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We always get a lot of questions on Medicare Part D.  Here are some commons questions that we hear and additonal information on part D.  If you have other questions, please email Ed Crowe at Edward@Croweandassociates.com

1.  Popular Summer Medicare Part D Coverage Questions

2.  More on your Medicare Part D Coverage and the 2012 Donut Hole

3.  Average Retail Drug Prices

1.  Popular Summer Medicare Part D Coverage Questions

Question:  As we travel around this summer, will we still have Medicare Part D prescription coverage outside of our home state? Read more

We always get a lot of questions on Medicare Part D.  Here are some commons questions that we hear and additonal information on part D.  If you have other questions, please email Ed Crowe at Edward@Croweandassociates.com

1.  Popular Summer Medicare Part D Coverage Questions

2.  More on your Medicare Part D Coverage and the 2012 Donut Hole

3.  Average Retail Drug Prices

1.  Popular Summer Medicare Part D Coverage Questions

 Question:  As we travel around this summer, will we still have Medicare Part D prescription coverage outside of our home state?

Yes.  You can use your Medicare Part D prescription drug plan at any of your plan’s network pharmacies, and most Part D plans include more than 50,000 pharmacies in their network.  If you are in a remote area of the country and are having trouble finding a network pharmacy, you can always telephone your Medicare Part D plan’s Member Services department and ask them to help you find the nearest pharmacy (the toll-free number is on the back of your Member ID card). 

Question:  If I purchase prescription drugs while outside of the United States, and bring them back with me, will my Medicare Part D plan reimburse me for these drugs if they are on my Part D plan’s formulary?

 Probably Not.  Although you can always ask your plan for more information, the Medicare Part D program does not anticipate coverage for medications purchased outside of the United States. 

Question:  We just moved from North Carolina to Florida and our Medicare Part D plan was cancelled because of our relocation.  Can we enroll back into our same plan now (in July) or do we have to wait until November/December?

 You can enroll now into a new Medicare plan.  Most people are not allowed to change Medicare Part D prescription drug plans outside of the annual Open Enrollment Period (or Annual Election Period) that runs from October 15 through December 7 of each year.  However, a Special Enrollment Period is available for people who move to a new Medicare plan service area during the plan year and allows people to join a new Medicare prescription drug plan or Medicare Advantage outside of the annual Open Enrollment Period.   

 Question:  I will turn 65 in September and will be eligible for Medicare.  When is the best time to join a Medicare prescription plan?

 It depends on when you need your Medicare prescription plan coverage to begin.  Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan.  So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month).  If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month.  Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.

 Did you have a question that needs answered?  No problem, you can email Ed Crowe at Edward@Croweandassociates.com for answers.

2.  More on your Medicare Part D Coverage and the 2012 Donut Hole

 Question:  How do I find out how much more money I need to spend before I exit this year’s Donut Hole?

 The easiest way may be to check your monthly Explanation of Benefits letter.  Your Medicare Part D plan regularly sends you an Explanation of Benefits (EOB) statement detailing your Medicare plan coverage.  You will notice that the letter is separated into sections and in Section 2, you will find information on your current stage of coverage.  You will also see a box in Section 2 of your EOB letter that is entitled, “What happens next?”  In this box, your Medicare plan shows the details of how much more you will need to spend before moving into the next stage of your plan’s coverage. 

 So if you are in the Initial Coverage stage, the “What happens next” area will tell you exactly how far away you are from your Coverage Gap (or Donut Hole).  If you are in the Donut Hole, you will see how much more money you will need to spend before entering the Catastrophic Coverage portion of your Medicare Part D plan.   

Question:  I have already reached my Medicare drug plan’s initial coverage limit of $2,930 and entered the 2012 Donut Hole, so do I now pay the difference between the $4,700 out-of-pocket limit and my plan’s $2,930 initial coverage limit before exiting the Donut Hole?

 Not exactly.  You will stay in the 2012 Donut Hole until your total out-of-pocket costs exceeds the $4,700 threshold – less any name-brand drug discounts you receive while in the Donut Hole.  As a note, there are two different numbers that are used to define your Medicare drug plan’s Donut Hole or Coverage Gap: (1) The total negotiated retail value of your medications:  When the total value of the retail cost of your drug purchases exceeds $2,930, you go into the 2012 Donut Hole. (2) Total Out-of-Pocket Spending:  After your actual spending for covered medications has reached $4,700, you exit the Donut Hole.  (Remember, the brand-name discount counts toward meeting this total out-of-pocket spending amount).

 For example, if you are in your Medicare Part D plan’s Initial Coverage Phase, purchase a medication with a $100 retail cost, and only pay a $30 co-payment out of your own pocket (the plan pays the other $70), you get $30 credit toward the $4,700 Donut Hole exit point and $100 toward your $2,930 Initial Coverage Limit.

Now when you are in the Donut Hole and you buy the same $100 medication, and your plan does not have any Donut Hole coverage, you are responsible for the full $100 drug cost.  However, this year, you will get a 50% discount on all brand-name drugs bought in the Donut Hole, or a 14% discount on generic drugs purchased in the Donut Hole.

 If your $100 medication was a name-brand, then you will pay only $50 – but, you will get the full credit for the $100 purchase toward meeting your $4,700 out-of-pocket threshold or Donut Hole exit point.

 On the other hand, if the $100 medication was a generic drug, you would pay $86 dollars and get credit only for the actual $86 you spent toward meeting the $4,700 Donut Hole exit point or out-of-pocket threshold.

Question:  Will the Medicare Part D plan’s Coverage Gap or Donut Hole really ever go away?

 Yes, but only to the extent that you will still pay 25% in the Donut Hole.  As many people know, the Medicare Part D Donut Hole is scheduled to “close” in 2020.  But medications will not be free when the Donut Hole is finally “closed”.  In 2020, the co-insurance or cost-sharing for both generic and brand-name drugs purchased in the Donut Hole will be no more 25% of the plan’s negotiated retail price.  So, if your 2020 Medicare Part D plan follows the CMS standard Medicare Part D parameters with 25% co-insurance paid during the Initial Coverage Phase, you will pay no more in the Donut Hole than you would pay during normal coverage and the Donut Hole will be effectively eliminated.

 On the other hand, if your 2020 Medicare Part D plan has a $0 (or low) co-payment for your medications during the Initial Coverage phase, and then you find that you are paying 25% of your medication retail prices in the Donut Hole, it may not seem as though the Donut Hole is “closed,” although it technically is.  

3.  Average Retail Drug Prices

 Question:  What does the “negotiated” retail drug price mean and why is it important?

 The negotiated retail drug price is the amount that you would pay for your medication at a particular pharmacy when you have a Medicare Part D prescription drug plan.  The negotiated retail price for a certain medication may be different from the pharmacy’s regular price, and it can be different from pharmacy to pharmacy and from Medicare Part D plan to plan.

For example, if you purchase a formulary medication like Lipitor®, you may see on your receipt a negotiated retail price slightly more or slightly less than someone who is enrolled in another Medicare plan.  And, if you were to go to a different pharmacy using your same Medicare plan, the negotiated retail price could also be slightly different.

 The negotiated retail price is important to you because your total annual negotiated retail drug costs are used to determine the point when you enter into your plan’s Donut Hole phase.  So based on the differences in negotiated retail price between plans, you may meet someone using the same medications, but entering the Donut Hole a short-time before or after you.  Also, if you are in the Donut Hole, you will receive a discount on the negotiated retail price of your formulary medications.  So, based on the negotiated retail prices, people in different Medicare plans will pay different discounted prices in the Donut Hole.

I get a lot of questions about the various Medicare penalties and how much they cost.  I will summarize them here and then provide a link to a site which provides the specific detail.  Here is the overview.

