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Home 2023 April
Medicare prescription drug prices

Medicare prescription drug prices

By Ed Crowe | General Articles | 0 comment | 19 April, 2023 | 0

Medicare prescription drug prices

Every time you turn on the tv or talk to a Medicare beneficiary, you hear about Medicare prescription drug prices.  The actual cost of prescription drugs with a Medicare plan can have a lot of moving parts.

Here is a list of some things that determine what Medicare beneficiaries pay for their prescriptions each year:

  1.  The premium for your Part D (if you have a stand alone prescription drug plan).  This cost varies depending on the carrier and plan coverage option you choose.  The price can be as little as about $7 up to about $100.  This all depends on your personal needs.
  2. Most plans have an annual deductible for certain medications.  This depends on where the medication falls on the plan’s formulary.  In other words, what tier it is classified as (Most plans do not charge a deductible for Tier 1 medications).  In 2023 PDPs cannot exceed an annual deductible of $505 .
  3. Copayments and coinsurance are the amounts you pay for covered drugs once you have met your plan’s deductible (if your plan has one).  The amount you pay for a copay or coinsurance depends on the tier level assigned to your medication by your particular drug plan.
  4. If you hit the coverage gap (sometimes called the donut hole), you will not pay more than 25% of the cost of  covered brand name drugs.  Many people don’t reach the coverage gap. Once you and your drug plan spend a specified total amount of money for your prescriptions ( $4,660 in 2023), you reach the coverage gap. spent a certain amount for covered drugs. This amount may change each year.  Please note; people with Medicare who get Extra Help paying Part D costs do not fall into the coverage gap.

Some other things that effect the cost of your Medicare prescription drug prices:

  1.  Medicare provides “Extra help” to individuals who have limited income and resources.  This is a program that helps pay for Medicare Part D costs including; premiums, deductibles and coinsurance as well as other costs.   It will also cover any late enrollment penalty that an individual may have incurred.  Some people automatically receive Extra Help if they are on full Medicaid coverage while others have to apply.  After you apply for extra help, you will receive a letter stating what level of help you will receive and how much you will pay for your prescriptions.
  2. You may have to pay a late enrollment penalty.  The penalty is added to your (Part D) Medicare prescription drug plan premium. This penalty applies after the initial enrollment period is over; if there was a period of 63 or more days in a row where you did not have either Medicare Part D or other credible prescription drug coverage.
    In most cases, you will pay the penalty for as long as you have Medicare Part D.  Please note: this applies even if you have a $0 Medicare advantage plan.

    Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2023) by the number full months you didn’t have either Medicare Part D or other creditable drug coverage. The penalty amount is added to your monthly Part D premium by rounding to the nearest $.10.

  3. Each prescription drug plan has it’s own monthly premium.  This amount varies by carrier and plan offered.  It can be helpful to enlist the help of a licensed Medicare agent to find a plan that covers your prescriptions best.

Important:  The inflation reduction act may change the amount Medicare beneficiaries pay annually for their medications; click here to learn more.

Additionally; The cost for Part D covered insulin drugs is now capped at $35 for a one month supply. A deductible does not apply to this amount.  If you receive either a 60 or 90 day supply of insulin, The price cannot exceed $35 for each month’s supply as long as it is a Medicare covered insulin brand.

Sometimes the cost for a particular prescription is higher than you had anticipated.  If this is the case, ask your doctor if there is a lower cost alternative.  You can also check with your prescription drug plan provider and see if they cover an alternative drug at a better rate.   If you want more information on drug prices, visit the cms.gov website where you can view a list of year-to-year drug price information.  This is general information on prices and increases.  It may not match what you pay.

 

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What Does Medicare Part A Cover

What Does Medicare Part A Cover

By Ed Crowe | General Articles | 0 comment | 14 April, 2023 | 0

What Does Medicare Part A Cover

What does Medicare Part A  cover?  As a broker, it is vital that understand how Original Medicare Part A works. This enables you to help them choose supplemental or advantage plans that work best for their individual medical needs and cover any gaps in health care coverage.  Click here to learn how to compare Medicare Supplements to Advantage plans. 

