medicare information Archives

What Medicare Part B covers

By Ed Crowe | General Articles | 0 comment | 16 October, 2023 | 0

What Medicare Part B covers

Because many people are confused as to what each part of Medicare covers, in this post we will go over what Medicare Part B covers. Understanding what Medicare Part B covers and doesn’t cover is crucial for individuals who rely on this program for their healthcare needs. Although Part B provides extensive coverage for various essential medical services, it is important to consider additional coverage options. These options help provide comprehensive healthcare coverage access to members for services not 100% covered by original Medicare plan.

Medicare Part B Covers:

Part B provides coverage for a wide array of services provided by your doctor. The appointments can include office visits, consultations & preventative services as well as screenings for various conditions.
If you require any outpatient care, Part B will cover it. Outpatient care may include some services you receive at the hospital as well as various other healthcare facilities.
Preventive services are a very important part of Part B coverage. Preventive care, includes screenings for cancer, cardiovascular diseases, and diabetes, among others. These screenings are important to have in order to detect health issues early and promote overall wellness.
It pays for Medical Supplies when they are medically necessary. Supplies include things such as; blood sugar monitors, lancets, and test strips for diabetics as well as durable medical equipment such as wheel chairs, walkers or hospital beds when it is specified as medically necessary.
Some Home Health Services are covered by Part B. As previously stated, Part B covers specific medically necessary services. If you require the care of a home health agency under certain circumstances, it is covered.

Click here for a list of covered DME

Medicare Part B Doesn’t Cover:

Long-Term Care is not covered by Medicare Part B. This includes any custodial care you receive in a nursing home or assisted living facility.
If you require routine dental care, such as check-ups, cleanings, fillings, and dentures, they are not covered by Medicare Part B.
Routine care for vision is also not covered. Routine vision care includes, eye exams for prescribing glasses. Although in specific cases where you require treatment for eye disease or an injury, you will be covered.
The cost of hearing aids or exams is also not covered by Medicare Part B.
Although some Medicare Advantage plans may offer members coverage for acupuncture services, original Medicare including Part B does not cover this treatment option.
This one is not going to be a surprise; procedures considered solely cosmetic, such as facelifts or other elective surgeries, aren’t covered by Medicare Part B.

Some things to remember:

Part B does not cover 100% of your approved medical costs. In most cases, it covers about 80% of your cost after your meet your annual deductible.

This leaves about 20% of the cost for you to pay. That is why many beneficiaries opt for supplemental insurance to help cover the gaps in their healthcare coverage needs. Both Medigap and Medicare Advantage plans are popular options that can provide additional coverage to beneficiaries.

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What is Medicare Part C

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

What is Medicare Part C

Many people see television ads telling them they need Medicare Part C. In this post we answer the question; What is Medicare Part C and do you actually need it.

Medicare Advantage (Part C), gives Medicare beneficiaries an alternative coverage option to Original Medicare. Medicare A & B provide coverage for essential health care benefits such as; doctor visits and hospitalization. Part C (MA plans) take the place of your Medicare Part A & Part B benefits and are available through private insurance companies. They also provide many value added benefits such as prescription coverage (Part D), dental, hearing, vision, OTC benefits and more.

More details about Part C:

All Medicare Advantage (Part C) plans are offered by private insurance companies. MA/MAPD (Part C) carriers are regulated by CMS and must provide beneficiaries the same level of medical coverage that Original Medicare (A&B) provides.

Most Part C (MA/MAPD) plans offer a very competitive premium, many plans have a $0 premium as well as low out-of-pocket costs. This gives people a very cost effective way to get the healthcare coverage they need.

If you opt for a MA/MAPD (Part C) plan, you should be aware of the plan’s provider network and confirm that your doctors are in-network with your selected plan. Even if you choose a PPO plan, using an out-of-network provider can be a costly mistake.

Each year, during the AEP, you have an opportunity to either enroll in or out of your current Medicare plan. The AEP starts on Oct. 15th and ends on Dec 7th. If you are enrolled in a MA/MAPD, you have an extra opportunity to change your coverage options starting Jan 1 and ending March 31 each year; this is called the OEP.

Summary – Why Choose a Medicare Advantage Plan (Part C):

Part C (MA/MAPD) plans provide comprehensive coverage including additional benefits such as; dental, vision, hearing, prescriptions, OTC, rides to appointments and more. They also cover Medicare A & B charges for doctors and hospitals. Many plans include Part D, prescription drug coverage. All you need is one card to cover your medical costs.

Because MA/MAPD plans have annual out-of-pocket maximums, beneficiaries can feel safe knowing the cost of their annual healthcare has a limit. Plans also offer clear costs for services. Some carriers offer coordination of care benefits which is a great way for all our providers to stay in the loop on your care needs.

There are several different plan options to suit your personal needs including; HMO, PPO, PFFS, DSNP, ISNP, etc.

A Medicare Advantage plan (Part C) is not for everyone:

It is important to consider many factors before choosing Medicare Part C coverage. Some things to think about are; your personal healthcare needs as well as your budget. With careful research and an understanding of the plan’s features, you can make an informed decision that supports your health and well-being.

One of the most important points is to make sure our providers are in-network with the plan you choose.

Consider any medical conditions you may have an dhow often you will require medical attention. It may be a better bet to join a Medicare Supplement and prescription drug plan depending on your personal health needs. There are co-pays, deductibles and out-of-pocket maximums to think about with a Part C plan.

Make sure you are aware of the plans Star Ratings to be sure yo consider a good quality plan.

Remember; plans change every year. Benefits are added and taken away. That is why it is important to work with a knowledgeable, licensed Medicare agent to help you sort out all your plan options during the AEP or OEP enrollment periods.

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How to disenroll from Medicare Part B

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

How to disenroll from Medicare Part B

In this post, we will go over how to disenroll from Medicare Part B. Although it is a rare occurrence, you can terminate your Medicare Part B (Medical Insurance). Although you may need to have a However, you may need to have a personal interview with Social Security to go over the risks of dropping coverage. They will also be able to help make sure you have everything you need to process your request.

If you want help terminating your Medicare Part B or to schedule a personal interview, you can contact Social Security either at 1-800-772-1213 (TTY: 1-800-325-0778) or in person. Click the following link to find your local Social Security office.

To cancel Medicare Part B, you will need to download and print Form CMS 1763. Once you have the form, do not fill it out until you have your interview with Social Security. They provide instructions on how to fill it out. If you already have your Medicare card, you’ll need to return it. You can do this either during the in-person interview or by mail once you complete the phone interview.

Reasons to disenroll from Part B:

You were automatically enrolled

If you are receiving either Social Security or Railroad Retirement Board benefits when you age into Medicare, enrollment in Medicare Parts A & B may happen automatically. If that is the case, you will probably receive a Medicare card even if you have not applied for benefits.

You may not want to pay a Part B premium. If you do not opt out in time, your Part B premium might be automatically deducted from your Social Security or Railroad Retirement Board check.

You have insurance coverage through your employer

If you have rejoined the workforce and now have access to employer-sponsored health insurance, you may decide to disenroll from Part B and stop paying the premiums. If this is the case, you need to determine if your employer coverage is either primary or secondary to Medicare.

When your employer coverage is primary, they pay for your care before Medicare kicks in; if there are any left over charges. If your employer coverage is secondary, Medicare pays your medical bills and then the employer coverage pays if there are any left-over charges.

In the event your employer coverage is the primary payer, It may be a good idea to disenroll from Part B if you like. The added coverage you receive may not be worth paying the Part B premium. When your employer coverage is secondary, it is probably better to stay on Part B so you do not get charged Medicare’s portion of your medical expenses.

It is always a good idea to speak with your human resources department at work as well as a licensed Medicare agent to determine what your best coverage options are. They can also help determine which plan would be primary and which would be secondary.

