Correction to recent post: Medicare Prescription Drug Plan Annual Open Enrollment 2020

Correction: it was an acquisition of Aetna by WellCare.

The Medicare Prescription Drug Plan (Part D) Annual Open Enrollment begins October 15 and runs through December 7, 2019. This is the period when you are allowed to change your Medicare Prescription Drug Plan for the 2020 plan year or, if eligible, enroll in a plan for the first time.

2020 Update: Next year there will be thirty-two plans available, two more plans than this year. The recent accusation acquisition of Aetna drug plans by WellCare will result in some plan name changes. The trend is for additional lower premium plans; six more plans will be priced under $25 a month. However, the number of plans with deductibles will increase too. Next year only five plans will have a $0 deductible, the cheapest being $74.20. Ten plans will see premium decreases with seventeen having increases. The parameters within the Part D plan benchmark design will increase slightly (deductible, initial coverage, donut-hole and catastrophic level) resulting in a potentially higher out-of-pocket.

It is very important to review your plans renewal material and confirm that your current medications will be covered next year. Changes to your plan’s deductible, copays and premium will also be communicated to you in the renewal packet.

If you would like our assistance in evaluating all plans, we again will be offering our advisory services. For our evaluation, recommendation and enrollment assistance, we charge a $175 fee per evaluation. (Note: we do not sell market or represent any Part D drug plans).

If you would like our assistance, please request our Prescription Drug form and we’ll send you one. Once you have completed the form, mail it to the address below along with a check for $175 payable to OnlyHealthInsurance. We will then contact you with results, a recommendation, and assist with enrollment as necessary.

Important for you do-it-yourselfers! It will be important to get an early start this year. Medicare has changed their Plan Finder tool significantly. It offers a much more user friendly experience however some key information and functionality have been removed. We will be supplementing information from other resources (some are listed in the self-help section below), to complete our reviews and make our recommendations.

We appreciate the opportunity to assist you.

Medicare offers free resources to assist you in evaluating plans and enrollment:

  • www.medicare.gov – Using their Plan Finder (www.medicare.gov/find-a-plan) you can enter your medications and preferred pharmacies, review all plan options, and enroll online.
  • Call 1-800-633-4227 – Medicare representatives are available 24/7 to provide free analysis, recommendations and enrollment over the phone.
  • www.q1medicare.com – Best private website on the subject of Medicare Part D. This site has the most information available with tools to compare plans, search the drug formulary of any plan and review star ratings.

Medicare Prescription Drug Plan Annual Open Enrollment for 2020 Plan Year

The Medicare Prescription Drug Plan (Part D) Annual Open Enrollment begins October 15 and runs through December 7, 2019. This is the period when you are allowed to change your Medicare Prescription Drug Plan for the 2020 plan year or, if eligible, enroll in a plan for the first time.

2020 Update: Next year there will be thirty-two plans available, two more plans than this year. The recent accusation of Aetna drug plans by WellCare will result in some plan name changes. The trend is for additional lower premium plans; six more plans will be priced under $25 a month. However, the number of plans with deductibles will increase too. Next year only five plans will have a $0 deductible, the cheapest being $74.20. Ten plans will see premium decreases with seventeen having increases. The parameters within the Part D plan benchmark design will increase slightly (deductible, initial coverage, donut-hole and catastrophic level) resulting in a potentially higher out-of-pocket.

It is very important to review your plans renewal material and confirm that your current medications will be covered next year. Changes to your plan’s deductible, copays and premium will also be communicated to you in the renewal packet.

If you would like our assistance in evaluating all plans, we again will be offering our advisory services. For our evaluation, recommendation and enrollment assistance, we charge a $175 fee per evaluation. (Note: we do not sell market or represent any Part D drug plans).

If you would like our assistance, please request our Prescription Drug form and we’ll send you one. Once you have completed the form, mail it to the address below along with a check for $175 payable to OnlyHealthInsurance. We will then contact you with results, a recommendation, and assist with enrollment as necessary.

Important for you do-it-yourselfers! It will be important to get an early start this year. Medicare has changed their Plan Finder tool significantly. It offers a much more user friendly experience however some key information and functionality have been removed. We will be supplementing information from other resources (some are listed in the self-help section below), to complete our reviews and make our recommendations.

We appreciate the opportunity to assist you.

Medicare offers free resources to assist you in evaluating plans and enrollment:

  • www.medicare.gov – Using their Plan Finder (www.medicare.gov/find-a-plan) you can enter your medications and preferred pharmacies, review all plan options, and enroll online.
  • Call 1-800-633-4227 – Medicare representatives are available 24/7 to provide free analysis, recommendations and enrollment over the phone.
  • www.q1medicare.com – Best private website on the subject of Medicare Part D. This site has the most information available with tools to compare plans, search the drug formulary of any plan and review star ratings.

Medicare Prescription Drug Plan Annual Open Enrollment for 2019 Plan Year

The Medicare Prescription Drug Plan (Part D) Annual Open Enrollment begins October 15 and runs through December 7, 2018. This is the period when you are allowed to change your Medicare Prescription Drug Plan for the 2019 plan year or, if eligible, enroll in a plan for the first time.

2019 Update: Overall the news is good. Five additional plans will be offered next year for a total of thirty plans. There will be twice as many plans under $25 (6) and eight plans with rate decreases. Five plans will see rate increases with a weighted average of $5.90. Also, the Coverage Gap or “donut-hole” parameters will improve ahead of schedule. By 2020, beneficiaries were expected to only pay 25% of their brand name drug costs while in the donut hole. But that change is coming a year early. Next year, the discounts provided by drug manufacturers and plans for brand-name drugs will increase to 75% thereby closing the gap.

It is very important to review your plans renewal material and confirm that your current medications will be covered next year. Changes to your plan’s deductible, copays and premium will also be communicated to you in the renewal packet.

If you would like our assistance in evaluating all plans, we again will be offering our advisory services. For our evaluation, recommendation and enrollment assistance, we charge a $175 fee per evaluation. (Note: we do not sell market or represent any Part D drug plans).

If you would like our assistance, please print our Prescription Drug form. Once you have completed the form, mail it to the address below along with a check for $175 payable to OnlyHealthInsurance. We will then contact you with results, a recommendation, and assist with enrollment as necessary. For those of you wanting to review plans on your own, there are self-help resources available which I have listed below.

Medicare offers free resources to assist you in evaluating plans and enrollment:

  • www.medicare.gov – