI, the state cannot recover the cost of helping you from your estate when you die.

But if your income and assets are low enough and you get MaineCare plus an MSP, the state MAY try to recover some costs when you die if you are over 54 and have no surviving spouse or dependent child.

How Do I Apply?

  1. Call toll Free: (866) 976-9038 for help or to find someone in your area to help you apply.
  2. Or use My Maine Connection to apply online: www.Maine.gov/MyMaineConnection

If you have both Medicare AND MaineCare (Medicaid) then you may qualify.

Special Needs Plans (SNP) are plans that offer more benefits than you get with traditional Medicare like Dental, vision and hearing aids. These plans are under Part C of Medicare.

What is a MSA Plan?

Simply speaking a Medicare Savings Account (MSA) plan is the Medicare equivalent of a traditional HSA plan. The biggest difference is that your insurance company deposits the money in your health savings account, instead of you.

I’ve been getting a lot of questions about this new plan with a Medicare Savings Account offered in New Hampshire in 2021. So here is some information on this type of plan and how it works. If you’d like more information or have additional questions click the button below and we’ll set up a time to chat or I can mail you more information.

How does a Medicare MSA work?

MSA plans are required to provide you with the same basic coverage as Original Medicare. They are a Medicare Advantage plan under Part C of Medicare with a high-deductible plus a medical savings account.

Your MSA plan makes an initial deposit each year into your account. This money is yours to spend, move to your own bank and/or invest as you choose. And if you change plans later during open enrollment, you keep the money.

MSA plans annual deposits typically range from $2,000 to $3,000 each year, reducing your out of pocket costs to between $3,000 and $5,000 which can be much less than other Medicare Advantage plans.

MSA plans come with a high deductible health plan (HDHP) and a bank account to help pay your medical costs. These plans typically have deductibles that range from $5,000 to $8,000.

HDHPs, as you might have figured out, have a high deductible that you must pay in full before receiving coverage. After you pay off the deductible, the HDHP covers all of your costs for the remainder of the year.

As stated earlier, MSA plans also come with a bank account where the plan provider deposits funds each year for your medical expenses. You can use these funds to pay on the deductible. (See some examples at the bottom of this page.)

Who should consider a MSA Plan?

MSA plans are great for people who are fairly healthy or who do not use traditional medicine. There are generally three main groups of people who choose MSA plans.

  • Christian Scientists
  • Users of Holistic or Naturopathic Medicine
  • Healthy people who travel frequently or may stay long periods in other states
  • Healthy Self-employed small business owners

Key Feartures of MSA Plans

  • $0 Monthly Premium
  • No network — access to any Medicare-participating provider
  • Freedom to choose the best Part D plan
  • Potential to grow account balance over time
  • Investment opportunities for balances over $2,000
  • Special tax advantages — balance and qualified expenditures not taxed
  • Some plans also offer extra benefits.

Other important notes regarding MSA plans: 

  • Funds contributed to MSA plans are not taxed as long as they are used for qualified medical expenses.
  • You cannot personally deposit more money in your MSA bank account. Once you’ve used up all the money in the account, you pay out-of-pocket until the deductible is reached. 
  • If you have any money leftover at the end of the year, it will remain in the account for the following year. 
  • To be in a MSA plan you have to remain enrolled in Medicare Parts A and B.
  • MSA plans are not allowed to include Part D prescription drug coverage. To get prescription drug coverage, you will have to join a standalone Part D plan
  • If you choose to join a Part D plan, out-of-pocket costs associated with the prescription drug plan do not count toward your MSA plan’s deductible but copays for your prescriptions can be paid for from HSA or MSA funds.

For a list of Qualified Medical Expenses go here: https://www.mainemedicareoptions.com/qualified-medical-expenses

We can mail you a copy of the plan if you like.

Just fill out the form and we’ll send you a copy of the MSA plan(s) available in your area.

Some Examples of Medicare Medical Savings Account (MSA) plans

Remember, these are only examples. Plans vary and actual deposits and deductibles may be different from these examples.

Example #1

James and Mary are interested in joining Medicare MSA Plans. Plans ABC and XYZ are available in their area.

 PLAN ABCPLAN XYZ
Yearly deposit$2,500$1,500
Yearly deductible$4,000$3,000
What you pay after the deductible$0$0
Out-of-pocket maximum$4,000 (same as deductible)$3,000 (same as deductible)

If James joins Plan ABC:

  • Plan ABC deposits $2,500 into his account at the beginning of the year.
  • If he uses the money in his account for Medicare-covered Part A and Part B services, he’ll have to spend $1,500 out-of-pocket before he meets his deductible and before the Medicare MSA Plan will begin paying for his health care.
  • Once James has met his deductible, Plan ABC pays all of his Medicare-covered Part A and Part B health care, and he pays nothing.
  • James must continue to pay the monthly Part B premium  

If Mary joins Plan XYZ:

  • Plan XYZ deposits $1,500 into her account at the beginning of the year.
  • If she uses the money in her account for Medicare-covered Part A and Part B services, she will have to spend $1,500 out-of-pocket before she meets her deductible and before the Medicare MSA Plan will begin paying for her health care.
  • Once Mary has met her deductible, Plan XYZ pays all of her Medicare-covered Part A and Part B health care costs, and she pays nothing.
  • Mary must continue to pay the monthly Part B premium.  

Example #2

Linda joins a Medicare MSA Plan with a $3,000 yearly deductible and deposits $1,500 into her account. The plan pays for all Medicare-covered services once Linda meets the deductible. Look below to see how Linda uses the money in her account.

Linda has a $500 doctor’s visit and uses her account to pay for this expense. Since the expense is a Medicare-covered service, the $500 is credited towards her deductible.

Account balanceDeductible
$1,500 − $500 = $1,000$3,000 − $500 = $2,500

Linda gets an MRI that costs $1,000. She uses her account to pay for this expense. Since the expense is a Medicare-covered service, the $1,000 is credited towards her deductible.

Account balanceDeductible
$1,000 − $1,000 = $0$2,500 − $1,000 = $1,500

Linda visits specialists and the total cost of the visits and additional tests is $1,500. She’s used all the money in her account, and must now pay out-of-pocket until she reaches her deductible. Since the expense is a Medicare-covered service, the $1,500 is credited towards her deductible.

Account balanceLinda’s out-of-pocket costsDeductible
$0$1,500$1,500 − $1,500 = $0 (deductible is met)

Linda is admitted to a hospital for surgery. The cost for her hospital stay is $12,000. Since she has met her deductible, the plan pays all of her Medicare-covered Part A and Part B services for the remainder of the year.

Linda’s out-of-pocket costsPlan pays
$0$12,000

Example #3

David joins a Medicare MSA Plan. On January 1, the plan deposits $1,500 into his account. The plan’s yearly deductible is $3,000. The plan pays for all Medicare-covered services once David meets the deductible. Look at how David uses his account.

David has a $500 doctor’s visit and uses his account to pay for this expense. Since the expense is a Medicare-covered service, the $500 is credited towards his deductible.

Account balanceDeductible
$1,500 − $500 = $1,000$3,000 − $500 = $2,500

David visits the dentist, who charges $600 for the service. He uses his account to pay for this expense. The dental service is a Qualified Medical Expense, but it’s not a Medicare-covered service. He may use his account for the dental service, but the expense isn’t credited toward his deductible.

Account balanceDeductible
$1,000 − $600 = $400$2,500 − $0 = $2,500

David’s electric bill is due. He uses the money in his account to pay the $200 bill. He’s allowed to use the account to pay for this non-medical expense, but it isn’t credited towards his deductible. He’ll also pay income tax and a 50% tax penalty on this non-medical expense.

Account balanceDeductible
$400 − $200 = $200$2,500 − $0 = $2,500

David falls and goes to the emergency room. The emergency room visit and other costs related to his fall total $3,500. He uses the remaining $200 in his account and must then pay $2,300 out-of-pocket until he meets his deductible. After he meets his deductible, the plan pays the remaining cost of his emergency room visit and for all of his Medicare-covered costs for the remainder of the year.

Account balanceDavid’s out-of-pocket costsDeductiblePlan pays
$200 − $200 = $0$2,300$2,500 − $2,500 = $0 (deductible is met)$1,000

How do you avoid tax withdrawals from your account for Qualified Medical Expenses?

File Form 1040, U.S. Individual Income Tax Return [PDF, 188 KB], and Form 8853 [PDF, 89.4 KB] each year to report your Qualified Medical Expenses.

Where can I get a list of Qualified Medical Expenses?