You can’t afford the premiums

When you are not sure you have the money to pay your Part B premium, please be aware of the risks of not having medical coverage. If you become ill, you could end up paying a lot more than a Part B premium. If you do not have health coverage that is at least as good as Medicare, you might have to pay a late-enrollment penalty once you do sign up. The penalties can make your premium even higher and they last for as log as you are enrolled in Part B.

You may be eligible for Extra Help or Medicaid coverage if you have a limited income and few assets. If you qualify for one of your states Medicare savings programs, you may receive help paying for your Part B premium.

Some risks to disenrolling from Medicare Part B:

If you do not have health coverage, you could become injured or ill and be stuck paying for all your medical services out-of-pocket.

Any time you go without creditable coverage, you have a coverage gap and will pay a late enrollment penalty unless you have a SEP (special election period) once you do sign up. You also need to wait until the next General Enrollment Period to get coverage. This period runs from January 1 through March 31st annually.

Any month that you are enrolled in Medicare Part B, you will pay a premium. Once you disenroll from Part B, it will end the first of the following month after you file the request. If you decide to keep Part A, you will receive a new Medicare card showing Part A only.

Can I re-enroll in Medicare Part B if I disenroll now

Disenrollment from Part B does not prevent you from re-enrolling at a later date.

Click here for Medicare Part B enrollment form

There is a good chance that you will not be able to enroll online if you have Part A and disenrolled from Part B. See instructions below to re-enroll in Part B.

Download and fill out the Part B Enrollment form –Click here for Medicare Part B enrollment form

If you currently have coverage through an employer, make sure you have them complete Section B of the form. You may need supporting documents from your employer to prove you had creditable coverage. Click here for help with your application

Send your completed forms either by mail to your local Social Security office or by fax to 1-833-914-2016.

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Inflation Reduction Act and Medicare Changes

By Ed Crowe | General Articles | 0 comment | 7 August, 2023 | 0

Inflation Reduction Act and Medicare Changes

This post will go over the Inflation Reduction Act and Medicare changes. The goal of the Inflation Reduction Act is to provide some financial relief for Medicare beneficiaries by making adjustments to the Medicare program. The new prescription law improves the Medicare program by expanding benefits, lowering drug costs and keeping the drug plan premiums stable.

Inflation Reduction Act and Improvements to Medicare Part D:

Medicare beneficiaries will have access to lower prescription drug costs as well as a redesigned prescription drug program. This new program includes benefits such as:

A $35 monthly co-pay for covered insulin prescriptions.

An annual cap of $2,000 on out-of-pocket costs, starting in 2025.

No cost for recommended adult vaccines.

Starting in 2024 the LIS/Extra Help program under Part D will be expanded to include 150% of the federal poverty level.

Inflation Reduction Act and Price negotiation of Medicare prescription drugs:

This is an important change. It gives Medicare the power to negotiate the cost of prescription drugs directly with the manufacturers. This will lead to lower costs on some of the most expensive, brand-name Medicare Part B and Part D drugs. Because of this change, more people will be able to afford the life saving treatments they need.

The inflation reduction act requires drug companies that raise their prices faster than the rate of inflation to pay Medicare a rebate. Because of this, drug manufacturers will be discouraged from charging Medicare beneficiaries ridiculous price increases.

Inflation Reduction Act and Changes to Medicare Part B:

Changes in the Medicare Part B program will improve access to high quality, affordable biosimilars for people with Medicare as well as impose a $35/month cost-sharing cap on insulin used in durable medical equipment pumps.

The Inflation Reduction Act makes Medicare stronger for current and future enrollees. It makes health care more accessible, equitable, and affordable by lowering what Medicare spends for prescription drugs and limiting increases in prices.

Find the answers to some FAQs on the Medicare drug price negotiation

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Losing Medicaid benefits

By Ed Crowe | General Articles | 0 comment | 28 July, 2023 | 0

Losing Medicaid benefits

Because of the recent Medicaid redetermination, many people are losing Medicaid benefits.

During the last 3 year period, Medicaid benefits have been automatically renewed for individuals who became eligible because of the public health emergency caused by COVID-19. During this time, beneficiaries were not required to recertify annually for Medicaid coverage.

Because the public health emergency has ended or “unwinding” as of May 11, 2023, the requirement to recertify for Medicaid coverage is back in place. This means there will not longer be any automatic renewal and Medicaid beneficiaries must prove the need for benefits.

In other words, beneficiaries will go through redetermination.

This process takes place each year and reviews each person’s need for health care assistance through their state government. It is important to reply to any valid communication you receive from your state’s department of Social Services or DSS. If you fail to respond, you may lose your coverage even if you do qualify.

Each state has 1 year to begin the redetermination process starting on March 31, 2023. All states must finish processing renewals within 14 months. In other words, beneficiaries may lose Medicaid coverage as soon as April 2023.

Millions of people will lose Medicaid coverage:

Although we do not know the exact number of people slated to lose coverage, it may be over 15 million. For many employment is a main factor in their loss of Medicaid coverage.

Some individuals will lose coverage due to not confirming eligibility with their state’s DSS offices before the expiration of their coverage. There also may be problems with a backlog of paperwork and a processing system that is simply overwhelmed. This can cause delays and coverage loss. This backlog has the potential to effect millions . That is why it is best to be proactive and go into your Medicaid account to ensure you are still eligible and covered.

Click here to learn more about the unwinding of Medicaid’s continuous enrollment

What if I no longer qualify for Medicaid:

If you reapply for Medicaid and do not qualify, there are other low cost or even free healthcare choices available to you. The choices depend on your personal circumstances.

If either you or your spouse/partner has an employer that offers health insurance coverage, you may qualify to join during either their open enrollment period or with a special election period.
In the interim, if you are not yet eligible for employer based coverage, you can enroll in a short-term insurance plan while you wait to qualify. There are several options for these types of plans.
You can also access healthcare through the healthcare marketplace. In many cases, beneficiaries may qualify for a subsidy and pay a low monthly premium. If you lose health coverage, you have a special enrollment period or SEP you can use to enroll in coverage. To find the market place for your state go to healthcare.gov/marketplace-in-your-state.
College students may be able to purchase health coverage directly through a campus health plan. Students can get details from their registrar’s office.
If you are either 65 or older or have a qualifying disability, you may be eligible for health coverage through Medicare. Contact a licensed Medicare agent for help going over all your plan options.
Anyone who is either a veteran or an active duty service member may qualify for Tricare. Use the following link to get more information: Tricare healthcare coverage.

It’s important to note that if you believe you qualify for Medicaid, you should reapply. We’ll discuss that next. But even if you do apply, you may need to explore some of the options above while you wait to be approved.

How do I reapply for Medicaid benefits:

If you have limited income/funds, you may be eligible to retain your Medicaid coverage. If this is the case, Click here to for information on how to apply for Medicaid. Contact your state DSS office for applications and guidance.

Medicare Card Numbers

By Ed Crowe | General Articles | 0 comment | 11 July, 2023 | 0

Medicare Card Numbers

Medicare is a national service that provides healthcare and medical coverage to any citizen over the age of 65 and some younger with certain disabilities. As one might imagine, there are many, many people who benefit from this service. At last count, in September of 2022, there were over sixty-five million people on Medicare in the United States, which was an increase of over one-hundred thousand since the previous year. Because of the staggering amount of people who are enrolled in this service, it becomes imperative to have a system to keep track of everyone’s personal information. There are two different numbers that are important to know for agents looking for help work with perspectives and manage their insurance enrollment. What are the important Medicare card numbers?

Medicare Card Numbers – Medicare Beneficiary Identifier

This number is important! The Medicare Beneficiary Identifier, or the MBI, is a randomly-generated personal identification number. Each person gets a unique number. That means spouses and families will have different numbers, one for each individual person. The MBI is an 11 digit mix of numbers letters, much like the Health Insurance Claim Number, or HICN.

Beneficiaries will find their MBI on their Medicare ID card. If the card is not available, there is an alternative way of finding the number. Login to Medicare.gov to create an account or call 1(800)Medicare. The Medicare Beneficiary Identifier is important to protect as it lets the beneficiary receive their benefits. Any doctor or healthcare services will require the patient’s Medicare card for their MBI. It is also required to access any of the additional assistance that can come from the federal government, like grocery assistance.

Medicare Card Numbers – National Provider Identifier

The National Provider Identifier, also called the National Provider Identifier Standard or NPI, is the other number that agents may need to access. The NPI is a unique identification number for covered healthcare providers who participate in Medicare. All covered doctors and providers must use their NPI in financial and administrative transactions under HIPAA regulations. The National Provider Identifier is a 10 digit number that can be looked up on the Center for Medicare and Medicaid Services (CMS) website. By entering the provider’s name and location, the database will be able to access their NPI.

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Medicare easy pay form

By Ed Crowe | General Articles | 0 comment | 16 May, 2023 | 0

Medicare easy pay form

The Medicare Easy Pay form is a quick option for individuals who are either still working or not collecting social security yet for some other reason. This option will ensure you never miss a Medicare payment. This is a great way to avoid the complications that could occur if you neglect to pay your Medicare premium.

Once you receive a bill from Medicare, you can sign up for Medicare easy pay. Medicare easy pay automatically deducts your Medicare premiums on the 20th of each month from either your checking or savings account.

Learn more abut signing up for Medicare A & B

There are 2 ways to enroll in Medicare easy pay:

The fastest option is online. You can either log in to an existing account or create an account. Once you log in, click on “My Premiums” and follow the links from there to sign up and fill out the online form.
Another option is to Click here to download the Medicare easy pay form. This option takes longer (from 6-8 weeks) for your deductions to begin. In the meantime, you need to be sure you pay your premiums in a timely manner. You can do this either online through your account or by using the paper bill you receive. Mail the completed form to: Centers for Medicare & Medicaid Services, Medicare Premium Collection Center, P.O. Box 979098, St. Louis, MO 63197-9000.

Once easy pay begins:

Each month you receive a statement that tells you how much will be deducted from your bank account.
The premium is deducted from your bank on the 20th each month. Your bank statement will show a payment marked “CMS Medicare Premiums”.

Click here to download Understanding your Medicare easy pay statement.

If your payment is rejected, you will receive a notice that provides instructions to get the payment in to Medicare. Once your account is up tp date, your easy pay will start up again as scheduled. Medicare will send you a notice if the premium amount changes. The new rate will automatically be deducted from your account on file.

More Medicare easy pay information:

What to do if you need to change the banking information for our automatic payments: simply log into your Medicare account and choose “My Premiums” and “see of change my Easy Pay” form there you can complete a quick online form.

If you do not like to do online forms, you can mail a completed SF-5510 form. Click here to download the Medicare easy pay form. Be sure that you indicate the change you want to make on the form. You can mail the form to the address indicated above. Again, this will take a long time to update (possibly 6-8 weeks). It can take about 4 weeks to stop Medicare easy pay deductions.

If you are having trouble with the Medicare easy pay; please contact 1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048 for assistance.

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How to avoid Medicare mistakes

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

How to avoid Medicare mistakes

If you are getting close to your 65th birthday, you need to know how to avoid Medicare mistakes. Some mistakes can be difficult to repair and may end up costing you money.

Let’s start by explaining what original Medicare is; Original Medicare is a health insurance program offered by the federal government. There are 2 parts to original Medicare. The first part is Part A. In general, Part A covers hospital costs. The second part is Part B. Part B covers things such as doctor’s visits as well as other outpatient services. Most providers participate in original Medicare.

Here are some mistakes people make with Medicare:

1. Waiting to long to sign up for Medicare

There are specific time that you can sign up for Medicare coverage. The most common is your initial enrollment period. This enrollment period begins 3 months before he month you turn 65 and ends 3 months after the month you turn 65.

If you choose not to sign up during your initial enrollment period (IEP), you will need to wait until the Medicare general enrollment period (GEP). The GEP starts January 1st and ends March 31st each year. Your Medicare coverage begins the first day of the month after you apply.

Signing up for Medicare late may leave you with a late enrollment penalty. This penalty can add 10% to your monthly Part B premium for every year (12 months) you delay. This penalty applies only if you do not have other credible insurance coverage (credible coverage is most likely an employer sponsored plan). If you have insurance either through yours or your spouse’s employer, you may be able to delay your Medicare enrollment until you retire or lose your group coverage.

2. Not enrolling when your employer coverage is considered secondary insurance

Although your employer provides health insurance, you may still need to enroll in Medicare. One thing that helps determine if you need to sign up is the size of the company. If there are 20 or more employees, your group health insurance is considered your primary coverage and Medicare is secondary coverage. When this is the case, you may want to delay signing up for Medicare while you or your spouse are still working.

If the employer has less than 20 employees, Medicare normally becomes the primary insurance once you turn 65 and the employer coverage becomes secondary. This can happen even if you have not signed up for Medicare yet.

Additionally, both retiree coverage and COBRA are considered secondary coverage. This means these plans will pay for claims only after Medicare has paid their portion. If this is the case, signing up for Medicare on time is very important.

Because there are exceptions to every rule, it is important to speak with your human resources or benefits manager to determine if your employment based health insurance is primary or secondary to Medicare.

Watch a quick video on Medicare with Employer coverage

3. A lack of understanding of your coverage options

Because original Medicare does not cover 100% of your medical expenses, you will need some type of additional coverage. In general, you have two options for coverage. You can choose either original Medicare with a supplement and drug plan or a Medicare Advantage plan. Many factors will help you decided which type of coverage is best for you. You will have to consider things such as; your health, the doctors you see, the area you live in (plan availability), your finances and weather or not you travel.

Some people prefer a Medicare Supplement plan:

These plans are a good choice for individuals who do not want to check a doctor’s network and do not like the idea of referrals for services needed. If you are considering this choice, keep in mind, you will need to purchase a separate prescription drug plan. Both the Medicare supplement and the drug plan will have a monthly premium.

When choosing a prescription drug plan (Part D), always check your list of medications and see which plan covers them the best

Find out more about Medicare Supplement plans

Medicare Advantage plans are another choice:

Medicare Advantage plans are offered by private insurance companies. They cover Medicare Parts A & B and most times Part D benefits as well. These plans are very competitive and offer many additional benefits that you cannot get with a Medicare Supplement plan. Some of the benefits include dental, eye and hearing as well as free transportation to medical appointments and much more.

Some things to consider when choosing a Medicare Advantage plan are; are you current doctors in the plans network? Although many of the plans are PPOs (this means they provide out-of-network coverage), Some of the plans are HMOs and they do not provide out-of-network coverage. This means it is very important to check your list of providers (doctors & hospitals) and make sure they are in-network with any plan you are considering. Click here to learn more about MA plans.

4. Forgetting to sign up for Part D

Because original Medicare does not cover prescriptions, you will need to enroll in a plan that covers your medications. Make sure you have Part D coverage as soon as you are eligible for Medicare. If you do not have credible drug coverage when you are first eligible, Medicare will penalize you. The penalty may not be a large amount but, it will last the entire time you are on Medicare.

Credible coverage is Drug coverage that is considered equal to or better than what a Part D plan provides. If you are either staying on employer coverage, receive retiree benefits or Tricare military benefits you probably have credible drug coverage. If you choose to enroll in a Medicare Advantage plan, most of them include Part D coverage as well.

When you choose to purchase a Medicare Supplement plan, you need to purchase a stand alone prescription drug plan (part D). Independent insurance companies offer Part D plans and the coverage varies from plan to plan. If you choose to purchase either a stand alone drug plan or a Medicare Advantage plan, you need to check the cost of your prescriptions on that possible new plan.

Each part D plan has a list of covered drugs (a formulary) this will tell you if your prescription is covered and what your co-pay will be. If your drug is not on the formulary, you may need to request an exception from the plan, pay for the drug out of pocket or file an appeal wit the insurance company to cover the cost.

Learn more about prescription drug prices

If you lose your drug coverage for some reason

You are eligible for a special enrollment period for up to two-months after. During this special enrollment period, you can sign up for a Part D plan without a penalty. If for some reason you lose your drug coverage and do not replace it for over 63 days, you may have to pay a penalty.

5. Being unaware of your Out-of-pocket costs

Once you meet your Medicare deductibles, Medicare pays about 80% of approved charges. You will be billed for the remaining cost as well as the deductible. That is why it is a good idea to purchase either a Medicare Supplement and Prescription drug plan or a Medicare Advantage plan to help pay these costs.

Here is a list of some of the costs associated with Medicare:

Plan premium – Medicare consists of many parts. Most people qualify for free Medicare Part A (hospital coverage) if they have worked the required amount of 40 quarters. If you have not worked long enough, there is premium for Medicare Part A. Medicare Part B (doctor’s visits) has a premium of $164.90in 2023. You will need to pay this amount via deduction from your Social Security check or by quarterly invoice. If you enroll in a Medicare Supplement plan and a Part D plan, they will both have a premium to pay. Medicare advantage plans may also come with a monthly premium although there are many $0 options for these plans.
Deductible – In 2023, the deductible for Medicare Part A is $1,600 for each benefit period. It is not an annual deductible. The Part B deductible is $226 annually in 2023. Most Part D plans also have deductibles, but this varies by plan.
Co-pays – this is an amount that is decided by the plan you are on and is applied to specific services/providers you use for care. To view the co-pays associated with your plan, please refer to the summary of benefits for your plan.
Coinsurance – this is a percentage of the cost of services or prescriptions you receive. Original Medicare usually pays 80% of the cost leaving the beneficiary with a 20% cost share. With Part D plans, you may need to pay a percentage of the cost for more expensive name brand drugs.

6. Not signing up because you assume you can’t afford to get Medicare coverage

Fortunately, there are many programs in place to help individuals with limited income pay premiums and cost shares.

The federal government offers a program called Extra Help. This program helps qualified individuals pay for both Part D premiums and the cost of their medications. To see if you qualify for Extra Help; click here.

In addition to the federal Extra Help program, several states offer pharmaceutical assistance. These program can also help individuals pay for prescriptions. Check to see if the programs are available in your state.

Most states offer the MSP (Medicare Savings Program). This program offers help to pay for both Part A & Part B premiums as well as deductibles, co-insurance and co-pays. There are 4 levels of help available on this program based on the individuals income. Learn more about the MSP

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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:

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.
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 .
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.
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:

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.
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.
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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Medicare supplement sales

By Ed Crowe | General Articles | 0 comment | 24 March, 2023 | 0

Medicare supplement sales

Although Medicare covers many medical expenses for qualified individuals, it doesn’t cover everything. That is why many health care agents go into Medicare supplement sales. Medicare supplement plans, also known as Medigap plans, help fill the gaps in Medicare coverage.

If you want to offer Medicare supplement plans to your clients, there are several things you should know:

First, it’s important to understand the basics of Medicare as well as the different types of Medicare supplement plans.

This information will help clients choose the plan that best meets their needs. You may have to ask questions about your client’s health, budget, and preferred providers, as well as explaining the plan differences.

There are four parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare supplement plans are designed to work with Parts A and B. There are 10 standardized Medigap plans available in most states.

