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Home Posts tagged "medicare coverage" (Page 3)
How to get a replacement Medicare card

How to get a replacement Medicare card

By Ed Crowe | General Articles | 0 comment | 6 February, 2024 | 0

How to get a replacement Medicare card

If you find yourself in need of a replacement Medicare card due to loss, damage, or a name change, the process is straightforward. We will go over the process to get a replacement Medicare card, ensuring you have access to your necessary healthcare information when you need it.

Find out about Medicare premiums.

The importance of a Medicare card

Before we dive into the replacement process, it’s essential to recognize the significance of your Medicare card. This card contains valuable information, such a as your Medicare number as well as the effective dates of your Part A and Part B coverage. Beneficiaries need to have access to it as proof of Medicare coverage when they require necessary medical services. Whether you’ve lost your card, or it’s been damaged, it is important to obtain a replacement card quickly.  This will help enrollees maintain their access to healthcare.

Ensure eligibility

If you are eligible for Medicare but have not enrolled yet, you need to complete the initial enrollment process before you request a replacement card. Once you complete your initial enrollment, you will receive your card within a few weeks.

Click here to learn about Medicare enrollment periods.

Ways to obtain a new Medicare card

There are a couple different ways to obtain a replacement Medicare card.  Because of this, beneficiaries can choose the method that they are most comfortable with. The two ways to get the new card are:

Online:

Beneficiaries can log into their personal account on the official Medicare website www.medicare.gov.  Once they are logged in, it is easy to follow the prompts and request the replacement card. This method is convenient and typically provides a quicker turnaround. Beneficiaries can print an official copy of their card from their online account to retrieve an immediate copy.

Over the phone:

To request a replacement card over the phone, contact Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778). Beneficiaries need to have their Medicare number as well as other pertinent information to verify your identity.

Provide necessary information

No matter what method you opt for, you need to provide personal information to verify your identity and facilitate the replacement of your card. It is imperative that you use only official channels to request the new card.  Medicare will need details such as your full name, Social Security number, date of birth, and even your Medicare number to verify your identity before they can process the request.

Confirm Your Address

Because Medicare will send the replacement card to the address on record, it is important to make sure you update your current address in the Medicare system if you move.  Keeping your records up to date will ensure you receive your new card a quickly as possible.

Learn the difference between Medicare Advantage and Medicare Supplement plans – watch a quick YouTube video

Be Patient

Once you submit your request your replacement card, it will take time for the request to be processed and sent out to you. The time required to process the request will vary depending on how busy the Medicare office is, so you need to be patient while you wait for the Medicare card to arrive.

Obtaining a replacement Medicare card is a straightforward process.  Following these steps and keeping your information current, will ensure the process is smooth should you need a replacement card.

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Wellcare prescription plans

Wellcare prescription plans

By Ed Crowe | General Articles | 0 comment | 6 February, 2024 | 0

Wellcare prescription plans

Because the ability to access affordable prescription medications is crucial to maintaining good health, beneficiaries must be aware of all their options.  In order to help individuals make an informed decision, we will discuss some benefits of the WellCare prescription drug plans.

Important; CMS has guidelines in place to regulate the types of medications that prescription drug plan providers must cover.  This includes a minimum standard of benefits for providers to follow. The formulary for each plan Each plan meets the requirements as required by law. Because each plan differs, the cost and drugs included in the formulary can vary.

Find out about the Medicare drug price negotiations

Although Wellcare offers three different plan choices, it is important to review each plan formulary and make sure it provides coverage to fit the prescription needs for anyone considering enrollment.

The three Wellcare PDP plans for 2024

  1. Wellcare Medicare Rx Value Plus – is a great option if you require more comprehensive prescription coverage. See what this plan has to offer, Wellcare RX Value Plus summary of benefits.
  2. Wellcare Classic PDP – those who receive Extra Help may be eligible to enroll in this plan for a$0 premium as well as a low co-pays, view the  Wellcare Classic PDP summary of benefits.
  3. Wellcare Value Script – this plan provides low-cost coverage an dis a good choice for those that require few medications. For more details, look at the Wellcare Value script summary of benefits 2024.

Some features of the Wellcare prescription plans

Wellcare has no or low premium plans available to provide coverage for individuals who qualify for Extra Help.  These plans are available in all states and offer low or no copays when enrollees purchase prescriptions from preferred pharmacies.

Some Wellcare plans include no deductible, so plans cover prescriptions on day one.

Wellcare has a nationwide network of preferred pharmacies that includes thousands of national, regional and local pharmacy chains. It also includes grocers and independent pharmacies as well.  These relationships help plan members save money on prescription drugs.

Use this link to the Wellcare preferred pharmacy tool and find a local in-network pharmacy.

Find a preferred pharmacy tool to find a local pharmacy.

The member service representatives are available either online at wellcare.com/PDP or by phone at 866-822-1339 (TTY – 711) during the hours of 8am – 8pm EST Monday – Friday. They can provide answers to members coverage or medication questions.

If you want to view the plan formulary (complete list of drugs each plan covers), visit Wellcare’s website or contact their member services department.

Click here to download a 2024 Wellcare Summary of Benefits

Understanding PDPs

Comprehensive Coverage

Prescription Drug Plans( Medicare Part D or PDPs), provide coverage for a wide range of prescription medications. These plans are designed to complement Medicare coverage provided by Original Medicare and or a Medicare supplement plan. PDP plans offer a cost-effective way to manage prescription drug expenses.

Medication Formulary

Each prescription drug plan comes with a specific list of covered medications known as a formulary. It’s essential to review this list to ensure that the medications each member takes or may need in the future are covered under the plan.  In most cases, PDP plan providers update their formularies each year.  This means it is imperative that enrollees go over plan changes each year to ensure they are still on the best plan for their needs.  In many cases, it is a good idea to enlist he help of a licensed Medicare agent to help go over all your coverage options.

Learn about the Part D drug cap

Pharmacy Network

Prescription drug plans have a network of preferred pharmacies where enrollees can fill their prescriptions. It’s important to check the pharmacy list to maximize cost savings. If you opt to use non-preferred pharmacies, your out-of-pocket costs may be higher.

Tiered Cost Structure

Prescription medications are categorized into different tiers, each with its own associated cost. Lower-tier medications generally have lower copayments or coinsurance, while higher-tier medications may have higher out-of-pocket costs. Understanding the tier structure can help you plan for and manage your prescription drug expenses.

When can you enroll in Medicare Part D

WellCare is dedicated to providing affordable healthcare solutions. Their prescription drug plans are designed to help individuals save on out-of-pocket costs for prescription medications. This can be beneficial for those who rely on multiple medications to manage chronic conditions. WellCare PDP Plans include the option for mail-order services. This convenient feature allows members to order a 90-day supply of  medications. This saves trips to the pharmacy and potentially reduces overall prescription costs.

Please note:

It is important to always review plan details, this includes the formulary and preferred pharmacy network to ensure the best coverage for each individual enrollee is chosen. Beneficiaries should consider using the help of a licensed Medicare agent when making important Medicare coverage choices.

Click here to learn how a Medicare agent can help you

Aetna Silverscript

Aetna SilverScript

By Ed Crowe | General Articles | 0 comment | 31 January, 2024 | 0

Aetna SilverScript

For Medicare beneficiaries who are on Original Medicare or Original Medicare and a Medicare Supplement plan, it is a good idea to add a Medicare prescription drug plan to cover your prescriptions. One prescription drug plan that provides coverage to many beneficiaries is the Aetna SilverScript Plan.  In this post, we will go over some of the benefits these plans provide.

Aetna SilverScript Overview

Aetna SilverScript is a Medicare prescription drug plan provider.  It is part of the Aetna family of medical insurance plans. These plans are designed to work with Original Medicare or Medicare supplement plans and cannot be sold to anyone who is currently enrolled in a Medicare Advantage plan and wants to remain on that plan.

Eligibility for prescription plan enrollment

In order for a beneficiary to eligible for enrollment in any PDP plan, they must be enrolled in either Medicare Part A or both Medicare Part A & Part B.  Beneficiaries must also live in the service area of the plan they want to enroll in.

There are specific times you must use to enroll in a Medicare prescription drug plan (Part D).

  1. During your initial enrollment period (IEP).
  2. Enroll during the Annual Election period (AEP).
  3. If you have a Medicare Advantage plan, you can enroll during the Medicare Advantage Open Enrollment Period (MAOEP).
  4. When you qualify for a special election period (SEP).

Learn more about Medicare’s enrollment periods

Aetna SilverScript plans

In 2024, Aetna is offering 3 different plan choices:

  1. First, the SilverScript Smart Saver plan – This plan has an average monthly premium of $11.19, Please note, this cost is an average.  Actual cost depends on the service area. This plan offers a $0 copay for a 30-day supply of Tier 1 drugs.   There are almost 600 drugs that fall into Tier 1 and Tier 2 on this plan, drugs on tier 2 have a copay amount of $5.  The SilverScript Smart Saver plan also provides members a low deductible of $280 for Tier 2 through Tier 5 drugs.
  2. Second, the SilverScript Choice plan – Members of this plan pay an average monthly premium of $46.59.  Please note, this cost is an average and the actual cost depends on the service area.  There is a $545 deductible applied to all tiers of this plan.  The copay amount for Tier 1 drugs is $2 while the Tier 2 copay amount is $7.  Beneficiaries who qualify for Extra Help do not have to pay a plan premium.
  3. Third, the SilverScript Plus plan – The premium for this plan averages $103.51 although the actual amount varies depending on the service area.  This is a top-notch plan that offers members a $0 deductible for both Tier 1 and Tier 2 drugs.  On this plan, there is a $0 copay for many prescription vitamins, minerals and some other types of drugs. members also receive additional gap coverage.

Watch a video on Drug plan changes for 2024

Features of Aetna SilverScript PDP plans

Variety of Plans

Aetna offers a wide range of prescription drug coverage options.  This allows beneficiaries to choose a plan that aligns with their personal needs and budget.  Each plan covers different medications at varying costs.

Extensive Network of Pharmacies

All Aetna SilverScript plans offer an extensive network of pharmacies.  This gives beneficiaries the flexibility and convenience to choose where they fill their prescriptions.

Mail-Order Options

The Aetna SilverScript plans provide the option for mail-order prescriptions, allowing beneficiaries to receive a 90-day supply of their medications conveniently delivered to their door.

Members of Aetna SilverScript PDP plans can visit AetnaMedicare.com to access and print plan materials, pay their plan premiums, check coverage of their drugs or locate a local, preferred pharmacy.

Aetna also provides members a secure site, Caremark.com, to find prescription prices, see possible prescription savings options, sign up for mail delivery, check order status and more.

Click here to learn why you should use a Medicare agent

To see if these plans are right for you, check with a licensed Medicare agent who can ensure your coverage needs are properly met by either these plans or another one.

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How to find my Medicare ID number

How to find my Medicare ID number

By Ed Crowe | General Articles | 0 comment | 30 January, 2024 | 0

How to find my Medicare ID number

There are times when you need to have your Medicare ID number. For example, when it is time to enroll in a new Medicare plan, you need to have your Medicare ID to enter on the application.  If you are a Medicare beneficiary, you may be wondering; how to find my Medicare ID number.

Please note:  if you need to sign up for Medicare Part A and or Part B, you go through Social Security. Once you are enrolled, you will need to manage your benefits through Medicare.

Click here to learn about Medicare enrollment periods

How to get your Medicare ID number

If you need to get your Medicare ID number quickly, you can go to www.ssa.gov and sign in to your Social Security account. Once you are in there you can view your benefit verification letter.

There are a few ways to sign into your account

You could sign in with Login.gov if you created an online account with Social Security after September 18, 2021.

If you were not able to create an account with Login.gov, you may have created an ID.me account.  When this is the case, you can log in with your ID.me credentials.

Sign in with your Social Security username if you made an online account with Social Security before September 18, 2021.  You should also use this method if you have signed in in the past with a username and not an email address.

Watch a quick video on how Medicare works with employer coverage

If you need a replacement card

Just sign in to your Medicare.gov account and follow the prompts to print a new card. When you do not have a Medicare.gov account, you need to know your Medicare number as well as your Part A start date.  This information is located on your benefit verification letter.  We mentioned how to find this letter (at ssa.gov) in the beginning of this post.  If you are unable to do this, call Medicare and ask for a replacement card. You can reach them at 1-800-633-4227.  The representative will ask a few questions to verify your identity and then they will mail you a new card.

Why you need a Medicare agent

What else you can do at your local Social Security office or ssa.gov

Make changes to your personal information

Beneficiaries can change personal information such as name changes, or changes in address or phone number.  Because Medicare uses the name, address, phone number, and date of birth that is on your record at Social Security record. This can be done online at ssa.gov.  Sign in and click on “card and record” and choose the option you need and report the necessary changes.

To cancel enrollment in Original Medicare

If you decide to cancel Medicare Part A and or B (you can only cancel Part A if you do not receive it premium free) fill out form CMS-1763. Once you complete the form, you can either mail to your local social security office or fax it to them.

Use this link to find your local Social Security office.

 

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Eligibility for Medicare Part B

Eligibility for Medicare Part B

By Ed Crowe | General Articles | 0 comment | 28 January, 2024 | 0

Eligibility for Medicare Part B

Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services.  In this post, we will go over the rules for eligibility for Medicare Part B.

To be eligible for Medicare Part B, individuals must meet certain criteria

Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare.  However, there are other scenarios when an individual may be eligible to enroll.

Turning 65

The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years.  This period of time is referred to as the IEP.  It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.

Disability

In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B.  Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.

End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage.  This coverage includes Medicare Part B.

Watch a YouTube video on SEPs. OEP and Late Part B Enrollment

Enrollment periods

When enrolling in Medicare Part B, there are a few different enrollment periods available.  Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.

IEP (Initial Enrollment Period)

The IEP is the seven-month period that begins three months before the individual turns 65.  It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.

SEP (Special Enrollment Period)

Some individuals may qualify for a Special Enrollment Period.  For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.

Learn more about SEPs

GEP (General Enrollment Period)

If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period.  This enrollment opportunity runs from January 1 to March 31 each year.   It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.

Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.

Medicare agents, click here to become part of the team at Crowe

A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.

Click here to see why a licensed Medicare agent is a great asset.

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Medicare premiums

Medicare premiums

By Ed Crowe | General Articles | 0 comment | 18 January, 2024 | 0

Medicare premiums

If you are either a Medicare beneficiary or a Medicare agent, you need to know the cost of Medicare premiums.  Each year the costs are subject to change.  Both enrollees and agents should stay updated on cost and coverage changes. Not having the correct information can be a costly mistake.

Medicare Part A

There is no premium ($0) for Part A for the majority of people most people.  Beneficiaries who worked or had a working spouse who paid Medicare taxes for at least 40 quarters (10 years) receive premium free Part A.

Those who do not qualify for the $0, premium free Part A may be eligible to purchase it.  Beneficiaries must sign up for Part B in order to purchase Part A.  For 2024, the monthly premium is either $278 or $505.  This depends on the length of time either the beneficiary or their spouse worked and paid Medicare taxes.

Please note:  Beneficiaries who do not purchase Part A when they are eligible (in most cases at 65 years old), may pay a penalty.  The penalty adds 10% to the monthly Part A premium and lasts for twice the number of years that you neglected to sign up for Part A.

Medicare Part B

The monthly premium for Part B is $174.70 in 2024.  This amount usually changes on January 1st each year. This premium may be higher for some individuals with a higher income level. This additional charge is called an IRMAA, and it effects about 8% of Medicare beneficiaries.  The Additional charge ranges from $69.90 up to $419.30 added to the monthly premium.

Medicare may charge a late enrollment penalty to anyone who did not enroll in Medicare Part B when they were first eligible or did not have creditable coverage in place at that time.  The LEP for failing to enroll in Part B is 10% for every year the beneficiary did not sign up for Part B.  This penalty is different than the Part A penalty; it will last for as long as the beneficiary has Part B.

Some individuals qualify for help with Part A & Part B costs

If you have limited income and resources, you may be able to get help from your state to pay your premiums and other costs, like deductibles, coinsurance, and copays.

Learn more about help with costs.

Medicare Part D

This premium varies greatly and depends on the plan each beneficiary chooses. The premium for each plan can change annually as well as the plan choice of each individual may also change each year.  If a beneficiary receives an IRMAA on their Part B premium, they will also receive an IRMAA on their Part D premium.

Find out about Part D enrollment periods

Part D plans can charge a LEP if the beneficiary goes without creditable coverage for a period of 63 or more.  The penalty is 1% for each month the beneficiary neglects to enroll in a Medicare Part D plan.  That can equal an additional 12% for each year without coverage.  This LEP is similar to the LEP for Part B because, it is applied for as long as the beneficiary has Part D coverage.  Enrollees who have Extra Help, do not have to pay the LEP.

Medicare Part C (Medicare Advantage)

Not all Medicare beneficiaries enroll in Medicare Part C (Medicare Advantage) plans.  Enrollment in these plans is an individual choice.  The premiums for these plans vary greatly and can cost as little as $0 and can go up from there.  Many of these plans are available for $0, but that depends on the plan and the area it is offered in.

To enroll in a Medicare advantage plan, beneficiaries must pay their Part B premium.  Medicare Advantage plans are not completely free even if they have a $0 premium, members are still responsible for deductibles, co-pays and coinsurance payments.  This cost of these expenses varies based on the plan.

Additionally, these plans have an annual out-of-pocket maximum.  Once that amount is paid by the enrollee, the plan pays 100% of the cost for covered health services.  This amount is another variable that is based on the plan choice.

Watch a quick Youtube video on the differences between Medicare advantage and Medicare Supplement plans

Medicare Supplements (Medigap)

Medicare Supplements help pay the enrollees share of costs after Original Medicare pays it’s share.  In most areas, there are 10 different plan choices and several carriers offering each plan.  For that reason, it is impossible to give a flat premium rate for these plans.  Each plan is quoted based on plan, area and carrier.  Anyone who enrolls in a Medicare Supplement plan must have Part A and Part B coverage and pay that premium.

Learn more about comparing Medicare Supplements

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Why use a Medicare agent

Why use a Medicare agent

By Ed Crowe | General Articles | 0 comment | 31 December, 2023 | 0

Why use a Medicare agent

If anyone asks why use a Medicare agent, we can provide you with some good reasons anyone should consider using a Medicare agent.

Because Medicare agents complete hours of training on both compliance regulations and the Medicare products available in their area, they are well versed on the plans available and provide valuable information to clients. They can provide clients and potential clients comparisons of several plan options and help find the Medcare plan that best fits their needs.

To learn the difference between Medicare Advantage and Medicare Supplements, click here

Compare plan choices

Because health insurance coverage is such an important decision, it is important for clients to understand all their choices. Choosing the wrong plan can be a very costly mistake.  For this as well as many other reasons, the help of a licensed Medicare agent is essential. A Medicare agent can go over the client’s list of wants/needs for coverage and find plan options that are right for them. Agents help clients weigh the benefit of each plan. Medicare plan benefits, rules, and exceptions may be overwhelming to sort out without a trained professional.

Medicare agents can easily narrow down the options and provide a comparison of potential plans.  They can provide clients an understanding of each plan to help them make an informed decision as well as enroll the client in the plan of their choice.

To find out about our quoting tools, Connecture and Sunfire, click here

Many Medicare agents have quoting and enrolling tools that can show you plan options side by side within minutes.  This can save clients countless hours of research.

Consider the client’s current coverage

It is important to consider the client’s current Medicare coverage and find out what about the plan works or does not work for them.  With this information in mind, it is easier to find help them decide whether they should stay in their current plan or if there are better options available to them.

Agents do not charge for their service

As a Medicare agent, you cannot take money from the client for the advice you provide.  This means clients receive expert advice at no cost.  This service is provided for free.  That is one deal you cannot beat!

Medicare agents receive payment through a couple different ways depending on the type of agent they are.  Agents who are employed by and insurance company receive payment based on their agreement with their employer.  Many other agents who are not captive with a carrier, receive payments through the commissions they earn.  They may receive this payment directly from the carrier or if they are LOA, they receive payment from their up-line.  Either way, the amount they make is based on their total number of sales made.

Please note: commission amounts vary based on the plan type and carrier as well as the level each individual agent is contracted at.

Find out about commission levels for 2024

How clients choose a Medicare agent

Here are some things clients may consider when they choose a Medicare agent.

  1.  The first way clients choose an agent is usually word of mouth.  If you have done a great job helping their friends, relatives or co-workers, believe me they will hear about it.  People love to tell their friends about an agent who really did a good job for them.  That is why all your clients need to know that you are there to answer any questions or concerns they have.
  2. Clients feel better knowing they are working with an experienced agent someone who understands the plan benefits and how they work.  Be sure you are up to date on all the plans in the areas you sell in as well as what the rules for enrollment are.
  3. Offer many different carries and plan types for each area you sell in.  Clients want to work with an agent who has access to all the best plans in their area.  Each client is an individual and one plan type may not be the best choice for every client. Do not offer only Medicare Advantage plans as some clients are better off with a Supplement and PDP plan.

Click here for a scope of appointment

    A knowledgeable and caring Medicare agent is a very valuable resource for the community. If you make sure you are well informed and truly enjoy helping those who need advice on Medicare coverage, you can become a successful agent with the right amount of time, effort & training.

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    Medicare prescription payment plan

    Medicare prescription payment plan

    By Ed Crowe | General Articles | 0 comment | 9 December, 2023 | 0

    Medicare prescription payment plan

    The Medicare prescription payment plan is also referred to as “smoothing“. This is a way to help Medicare beneficiaries pay for the high cost of prescription medications.  The Medicare prescription payment plan is one small part of the inflation reduction act of 2022.

    Watch a quick YouTube video on potential changes to commissions in 2025

    When will the program start

    In 2025, Medicare Part D (PDP) plan enrollees have a chance to opt for a prescription payment program.  The plan will help beneficiaries pay out-of-pocket costs for prescriptions.  Everyone in a PDP plan has a chance to enroll in the payment program, it is not based on income.  Enrollees have the option to enroll before the plan year starts or during any month of the year.   Please note, the payment plan does not include plan premium payments.

    Here are some of the details

    Participation in the Medicare prescription payment plan is optional.  PDP plan enrollees must choose to be part of the program.  Once an enrollee joins the program, and has out-of-pocket prescription costs, they receive a monthly bill to cover those costs.  Any out-of-pocket costs for prescriptions are included even during the deductible phase of PDP coverage.  There is no minimum out-of-pocket amount required before anyone can join.  Participants receive a monthly bill as long as they remain part of the program.

    How is the monthly payment amount decided

    There will be an annual cap of $2,000 on out-of-pocket costs in 2025.  The amount each beneficiary pays for their monthly plan depends on a few different factors.  It is not as easy as dividing $2,000 over the course of 12 months.

    Learn more about the Part D drug cap

    1. The Medicare prescription payment plan will deduct the out-of-pocket amount beneficiaries have already paid before enrollment in the program.
    2. Any remaining costs are then divided by the number of months left in the year.

    CMS will create a payment calculator so Part D beneficiaries can decide if enrolling in the payment plan is a good idea or not.

    CMS is still working out the details of this program

    We do not know exactly how the prescription payment program will work yet because the details have not been finalized by CMS yet.  We will post additional details as they are available to the public.

    Please note:  This program is set to start in 2025, the same year the annual drug cap will be set at $2,000.  In other words, no Part D enrollee will pay more than $2,000 out-of-pocket for their prescriptions.

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    Anthem OTC catalog 2024

    Anthem OTC catalog 2024

    By Ed Crowe | General Articles | 0 comment | 5 December, 2023 | 0

    Anthem OTC catalog 2024

    The Anthem OTC catalog 2024 provides members of participating plans access to many useful items at no charge with their prepaid Benefits Mastercard.  Plan members have the choice to pick up items in store or have them delivered to their doorstep.

    Download a copy of the 2024 Anthem OTC Catalog

    Here’s what you can find in the catalog

    1. OTC benefit details.
    2. Details of all the different ways to shop for OTC items.
    3. Eligible items listed by category.

    Members can call the number on the back of their Benefits Prepaid card for any assistance they need.  Members can also get answers to their questions by logging into their secure account in the Benefits Pro Portal at MyBenefits.NationsBenefits.com.

    Here’s how to create an online account

    Access your benefits when it’s convenient for you 24/7 at MyBenefits.NationsBenefits.com

    First time users need to create an account visiting the Benefits Pro Portal or using the Benefits Pro mobile app.  Once you are on the Nations Benefits portal, just click the “register” button and follow the prompts from there.

    If you need assistance, just call 866-413-2582 (TTY: 711)
    Once your portal is set up you can log in and view your spending allowance.  Find participating stores nearby, view and track recent orders and look for eligible products.

    How to shop for OTC products

    Because there are many ways to shop for OTC products, you can easily find the one that works best for you.

    In a participating store

    Members can use their Benefits Prepaid Card to purchase eligible OTC products at one of the many participating stores.  TO find a store near you, visit MyBenefits.NationsBenefits.com and enter the area you want to shop in.  You will quickly find a list of local stores.  The OTC catalog provides an instore shopping guide with information on the available items.  You can also find eligible items in your member portal as well as by scanning the UPC code found on any product by using the Nations Benefits Pro app.

    Once you finish shopping, place your benefits card into the card reader and choose “credit” when prompted.  You do not need a PIN to use the card.  You r eligible spending amount will apply to the purchase.  If you’re spending more than your available balance, you can use another form of payment to cover the remaining balance.