Everyone who qualifies for Medicare does not need to pay for Part A of Medicare.  Some people do not qualify for part A and they need to pay a premium if they want the coverage.  For them, part A costs $451 a month but for most people it costs $0

Medicare Part B costs $99.90 a month for most people.  It can cost less for some people and more for higher income earners.  For example, an individual making over $85,000 a year will pay $139.90. The scale tops out at $319.70 a month for those that make over $214,000 a year.

If you sign up late for part B, you will pay a 10% penalty for every 12 months you didnt have part B, for life.   If you are over age 65, actively working and getting health coverage, you do not need to sign up for part B.  If you are not actively working and getting retirment coverage over the age of 65, you should sign up for part B because the penalty will count for you.

There are two Part D penalties.  The first is for those that sign up late for part D drug coverage.  The penalty is 1% of the average premium for every month you do not have a part D plan.  The average premium is about $31.00 a month which puts the penatly at about 30 cents for every month you do not have a plan.  The penatly never goes away.

There is also a Medicare Part D income penalty.   The penalty starts at about $11.00 a month for those that make over $85,000 a year.  It is added on to the insurance plans premium every month.   Here is a grid of the penalty levels

CMS has a very good page which summarizes this information.  You can see it by clicking here.

Crowe & Associates will holding a number of seminars for Untied Health Care Medicare Advantage plans  and AARP branded Medicare supplement plans.  The meetings will run from 10:30 am to 12:00 and will provide a review of the Medicare offerings by United Healthcare for 2013.  The review will include basic information on Medicare A and B and, reviews of the United products and the enrollment rules for 2013.

The sessions will be presented by Edward Crowe and Paul Smith of Crowe & Associates. There will be ample opportunity to ask questions before and after the presentation.  The meeting dates, locations and times are listed below.  You must call or email in order to reserve a seat at one of the meetings.  

You may call one of two numbers 860-992-4494,  203-241-7261 or email Edward@Croweandassociates.com to reserve your seat.

Location:  304 Federal Road,  Suite 107,  Brookfield, CT 06804

Dates:  Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, November 27, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Location: Danbury Library (170 Main Street, Danbury, CT 06810)

Dates: Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, December 4, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Call or email to reserve you seat(s) today!

Medicare A and B provides coverage for most medical services.  Many seniors purchase a Medicare Advantage plan or a Medicare Supplement to pick up the costs not covered by A and B. Medicare A and B does not provide coverage for Dental, Vision and Hearing.  In the past, many Medicare Advantage plans would also provide benefits for these services but in the past 2 to 3 years they have been dropping these benefits.

It is very difficult to find a stand along dental or vision plan for seniors let alone to find one which is worth the premium.  There is now a discount plan from Carington that provides substantial discounts on all these services and is available to those over age 65.  The plan provides discounts on Dental, Vision and hearing services ranging from 20% to 60%.  Carington has an online function that allows you to search providers and also allows you to see how much a service will cost and to what extent it is going to be discounted.  They utilize an Aetna dental and vision network for better access to choice of providers.

The plan is priced very reasonably at $6.95 a month for an individual up to $15.95 for a family.  Carington Plan Design and Rates Document

If you have questions about this plan, please contact Edward Crowe at 203-796-5403 or email at Edward@croweandassociates.com

People that are about to turn 65 or are newly eligible for Medicare have choices about how they want to cover the gaps in Medicare. They can go with a Medicare Supplement plan, an Advantage plan, a part D plan or just Medicare A and B. This guide provides the basics on Medicare and the coverage choices available.

It may seem confusing at first but choosing the right option is not that difficult once you have a basic understanding of the programs. The attached document will certainly be a good start.

For more specific questions or information needs please email Edward Crowe at Edward@Croweandassociates.com or call at 203-796-5403.

Medicare Buyers Guide EC

If you are turning 65 or have recently become Medicare eligible, you have choices to make. Medicare and your choice of coverage does not need to be complicated. The link below contains a quick guide which will provide the basics of Medicare and explain the choices to make.

The guide is a basic overview but will clearly tell you the options available. Contact information is provided in the guide. You are welcome to call or email with any specific questions.

Medicare Buyers Guide EC

One of the biggest points of confusion for seniors seems to be making a decision between a Medicare Advantage Plan and Medicare Supplement Plan. I receive phone calls on a daily basis from people either turning 65, moving from an employer plan to Medicare or just trying to decide what to do for the Medicare Annual Election period. Often they are confused and feel overwhelmed by the amount of information and plan choices available.

The reality is that it is actually very easy to learn enough to make an educated decision. This article is going to point out the basic differences between the plans and point out the strengths and weaknesses of each. With this info, anyone will be on their way to having enough information to make a confident decision on the best plan for them. (This Article is for people in Connecticut and NY- I will write one for other states in the next few days)

First, we need to break down the differences between the two types of plans and also dispel some myths about both.

Medicare supplement plans-

-They are secondary to your Medicare A and B (In other words, providers bill Medicare first and then your supplement covers some or all of the remaining costs depending on the plan you choose.

-They are for Medical only. You buy Rx coverage separately

-There is not a network. You can go to any doctor that accepts Medicare

-There are plans A-N available but only a few are popular. They Plan F, Plan N and High deductible F

-The plans are standardized in both Ct and NY. If a company offers a plan N, the benefits are identical regardless of the company offering it. Price is the only difference. Once companies plan N is not better than other companies. Just go by the price.

-There is no medical underwriting for them and in Connecticut and New York you can change them the first of any month at any time during the year.

Supplements are a good choice for people that do not want to have any network constraints. They also work well if you have doctors that do not take managed care plans (Medicare Advantage Plans) or if you travel to other states often.

Some clients like the fact that some of the supplements basically cover all of their costs for medical care. (Plan F and Plan C, Plan J for those whom still have it)

Finally, supplements work well for people that are very sick and receiving a high volume of care such as multiple injections at an outpatient facility or in the doctor’s office or people going to a number of physical therapy visits on a weekly basis. If you are on a plan F, you will not be billed for the services

I hear a tremendous amount of incorrect information being given out on a daily basis when it comes to Medicare Supplement plans. Here are some of the major areas where bad info tends to be most prevalent.

-” Such and such a company has the best Supplement plans”- In the world of supplements, there is no such thing as one companies supplement being better than the others. Supplements are mandated to have identical benefits. If United offers a plan F supplement, it has the EXACT same benefits as every other companies Plan F benefits. Supplement plans A-N are subsidized in Connecticut and New York. All plan benefits are the same. The only difference is the price that the company charges for them. If you have decided on a supplement and know which plan you want, take the company with the lowest cost for that supplement. (Example: You decide to take a plan N, Simply choose the lowest cost plan N being offered at the time.)

– “I can’t find all the companies offering supplements and the prices” – This is easy. Each state has a list of all companies in the state offering supplement plans and the prices of them. They can be found on the insurance websites of each respective state. Here is a link to Connecticut Supplement plans and prices for 2011

https://croweandassociates.com/images/stories/Medicare_Supplement_Rates_Connecticut_2011.pdf

“Supplements have underwriting outside of the guaranteed issue period”- There is no underwriting for supplements in Connecticut and NY. Both are guaranteed issue states even outside of the election periods.

“High Deductible F is not a good plan” – This could not be more off base. In Connecticut and Ny there are plans that have very low high deductible F plans. In fact, in Connecticut, Anthem BCBS offers a high deductible F plan for $39.00 a month. This math cannot be beat by any other supplement plan offered in CT. For more information on High Deductible F go to… https://croweandassociates.com/blog/?p=223 for NY

Although there are many good things about supplements, there is also a negative or two. First off is that they do not cover RX, you need to buy a separate drug plan if you want coverage. The going rate for Rx plans is about $32.00 a month. Secondly is the price of the supplements. The lowest cost plan F in CT is about $219.00 a month. When you add your Rx cost to that it brings you to about $250.00 a month for a plan. Keep in mind that you are going to be paying $3,000 in premium for the year no matter what. Even if you have a very healthy year you will have $3,000 less at the end of the year.

Medicare Advantage Plans
Medicare Advantage plans are managed care plans being offered by private insurance companies. They give you your A and B coverage, secondary coverage and Rx coverage all in one package. With a Medicare Advantage plan, your Medicare A and B is administered by the insurance company. As a result, when you go to the doctor you show them your Medicare advantage plan instead of your A and B card.

There are many positives and also negatives about an advantage plan. Here are the positives….

-They are included in your Medical and Rx in one package. You do not need to go and purchase a separate PDP plan.

-They are very inexpensive. All major carriers even offer $0 monthly premium* plans.

-They have out of pocket maximums.

-Preventative care is covered at no cost to the member.

*They can offer you a plan for $0 monthly premium because Medicare is paying the insurance company money to handle your enrollment and care for the year.

-Some carriers have national networks and plans with out of network coverage.

Some negatives about advantage plans…

-They have networks. If you take an HMO advantage plan (Which does not have out of network coverage) and you try to go to an out of network doctor, you will NOT be covered. Many people believe that Medicare will still cover them for the usual Medicare A and B amount if they go to an out of network doctor but it does not. You will need to pay the full cost.

-They have copays for services. You need to be aware of the copays on the plans you choose. Some plans cover certain services better than others. For example, one carrier may cover Major Radiology at 80% while the other covers it for an $80 copay.

-They have pre-certification requirements for some procedures. Your doctor is responsible for obtaining pre certs but they can hold things up at times.

Advantage plans tend to work very well for people in relatively good health that see a reasonable amount of doctors. You need to check to see that all your Docs and any hospitals you go to are in the network. There are now a number of plans with out of network coverage and national networks. This is good if you have a doc or two that is out of network.* The copays on most plans are reasonable and with $0 premium plans available, they can save the right person a lot of money for the year.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Often clients get upset when they go on an advantage plan and incur a large copay. (For example, a CAT scan which is a $150 copay on some advantage plans) They will say “If I was on a supplement, I would not have paid anything”. They tend to forget that the supplement is costing them money every month when the advantage plan is not.

The math on advantage plans actually makes sense for the majority of people but not everyone. Make sure you review the benefits and check networks prior to enrolling. Do the math and see how much you will save in monthly premium vs. how much exposure you have to copays. In the end, the advantage plan will likely win out but a little time needs to be devoted to make a comparison before you make a final decision.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Medicare Advantage Plans and VA benefits

We will explain why veterans should use $0 Medicare Advantage Plans and VA benefits .

There are a large number of Medicare eligible veterans who rely on VA facilities for their medical care and Rx coverage.  Although it is not possible to put all those using VA benefits in the same category, there is a general trend with veterans in Connecticut.  Most veterans go to VA doctors for routine care.  They also use the VA to fill their generic prescriptions.  The need for hospital or emergency care seems to be a different story as most usually tell me they prefer to go to the local hospital or emergency room.

The other trend I often see is:

They tend to have Medicare A and B benefits without either a secondary plan or Rx coverage.  This can lead to out of pocket costs when the veteran needs a name brand drug or chooses to use the local hospital or emergency room.  Medicare A and B leaves them with out of pocket expenses when they use non VA providers.

Read more

Medicare and Medicaid Dual Eligible Plans

Medicare and Medicaid Dual Eligible Plans:  Evercare (United HealthCare) is the only Medicare/Medicaid “Dual Eligible” plan available in the Connecticut market today. WellCare was offering a dual eligible plan but it is currently not being sold due to CMS restrictions.

The Evercare plan offers some benefits to Dual Eligible people that they would not have otherwise. It helps them cut down on potential out of pocket costs associated with visiting doctors whom do not accept Medicaid. The plan also provides a small benefit ($180 a year)toward over the counter drugs which can be purchased through a catalog. Finally, the plan offers 12 round trip rides per you to the doctor which can be useful for those who have trouble making it to their doctors appointments.

Evercare carries no premium for full qualifiers and can be added or dropped at any time. Medicare enrollment time frames are not applicable other than the need for the plan to start the first of the month after the member applies.