Generally, Medicare covers the following.

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health care

 

How to Find Out if Medicare Will Pay for What You Need:

Talk to your health care provider about why certain services or supplies are necessary.  Ask if Medicare will pays for these. Click here for more details.  There are times when a service is usually covered, but the health care provider thinks that Medicare will not cover it. In this case, you will have to read and sign a statement that explains that you may have to pay for the service or item.

 

Medicare Coverage is Based On 3 Main Factors:

Federal and state laws.

Medicare makes National benefit decisions regarding what is allowed.

Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

 

With this knowledge, you will be able to help your clients determine which supplemental or advantage plans work to ensure their complete medical coverage.  Click here to review parts a, b, c and d coverage. 

Medicare agents; find out what Crowe and Associates has to offer 

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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Does Medicare Cover Hospice

By Ed Crowe | General Articles | 0 comment | 14 April, 2023 | 0

Does Medicare Cover Hospice ?

How to Qualify for Hospice Care:

Your clients qualify for hospice care if they have Medicare Part A and meet the following conditions:

  • A hospice doctor (and regular doctor if applicable) certifies that they are terminally ill (defined as a life expectancy of 6 months or less).

  • They accept comfort care (palliative care) instead of continuing to try to cure the illness.

  • They sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.

Your clients can usually get Medicare-certified hospice care in their home or other live-in facility like a nursing home. They can also get hospice care in an inpatient hospice facility.

What is Hospice Care:

Depending on the terminal illness and related conditions, a hospice team will create a plan of care that can include any/all of these services:

  • Doctors’ services.

  • Nursing and medical services.

  • Equipment for pain relief and symptom management.

  • Medical supplies.

  • Drugs for pain and symptom management.

  • Aide and homemaker services.

  • Physical therapy services.

  • Occupational therapy services.

  • Speech-language pathology services.

  • Social services.

  • Dietary counseling.

  • Spiritual and grief counseling for you and your family.

  • Short-term inpatient care for pain and symptom management.

  • Inpatient respite care, which is care provided in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that the usual caregiver can rest.

  • Any other services Medicare covers as the hospice team recommends.

 

What it Costs in Medicare:

 

  • Clients pay nothing for hospice care.

  • Clients pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the case the hospice benefit doesn’t cover a drug, the client’s hospice provider should contact the Medicare plan to see if Part D covers it.

  • The client may have to pay for board if they live in a facility and choose to get hospice care.

  • To learn more about what is covered under Hospice Care, visit Hospice Care Coverage.

Find out what Medicare covers

Click  here to learn 5 things Medicare does not cover.

If you would like more information on Medicare enrollment, you can find it at Medicare.gov.

 

Already a licensed Medicare agent?   Click here to contract with a better FMO.

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NY prescription assistance program

NY prescription assistance program

By Ed Crowe | General Articles | 0 comment | 14 April, 2023 | 0

NY prescription assistance program

If you are a New York resident, there may be a time when you could use some help paying for your prescription medications.  That is why the NY prescription assistance program may be a useful tool for you.

Click here for some ways to get help paying for prescriptions

Community Health Advocates (CHA):

Residents of New York are eligible to receive free advice from a Community Health Advocate. It is helpful to understand; there are several insurance programs in New York that provide health coverage benefits to eligible residents of New York. To determine eligibility, several things must be considered including; your residence and income as well as your health.  A Community Health Advocate will work to help find you affordable health coverage options as well as discounted care programs. CHA counselors can provide advice either over the phone or in-person at one of the several agencies located throughout the state of New York.  To speak with a CHA advocate, call 888-614-5400 or email cha.cssny.org.

Please note:  Community Health Advocates provide free advice and do not offer medical care or prescription drugs.

 

EPIC (Elderly Pharmaceutical Insurance Coverage Program):

The EPIC program is a available to seniors in the sate of New York.  To be eligible, residents must be 65 or older and meet specific income requirements.  You must also have a Medicare Part D plan in place; there are a few exceptions to this requirement. If you are on a Medicaid spend down program, you are eligible to participate in this program as well.  However, if you receive full Medicaid benefits, you do not meet the requirements for participation in this program.

EPIC offers 2 different plans.  Participation in each plan is based on income. The first plan is the Fee Plan .  This is for eligible members who have income up to $20,000 (single) or $26,000 (married). The second plan is the Deductible Plan .  This is for members who have income that ranges from $20,001 to $75,000  (single) or $26,001 to $100,000 (married).

Additionally; EPIC provides prescription payment assistance to over a quarter million New York residents who save an average of 90% of the cost of their medications.

EPIC lowers the cost of medications by helping beneficiaries pay both deductibles and co-pays.  It also helps members pay their Medicare Part D premiums.  Members receive either free or reduced cost medications.  To find out if you qualify for EPIC, call 800-332-3742.  Anyone who has EPIC automatically qualifies for an extra special election each year.

To download an EPIC application; click here

NY Health Insurance Information, Counseling and Assistance Program:

If you are a New York state resident, you can call 800-701-0501 for a free consultation about health insurance options and issues with Medicare, Medicaid, managed care, or EPIC.

Click here to learn about Medicaid redetermination 2023

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How to Compare Medicare Supplement Plans

How to Compare Medicare Supplement Plans

By Ed Crowe | General Articles | 0 comment | 13 April, 2023 | 0

How to Compare Medicare Supplement Plans

Because there are so many things to think about when you are turning 65 and eligible for Medicare, it can be overwhelming.  Many people do not know where to start.  Well the first thing you need to do is decide if you are going to sign up for Medicare A &B.  This is when it is a good idea to enlist the help of a licensed Medicare agent who can provide the guidance you need.  Once you have applied for Medicare, you may decide to purchase a Medicare supplement plan and you will need to know how to compare Medicare supplement plans.

Please note; some people refer to Medicare Supplements as Medigap plans.

When choosing a Medicare supplement, you need to consider your healthcare needs as well as the plan cost.

The chart below shows the 10 Medicare Supplement plan choices and what they cover.

Medicare Supplement Plan Comparison

Benefits A B C D F G K L M N
Part A coinsurance &

Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100%
Part B copays/coinsurance Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% 50%Amount the plan covers 75%Amount the plan covers Plan covers 100% Plan covers 100%
Blood (first 3 pints) Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% 50%Amount the plan covers 75%Amount the plan covers Plan covers 100% Plan covers 100%
Part A hospice Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% 50%Amount the plan covers 75%Amount the plan covers Plan covers 100% Plan covers 100%
Skilled nursing facility Plan doesn’t cover Plan doesn’t cover Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% 50%Amount the plan covers 75%Amount the plan covers Plan covers 100% Plan covers 100%
Part A deductible Plan doesn’t cover Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% Plan covers 100% 50%Amount the plan covers 75%Amount the plan covers 50%Amount the plan covers Plan covers 100%
Part B deductible Plan doesn’t cover Plan doesn’t cover Plan covers 100% Plan doesn’t cover Plan covers 100% Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover
Part B

Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover Plan covers 100% Plan covers 100% Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover Plan doesn’t cover
Foreign travel emergency Plan doesn’t cover Plan doesn’t cover 80%Amount the plan covers 80%Amount the plan covers 80%Amount the plan covers 80%Amount the plan covers Plan doesn’t cover Plan doesn’t cover 80%Amount the plan covers 80%Amount the plan covers
$6,940 $3,470

It is important to understand that, all Medicare supplement plans are standardized.

In other words, each plan letter must provide the same benefits regardless of which carrier offers it.  However, there are differences in the amount each carrier charges for the plans.

Some things to know when learning how to compare Medicare supplement plans:

There are 10 standard Medicare supplement plans.  They are; A, B, C, D, F, G, K, L, M, and N.  These plans each offer different benefits.

Remember to compare the cost of the plan you are considering; plan prices can vary quite a bit depending on the carrier.   It is also good to know, each carrier may offer additional benefits and provide different levels of customer support.

Some carriers (not all) also offer high deductible plan options, HDF or HDG.  These plans are available at a lower cost, but the beneficiary must meet the high deductible amount before approved services are covered.

Please note; Plan F is only available to those who were eligible for Medicare before January 1, 2020.

There is a plan available that offers similar coverage; it is Plan G.  The difference between Plan F and Plan G is that the beneficiary must satisfy the Part B deductible with a Plan G.

The two most popular plans are G and N.  At this time, Plan G is the most comprehensive plan available to anyone eligible for Medicare after January 1, 2020.  However, Plan N has a lower premium and offers very similar coverage with the exception of Medicare Part B Excess charges.

It is important to keep in mind, excess charges are a rare occurrence.

Additionally; In most states, Medicare supplement plans are underwritten with the exception of a guaranteed issue period.  There are only 4 states that do not underwrite beneficiaries; CT, MA, ME and NY.  Underwriting also applies when moving from one supplement to another.

Crowe and Associates offers free access to several online Medicare comparison and enrollment tools.

Click here to view a Sunfire demonstration.

Watch a Connecture demonstration.

Click here to learn how to compare Medicare Advantage Plans.

If you follow these steps, you can make an informed decision and find the best plan for your needs.

When to start Medicare coverage

When to start Medicare coverage

By Ed Crowe | General Articles | 0 comment | 12 April, 2023 | 0

When to start Medicare coverage

If you are getting close to your 65th birthday, you are probably wondering when to start Medicare coverage.  The start date for your Medicare coverage is based on when you sign up and which election period you’re in.

If you already receive Social Security benefits, there is no need to apply for for Medicare Part A or Part B. You are enrolled in both A and B automatically.  Because you will pay a premium for Part B coverage, you can turn down Part B coverage.

Please Note: If you are a resident of either Puerto Rico or a foreign country, you do not get Part B automatically.  You must sign up for it.

How soon can I sign up; Initial Enrollment Period:

Generally, when you turn 65. This is called your Initial Enrollment Period or IEP. Your IEP lasts for 7 months.  It starts 3 months before you turn 65, and ends 3 months after the month you turn 65.

If your birthday is the first day of the month (ex. May 1st), your initial enrollment period will begin earlier than most people.  Your enrollment period begins 4 months before you turn 65 and ends 2 months after you turn 65.

When to Start Medicare coverage; There are a few different ways to sign up for Medicare:

  1.  Probably the easiest method is to sign up online.  Once you create a my Social Security account, you can move forward and sign up for both Medicare A & B benefits.  Important: be sure the website you are using to sign up has a URL ending in .gov.  This way you can be sure you are on an official government website and your personal information is safe.
  2. You can call Social Security at 1-800-772-1213, TTY users call 1-800-325-0778.
  3. Apply in-person at your local Social Security office.  Click here to locate an office near you.
  4. If either yourself or your spouse worked for the railroad, you  can contact the Railroad Retirement Board by calling 1-877-772-5772.you sign up for Medicare, you can also apply for Social Security benefits at the same time if you want.

Note: If you would like, you can also sign up for Social Security benefits while you are signing up for Medicare A & B.

Click here for more information on when to sign up for Medicare

Although many people are not able to enroll in Medicare until they are close to their 65th birthday, some people qualify to enroll in Medicare due to a qualifying disability.  Once an individual has received disability benefits for 24 months, or has been diagnosed with a qualifying medical condition, such as ALS ( Lou Gehrig’s disease) or end-stage renal disease (ESRD).  

When to start Medicare coverage; One more thing:

Once you are eligible for Medicare if you neglect to sign up, you’ll have to wait until the general enrollment period to enroll.  Each year, the general enrollment period runs from January 1 until March 31. Once you apply, your plan will start the first day of the following month.  Please keep in mind,  you may have to pay a late enrollment penalty if you do not enroll in Medicare during either your initial election period or a special election period.

Find out what Medicare covers

If you would like more information on Medicare enrollment, you can find it at Medicare.gov.

