Open Enrollment Is Here.

While attending a family reunion this summer, a distant cousin told me all about her “horrible” drug coverage. I told her she should review her options every year because there could be a better plan available for her.

Even if you’re happy with your current Medicare Advantage or drug plan, make sure you review your plan changes to avoid costly, unexpected changes that will take effect January 1st.

Why is it so important to pay attention to Open Enrollment?

You may be happy with the plan you have today, but the Part D drug plan or Medicare Advantage plan you have today is NOT the same plan you’ll have in the next calendar year or the year after. And when you chose that plan it may have been the best at the time but since them a new insurance company could have come into your area offering a plan that was not available before or the company you’re with could have a new plan that is less expensive.

This year there are 3 companies in Maine and New Hampshire that have introduced new plans with lower costs. One company has a new plan that is nearly identical to another plan that is $800 per year more expensive!

Each January 1st marks the start of a new plan year.

A new plan year means insurance companies can – and often do – make changes to their plans that can cost you. If you’re not paying attention and simply let your plan renew, these are changes you’ll have to live with for better or worse in the new year.

Here are some important things that insurance companies can change:

For Medicare Part D Prescription Drug Plans:

  • Your monthly premium.
  • Your annual deductible.
  • Your out-of-pocket co-pays.
  • The drug formulary (listing of medications the plan covers). Just one medication leaving your plan’s formulary can cost thousands over the course the year.
  • The network of pharmacies.
  • The pharmacy cost-sharing.
  • Coverage rule for medications (quantity limit, step therapy, prior authorization)
  • Coverage of medications in the Coverage Gap, commonly known as the donut hole.


For Medicare Advantage health plans:

  • Your monthly premium.
  • Your out-of-pocket co-pays and coinsurances.
  • The annual out-of-pocket spending limit. Each year these limits continue to creep up. Is your plan’s limit going up this year?
  • The network of providers.

Each year, prior to the Open Enrollment Period, your Medicare Advantage or drug plan must send information about changes in benefits and costs for the upcoming calendar year. Take time to study that information.

You can make changes anytime between October 15 and December 7.

If you have concerns about your coverage, you can use the Medicare Plan Finder to compare plans located at www.medicare.gov

Or, if you prefer to have an unbiased review your coverage by someone who has the knowledge and experience to help you choose the right plan and explain all your options just give me a call and I’ll be happy to help you.

Would you like my help?

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

The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

If you are turning 65 this year or retiring, you may have questions.

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 an in-person meeting.

I can answer all your questions over the phone or we can meet 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.

2019 Part D Costs

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

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

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

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

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

2019 Part D Changes

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

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

What does this mean to you?

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

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

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

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

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

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

What is the end result?

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

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

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

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

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

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

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

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

Book an appointment with Maine Medicare Options using SetMore

 

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

Want Some Advice? Shop Around!

Like the song says, “You better shop around!”

This is very good advice!

Whether it is groceries, heating oil, or anything else, everybody wants to get the best value for their money. And today’s options for health insurance can be pretty darn costly. That’s why it’s a good idea to shop around for the right Medicare supplement.

Cost is not the only thing to consider.

There are dozens of Medicare plans available in Maine and New Hampshire this year, all with different costs. 

Keeping the following things in mind will help you make a smart choice and get a plan that meets your specific health care needs.

  • How much are each plan’s premiums and deductibles?
  • How much will you pay for the benefits and services you’re likely to use?
  • Is there a limit on what you will have to pay out-of-pocket for the year? 
  • If you’re currently enrolled in a plan, how does that plan stack up to the other plans that are available this year?

Comparing costs of today’s options for prescription drug coverage is another part of the cost puzzle

  • Do you know how much your prescriptions will cost under each plan? 
  • Does the plan cover the drugs you take? 
  • Will the Part D coverage gap (or “donut hole”) effect you?

Only you can determine what mix of benefits and costs will work best with your needs and budget, but I can help. 

Meeting with me will make it easy to compare plans so you can pick one that best meets your needs. 
I will explain everything you need to know and after we’ve narrowed your options to a few really good plans, together we will review those plans to get more details about their benefits and services. 

And you pay nothing for my help!

That’s right. I will help you review your plan options.  I can answer any questions you have about these plans because I am trained by each insurance companies on how the plans work plus I have clients who use these plans and I have real experience helping them year after year.  And I am available throughout the year if you have any questions or need help! 

This means you get to benefit from other people’s experiences!

I will show you which medicare supplements will cost you less and I will also share with you which medicare plans my customers prefer based on their experiences with customer service and working with the insurance company so you’re not stuck fighting to get them to pay for something.
No one plan is perfect for everyone.  Each plan is different, just like each person is different.  I will help you understand the differences so you can make a choice with confidence!