    Have items delivered to your home

    Members can order products for home delivery from the NationsBenefits catalog or by going to MyBenefits.NationsBenefits.com search by product type or UPC code.
    Selected items are shipped to your home at no cost.

    Download a copy of the 2024 Anthem OTC Catalog

    Order through the Benefits Pro App

    You can download the app either by scanning the QR code you find in the OTC catalog or by going to the App Store or Google Play
    Once you have the app downloaded, you can choose the items you want to purchase and follow the instructions to pay and checkout.

    Place an order by Phone

    Find the items and the items number of the OTC products you want to purchase and call the number on the back of your NationsBenefits card.  Member Experience Advisors will assist you Monday through Friday from 8:00AM until 8PM local time.

    To order by Mail

    Find the items you wish to purchase and fill out the order form at the back of the OTC catalog.
    Send your completed order form to:
    NationsBenefits
    1700 N. University Drive
    Plantation, FL 33322
    Mail your completed form no later than 12/20/24 to use your available spending allowance before it expires.

    More information

    The products in the OTC catalog are subject to change.  In some cases, an item, quantity or size may change depending on availability.  Some items may be added or removed without notice.

    Visit our homepage for OTC catalogs from other Medicare carriers

    To view more images by this artist, click here

     

     

     

     

     

    Part D catastrophic coverage

    Part D catastrophic coverage

    By Ed Crowe | General Articles | 0 comment | 4 December, 2023 | 0

    Part D catastrophic coverage

    In 2023, when a beneficiary’s out-of-pocket spending for prescription drugs reaches $7,400, they reach the Part D catastrophic coverage level.  If this happens, the beneficiary pays 5% co-insurance for prescriptions covered by Medicare Part D for the rest of the year.

    2024 catastrophic cost change

    On January 1, 2024, the 5% co-insurance payment in the catastrophic phase will end.  Beneficiaries who reach $8,000 in out-of-pocket spending on Part D prescriptions in 2024 will automatically receive catastrophic coverage.  Medicare Part D plan provider will have to pay 20% of the total drug cost instead of the 15% they paid in the past. Once beneficiaries reach this level, they no longer have to pay either copayments or co-insurance for covered Part D prescriptions for the remaining part of the year.

    Learn more about Medicare Part D plans

    This updated rule applies to Part D enrollees who do not have an LIS (low-income subsidy).  When a Beneficiary reaches the catastrophic level in Part D coverage. they no longer pay 5% of their prescription costs.  In other words, there is a cap on Part D out-of-pocket spending for enrollees in 2024. the catastrophic threshold is $8,000.

    How the catastrophic limit is calculated

    The catastrophic limit includes the prescription costs paid out-of-pocket by Part D enrollees, as well as the value of the manufacturers price discount on brands of medications in the coverage gap phase.  In 2024, a Part D enrollee who uses only brand-name drugs and spends about $3,250 out-of-pocket pays no additional amount for their prescriptions.  The remaining part of the $8,000 catastrophic limit is taken from the manufacturer’s price discount for the medications.

    What this means for beneficiaries

    For beneficiaries who do not qualify for LIS and require expensive medications to maintain their health, annual out-of-pocket costs can be as high as $15,000 annually.  This cost applies to individuals who may take some lifesaving cancer medications.  This cost on top of fighting for their lives adds a terrible amount of stress for them. Once a beneficiary reaches the catastrophic phase, eliminating the 5% coinsurance in 2024 means that Part D enrollees who require high-cost medications covered by Part D can save thousands of dollars.

    Click here to watch a quick video about the Part D changes

    Changes in costs for Part D plan providers

    Due to the end of the beneficiaries required 5% coinsurance payment in the catastrophic coverage phase, Part D plans will have to pay 20% of total drug costs during the catastrophic phase in 2024.  This is 5% over the 15% they currently pay in 2023 and in previous years.

    Changes for 2025

    CMS is putting a hard cap of $2,000 on out-of-pocket, prescription drug spending in 2025.  They will also end the coverage gap phase (donut hole).  Part D plans will have a greater responsibility for prescriptions in the catastrophic phase and more manufacturer price discounts will be added.  These measures will reduce the liability for Medicare in this phase of coverage.  There will be changes to Part D plan costs as well as manufacturer price discounts in the initial phase of Part D coverage.

    Please note: the drug cap does not apply to out-of-pocket costs for Part B prescription drugs.

     

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