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Connecticut Medicare AEP kickoff

Connecticut Medicare AEP kickoff

By Ed Crowe | General Articles | 0 comment | 10 April, 2023 | 0

Connecticut Medicare AEP kickoff

This year, Pinnacle Financial Services will start the 2023 AEP with an exciting event; the Connecticut Medicare AEP kickoff.  This event will take place on Friday, September 8th, 2023 at the Mohegan Sun Convention Center.  The convention center is located at: 1 Mohegan Sun Blvd, Uncasville, CT 06328 and promises to be a great time for all who attend!

The festivities start at 10:00 am and run until 5:00 pm.

Be sure you save the date as there will be too much to miss.

Meet the carrier reps from all the top plans in CT.  Learn what each carrier has to offer and find out how your clients can benefit from the added plans as well as plan upgrades.

Learn how to get your blog posts seen.  This is a great tool to help you grow your business.

Find out about the NABIP updates.

We will discuss the changes in legislation that can effect your clients as well as the way you do business.

There will be much more to learn at this event, make sure you reserve your spot!

Click here to register for the AEP kickoff!

Let us help you make this your best year yet:

This is a great opportunity to get to know other professionals in the industry as well as put a face to the carrier reps we all like to call for help from time to time.

Get new ideas that could really jump start your 2024.

Pinnacle is providing all attendees with free food and beverages.  There will be three meeting times; breakfast, lunch and happy hour.  If you like, make it a weekend and stay over in one of the fabulous hotel rooms.  Be sure to click the link below for the special discounted rate:

Click here for discounted room rate, use code (PINN23)

 Are you looking for an upline that will actually answer your calls; Click here and see what we have to offer!

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Medicaid Redetermination 2023

Medicaid Redetermination 2023

By Ed Crowe | General Articles | 0 comment | 6 April, 2023 | 0

Medicaid Redetermination 2023

As of April 1, 2023, Medicaid redetermination 2023 will start on a state level.  The “Families First Corona Virus Response Act” established that anyone on Medicaid can not be re-certified every year.  The Consolidated Appropriations Act of 2022 puts a firm end date to guaranteed continuous coverage as of April 1. There are an estimated 92 million people on Medicaid.  Over 20 million have started Medicaid benefits in the last 2 years.

Prefer to watch a recorded webinar on the same topic?  CLICK HERE FOR WEBINAR

Why is Medicaid Redetermination 2023 needed?

During the Coronavirus Pandemic the Families First Act put a moratorium on the states ability to recertify those on Medicaid.  Many people lost their jobs during the pandemic.  As a result of income loss, a large number of people applied for Medicaid. Under normal circumstances, the states would re-certify those on Medicaid every year.  However, due to the Families First Act,  a certification process was not enabled to check the qualifications of recipients on an annual basis.  Many people who were able to find new jobs would have been taken off Medicaid due to the increase in income when they had to recertify.   Because of this fact, an estimated 14 million people are currently receiving Medicaid benefits although they do not qualify based on income.

Are you a Medicare agent looking for ways to write more business?  Learn about our T-65 Seminar program:  Averaging 50+ prospects per seminar

The Consolidated Appropriations Act of 2022

For Medicare redetermination 2023 the CAA allows states to recertify those on Medicaid beginning April 1, 2023.  Most states will not be able to immediately check everyone’s eligibility.   Instead, many will start the normal annual certification process that was in place prior to the Families First Act stopping the process.  However, there is a monetary incentive for states to move more quickly with this process.  The enhanced federal funding rate of 5% ends in June of 2023. (It went from an extra 6.2% down to 5% in April of 2023) This means states will receive 5% less from the federal government toward the cost of those who receive Medicaid.  In addition to the estimated 14 million that may no longer qualify, it is estimated another 6 million may lose coverage due to administrative churning.  This refers to the possibility of administrative errors in the redetermination process for Medicaid Redetermination 2023.

Recertification process

The process for Medicaid Redetermination 2023 will not be a manual process for everyone. People with the lowest incomes as well as those who are disabled, can be passively renewed.  This means they will not need to return any paperwork and will automatically keep Medicaid benefits.  Those that are not passively renewed will receive recertification paperwork in the mail that must be completed and returned.  If someone has moved without notifying the state, they may never receive that paperwork.

 

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Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033

All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here

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