Would you like my help?

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

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

Book an appointment with Maine Medicare Options using SetMore

Low Cost Insulin Alternatives

Medicare Part B covers some diabetes supplies, including:

  • Blood sugar (glucose) test strips
  • Blood sugar testing monitors
  • Insulin
  • Lancet devices and lancets
  • Glucose control solutions  
  • Therapeutic shoes or inserts

Note:  You may need to use specific suppliers for some types of diabetic testing supplies.

If you’re diabetic then you know how expensive it can be. 

While Medicare provides testing supplies to monitor your blood glucose levels at no cost the drugs to treat diabetes are covered under Part D so there is a cost associated with these medications.   Insulin and the syringes to administer self-injections are very expensive and often times can contribute to you entering the “donut hole” which means these drugs get even more expensive.

READ MORE ABOUT THE DONUT HOLE HERE

If you find yourself unable to afford your insulin or syringes or if you do not have Medicare yet here are some tips on how to get what you need.

Blood Glucose Test Strips

If you don’t have insurance or Medicare, test strips are obscenely expensive and the cost seems to be getting worse every month. Still, used properly they can be the most powerful tool you have in the battle to avoid high blood sugar levels and the damage that can cause.

The ReliOn brand meters and strips sold at Walmart are much cheaper than the name brand strips. Currently you can get a box of 50 test strips for about $9.00. (http://relion.com/products/relion-prime-blood-glucose-test-strips-50-ct)

Type 2 Diabetes Drugs

With most pharmacies and supermarkets selling generic drugs for $4 per prescription, you can afford these effective diabetes drugs.

The most prescribed drug for people with Type 2 diabetes is Metformin. Plain Metformin and Metformin ER, the extended release form that is easier on the stomach, are both available as generics. Some generic brands appear to be stronger than others, so if you aren’t happy with the results you are getting with one brand, ask the pharmacist to try another, or if that isn’t a possibility, switch your prescription to another pharmacy that dispenses a different generic brand. The pharmacist will tell you which brand they dispense if you ask.

Insulin

Analog insulins which most doctors prescribe are very expensive. The ones I see prescribed most often are Lantus, Levemir, Humalog, and Novolog. Fortunately there are other insulins that are much cheaper which you may be able to use instead. These cheap insulins are sold at Walmart under the ReliOn brand name.  Currently a vial of ReliOn Novolin is $24.88. (http://relion.com/products/?subcategory=insulin)

The pharmacy at Walmart also has a 100 count box of syringes for $12.58. (http://relion.com/products/relion-insulin-syringes-0330g-mis) as well as a 50 count box of Pen Needles for $9.00 (http://relion.com/products/relion-pen-needles-32g4mm)

 

CAUTION:  Always consult with your doctor before switching medications.

Ken Inchausti, director of media relations, communications and public affairs for Novo Nordisk, Inc., which is the maker of Novolog warns, “There are going to be some distinctions,” he says. “… You can have variations in terms of, one NPH is constructed this way, one NPH is constructed another way.”

Most doctors recommend any time you are switching medications in any situation, it requires delicate and close monitoring and care to make sure you will have a consistent outcome. Always consult with your doctor before switching medications.

The patient information sheet for Humulin states in bold capital letters: “Any change in insulin should be made cautiously and only under medical supervision. Changes in strength, manufacturer, type (e.g., regular, NPH, analog), species or method of manufacture may result in the need for a change in dosage.”  Likewise, printed on the Novolin box is the warning: “Any change in insulin should be made cautiously and only under medical supervision.”  The same warning appears on the website for ReliOn.

What if the cheap insulin is not for you?

If these cheaper insulins are not an option for you for whatever reason, ask your doctor to file the paperwork to get insulin via one of the hardship programs that help people who are insulin dependent. If he cannot or will not, call the largest regional hospital in your area and ask to speak to a social worker about how to sign up for one of these programs.

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 go to the CONTACT page of this site to send an email message to me.  

Call me today and I will explain all your options and help you understand those options so you can get the coverage you need for the most affordable price.

Call me today at (207) 370-0143 or toll free at (866) 976-9038.

 

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.

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. 

FAQ – Frequently Asked Questions

My mother has a very low income. Can she get extra help paying for her prescriptions? Yes. Have her contact her local Social Security office to find out if she qualifies for “Extra Help” with her drug costs. She should also contact the Dept. of Health and Human Services to find out if she qualifies for a Medicare Savings Plan.

» Read more
1 2