There 10 Medigap plans available in most states are; A, B, C, D, F, G, K, L, M, and N.

Each plan has its own set of benefits, so it’s important to understand what each plan covers and how it works with Medicare. Here are some of the key differences between the plans:

Plan F: This plan provides the most comprehensive coverage, covering all of the benefits listed above. However, it is no longer available to new enrollees as of 2020.
Plan G: This plan is similar to Plan F, but it does not cover the Part B deductible. It has become a popular alternative to Plan F since it provides similar coverage at a lower cost.
Plan N: This plan has lower premiums than Plans F and G, but it requires some cost-sharing. This includes copays for doctor visits and emergency room visits.

Please note; Medigap plans are standardized. This means that each plan must offer the same benefits, regardless of which insurance company is offering the plan.

Because supplement plans have their own benefits, it’s important to understand what each plan covers and how it works with Medicare. For example, some Medigap plans may cover deductibles, copayments, and coinsurance, while others may provide coverage for foreign travel emergency care or skilled nursing facility care.

In addition, it’s important to be aware of the rules and regulations surrounding Medicare supplement sales.

For example, there are strict guidelines around marketing and advertising, and it’s important to follow these guidelines to avoid any legal issues.

It is extremely important to build relationships with clients and provide any assistance you are qualified to offer. This may include answering questions about Medicare and Medigap plan coverage and plan enrollment.

In conclusion, selling Medicare supplement plans can be a rewarding career path for salespeople who are passionate about helping others. By understanding the basics of Medicare, the different types of Medigap plans, and the rules and regulations surrounding Medicare supplement sales, salespeople can help clients make informed decisions and provide ongoing support and assistance.

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What Medicare Part B covers

Medicare Part B Covers:

Medicare Part B Doesn’t Cover:

Some things to remember:

What is Medicare Part C

More details about Part C:

Summary – Why Choose a Medicare Advantage Plan (Part C):

A Medicare Advantage plan (Part C) is not for everyone:

How to disenroll from Medicare Part B

Reasons to disenroll from Part B:

You were automatically enrolled

You have insurance coverage through your employer

You can’t afford the premiums

Some risks to disenrolling from Medicare Part B:

Can I re-enroll in Medicare Part B if I disenroll now

Inflation Reduction Act and Medicare Changes

Inflation Reduction Act and Improvements to Medicare Part D:

Inflation Reduction Act and Price negotiation of Medicare prescription drugs:

Inflation Reduction Act and Changes to Medicare Part B:

Losing Medicaid benefits

In other words, beneficiaries will go through redetermination.

Millions of people will lose Medicaid coverage:

What if I no longer qualify for Medicaid:

How do I reapply for Medicaid benefits:

Medicare Card Numbers

Medicare Card Numbers – Medicare Beneficiary Identifier

Medicare Card Numbers – National Provider Identifier

Medicare easy pay form

There are 2 ways to enroll in Medicare easy pay:

Once easy pay begins:

More Medicare easy pay information:

How to avoid Medicare mistakes

Here are some mistakes people make with Medicare:

1. Waiting to long to sign up for Medicare

2. Not enrolling when your employer coverage is considered secondary insurance

3. A lack of understanding of your coverage options

Some people prefer a Medicare Supplement plan:

Medicare Advantage plans are another choice:

4. Forgetting to sign up for Part D

If you lose your drug coverage for some reason

5. Being unaware of your Out-of-pocket costs

Here is a list of some of the costs associated with Medicare:

6. Not signing up because you assume you can’t afford to get Medicare coverage

Medicare prescription drug prices

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

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

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

Medicare supplement sales

If you want to offer Medicare supplement plans to your clients, there are several things you should know:

There 10 Medigap plans available in most states are; A, B, C, D, F, G, K, L, M, and N.

Please note; Medigap plans are standardized. This means that each plan must offer the same benefits, regardless of which insurance company is offering the plan.

In addition, it’s important to be aware of the rules and regulations surrounding Medicare supplement sales.

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