For a list of services and products that count as Qualified Medical Expenses and for other tax information, view IRS publication #969 [PDF, 2.13 MB] for the year that you’re filing.

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can call 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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Learn more about Medicare Advantage Plans (Part C)


How do I choose a Medicare Plan

Congratulations, you no longer need to obtain a degree in Medicare!

There are resources available in our great states of Maine & New Hampshire that can educate you on the Alphabet soup of Medicare, while personalizing the approach to suit your needs.  

If you are reading this, you or a loved one may be approaching age 65, retiring from the workforce, or possibly experiencing significant changes to your current Medicare plan and are interested in finding a better insurance plan.

The good news is, we are experts in Maine and New Hampshire’s Medicare health plan options, residing in the communities we serve.  

By contacting one of our local Medicare Advisors we can guide you through all the steps needed to identify the most appropriate plan for you. 

Steps For Finding The Right Medicare Advantage Plan:

  • Utilize the Medicare Plan Finder tool to review prescription drug costs on each plan.
  • Review plans to make sure they are accepted by your physicians and hospitals.
  • Evaluate plans in total, comparing overall out-of-pocket costs, including monthly premiums.
  • Identify additional value and cost savings through carrier-specific programs list Over-the-Counter Allowances, Member Rewards, Dental, Vision, Hearing, Gym memberships, and more. 
  • Identify the need for coverage outside your service area, such as out of network scenarios or specific travel destinations.  

A local Medicare Advisor will not only dig into the details for a plan best suited for you, but assist with any service related needs you encounter after your plan becomes effective. If priorities or prescriptions change from year to year, we will conduct policy reviews to determine whether another plan is worth considering.  

There is no substitute for a qualified, local professional to navigate Medicare insurance with. Check out our map to find one of our 32 local agents endorsed by Plan Advisors.  

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

6 Things to Know When Comparing Medicare Plans

There are many things to consider when it’s time to choose a Medicare Plan. 

For example:

  1. How much are your premiums, deductibles, and other out-of-pocket costs? 
  2. How much do you pay for services like hospital stays or doctor visits? 
  3. Is there a yearly limit on what you could pay out-of-pocket for medical services? 
  4. Which doctors and hospitals do you need access to?  
  5. What prescriptions must be covered?  
  6. Can you qualify for extra help?  

By working with a local Medicare Advisor you get unbiased access to all your available options. We also make sure you understand each of the options, and keep you informed of new plans or changes to existing plans occurring each year.

Here the important points we will review with you in order to help you find the Medicare plan best suited for you.  

Medicare Costs 💸

With Original Medicare there’s no limit on out-of-pocket cost per year, unless you have supplemental coverage or a Medicare Advantage Plan (Part C).

When comparing out-of-pocket costs, remember to also include what you pay each month for your plan’s premium.

This is often overlooked and can cost you thousands more if you’re not careful. Your agent can easily help you compare costs of each option, so you can feel confident the plan you choose fits your budget and risk tolerance. 

Since so many details surrounding your costs & benefits are not covered beyond the benefit summary we help you with a deeper look at the plan in order to gain a complete understanding of the costs associated with each benefit and to make sure you understand all your benefits and how to access them.

Medical Coverage ⚕️

Medicare Supplements and Medicare Advantage Plans all offer coverage beyond that of Original Medicare.

Medicare Supplements work in combination with Original Medicare (Parts A & B) by filling in the gaps of Original Medicare.

These plans do not have networks and offer flexibility to see any doctor or use any hospital in the country as long as the provider accepts Medicare payments. But these plans do not offer additional benefits, such as dental, vision or hearing aids.

Medicare Advantage Plans offer the actuarial equivalent of all the services Original Medicare covers. Most do far better than this minimum requirement.

Some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.

By helping you understand the pros and cons of each option, you’ll be confident in the selection you make each year.  

Prescription Drugs 💊

Prescription drug coverage is a vital component to your plan choice, not only for the coverage it provides, but in order to avoid penalties and fees according to the Medicare regulations.

Whether you take prescription medicines or not, Medicare requires you to have minimum drug coverage. This can be obtained by enrolling in a Part D stand alone plan, Medicare Advantage Plan that includes drug coverage, or what Medicare deems “creditable coverage” like larger employer group plans, retiree plans, or veteran coverage. 

When you meet with your Plan Advisor, we will run a calculation with the Medicare.gov Rx Tool, taking your specific medications into account, ensuring they are covered under the desired plan and with an affordable copay

We will also help you apply for extra help or other available subsidies to cover the costs of medicines, as there are several resources and programs we can apply for.

For prescriptions alone, it pays to schedule a consultation. 

Doctor and Hospital Choice 😷

We will always start with helping you find a plan that your desired Doctors and Hospitals accept and we will confirm that your primary care physician is able to refer to the specialists when necessary. 

Many plans offer some out-of-network coverage. For out-of-network physicians we will help confirm that those doctors will accept your chosen plan as an out of network benefit. This is yet another important feature that our local agent will provide for you.

Quality of Care

The quality of care and services offered by plans and other health care providers can vary. 

Medicare Advantage plans are now graded on certain quality scores by Medicare, known as Star Ratings. A Star Rating is like the reviews you may read about with a local business or vendor.

It is important for you to know the star ratings as they also impact the funding of your selected plan, which may impact plan stability and costs.

Customer service is an important part of using your insurance. This is why having an agent is so important. If you cannot get the answers you need from your insurance company you can always rely on your agent to help.

With over 10 years of experience helping people with these Medicare plans in Maine I have gained a vast knowledge of how these plans work and help my clients resolve issues quickly and easily when the customer service rep on the phone cannot.

Travel Coverage ✈️

Original Medicare does not cover care outside the US so if coverage during travel is important to you, be sure to share this with your agent during our meeting.

Certain Medicare supplements do have travel features. Most Medicare Advantage plans cover emergencies or urgently needed care services outside the US as well.

Whatever your needs, we will review the plans and find one that travels with you.

Would you like my help? (it’s free!)

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Lower Insulin Costs in 2021

Maine medicare part d insulin drug costs 35 dollars novalin novalog humalin humalog n r vial insulin pens cost 35 in maine for 2021 relion walmart

Good news! Some Medicare Advantage and Part D plans in 2021 will provide supplemental benefits for insulin, including during the coverage gap (or Donut hole) phase.

A new program in 2021 called, the Part D Senior Savings Model will weigh the effects of offering people who are enrolled in Medicare more choices of insurance plans that would lower your out-of-pocket costs of insulin to $35 for a one-month supply – and these costs will stay at $35, even when you hit the Donut hole!

High insulin costs, in the past, have been a huge burden on many of my clients, being detrimental to their health and their finances.

During Medicare’s Open Enrollment this year, if you are a diabetic, you should review which plans in Maine will participate in this new program and what that may mean to the cost of your insulin and other medications.

Who is Participating?

In 2021, there will be 1,635 prescription drug plans participating in the Part D Senior Savings Model, including both Medicare Advantage Plans and stand-alone Part D Prescription Drug Plans.

  • For a full list of the drugs effected, click here.
  • To see all the plans that are participating, click here.
  • To talk to a local expert about this program, click here.

Why the New Model?

The new Part D Senior Savings Model was created in response to President Trump’s plan to lower the cost of insulin. For carriers with products participating in this model, a one-month supply of insulin would not cost any more than $35.

The model also intends to decrease Medicare expenses by offering a variety of supplemental benefits to cover costs such as copays and initial coverage.

The Part D Senior Savings Model’s goal is to provide beneficiaries with higher quality care and will benefit those who have either a Part D Prescription Drug plan or a Medicare Advantage Plan.

When Will These Changes Take Place?

Beginning with the Annual Enrollment Period for the 2021 plan year, which runs from October 15th to December 7th, participating insurance companies will offer Mainers on Medicare beneficiaries these supplemental benefits for insulin. The drug companies will pay the 70 percent discount for your insulin, if it is included in the program.

Under the new program, Medicare plans in Maine will offer Mainers more choices that will allow them access to more types of insulin. With the maximum copay being $35, the model projects members saving an average of over 66 percent in annual out-of-pocket costs on insulin.

Additional information on the 2021 Part D Senior Saving Model, including fact sheets and press releases, can be found linked at the bottom of the CMS report.

Would you like my help?

If you would like to talk about this program or schedule a meeting, 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 w not cost you anything 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, just like your car insurance agent.

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.

If you are diabetic and using insulin,
you may be able to save a lot of money.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a phone call or meeting today.

I can answer all your questions over the phone or we can talk face-to-face and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

Read more…

What is Medigap or Medicare Supplement?

Medicare Advantage plans are very popular in Maine, but since there is no one-size-fits-all plan, Medicare Supplements (Medigap) may still be the best option for you.

Supplements work in combination with Original Medicare (Parts A & B) to fill in the gaps of the traditional Medicare program, hence the name “Medi-gap”.

Generally Medicare covers 80% of your medical cost and the Medigap plan pays most or all of the balance of copayments, coinsurance and deductibles.

Medigap plans in Maine and New Hampshire are standardized, meaning every insurance company offers identical plans, with monthly premium costs and underwriting guidelines being the primary differences between them.

In Maine and New Hampshire plans are labeled with letters A, B, D, G, K, L, M, & N. In recent years, insurance companies have added extra benefits like discount dental and vision, and fitness programs, to try and differentiate beyond price.  

Medigap plans have their own set of enrollment periods and rules which vary from state to state. I can help you know when you qualify for one of these plans and go over the different options with you. There is no cost or obligation for my help.

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can call  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Medicare Rates for 2021

Medicare Rate Increases in 2021: What You May Be Able to Expect

Medicare rate increases are typically announced in November each year, so any Medicare cost changes effective for 2021 won’t be announced until late in 2020.

In this guide, we take a look at Medicare rate increases from 2019 to 2020 to shed some light on what we might be able to expect for 2021 Medicare costs.

We also outline some 2021 Medicare cost projections based on the annual Medicare Trustees Report.

2021 Medicare Part B Cost Projections

Based on reporting from the Centers for Medicare & Medicaid Services (CMS), the projected 2021 Medicare Part B premium will be $148.50 per month.1

It’s important to note that this figure only represents an estimate of 2021 Part B premiums. Actual 2021 premiums will be determined in the fall of 2020.

The standard Part B premium in 2020 is $144.60 per month. That’s an increase of $9.10 from $135.50 in 2019.

While most people pay the standard Part B premium, you may pay more if you had a higher reported income two years prior to enrolling in Medicare Part B..

The table below shows the additional amount you will pay in 2020 — called the Income-Related Monthly Adjustment Amount, or IRMAA – based on your Modified Adjusted Gross 2019 Income.

2018 Individual tax return2018 Joint tax return2018 Married and separate tax return2020 Part B premium
$87,000 or less$174,000 or less$87,000 or less$144.60
More than $87,000 and up to $109,000More than $174,000 and up to $218,000N/A$202.40
More than $109,000 up to $136,000More than $218,000 up to $272,000N/A$289.20
More than $136,000 up to $163,000More than $272,000 up to $326,000N/A$376.00
More than $163,000 up to $500,000More than $326,000 up to $750,000More than $87,000 up to $413,000$462.70
More $500,000More than $750,000More than $413,000$491.60

Medigap plans can help cover your 2021 Medicare costs.

Call 207-370-0143 to speak with a LOCAL licensed insurance agent.

Will My Medicare Supplement Insurance Premiums Go Up?

Medicare Supplement Insurance, or Medigap, provides coverage for certain Medicare Part A and Part B out-of-pocket expenses like deductibles, coinsurance and copayments.

The lowest cost Medigap plan premium in Maine currently is $198.60 per month.2

This cost figure is weighted, which means that some 2020 Medigap plan premiums in some areas may be higher.

Each type of Medigap plan offers a different combination of standardized benefits. Plans with fewer benefits may offer lower premiums.

Other factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.

Medigap premiums can increase over time due to inflation and other factors, so you can typically expect Medigap plan premiums to be higher in 2021 than they are currently in 2020.

Compare 2020 Medicare Supplement Insurance Plan Costs

A licensed insurance agent can help you find Medigap plans that are available where you live. You can find out the types of benefits each available plan may offer, the insurance companies that sell them and the premium costs you can expect to pay.

You can request an online plan comparison for free, with no obligation to enroll.

A local Medicare Advisor will not only dig into the details for a plan best suited for you, but assist with any service related needs you encounter after your plan becomes effective. If priorities or prescriptions change from year to year, we will conduct policy reviews to determine whether another plan is worth considering.  

There is no substitute for a qualified, local professional to navigate Medicare insurance with. Check out our map to find one of our 32 local agents endorsed by Plan Advisors.  

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

1 Medicare: Part B Premiums. (Updated April 4, 2019). EveryCRSReport.com. Retrieved from www.everycrsreport.com/reports/R40082.html.

2 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.

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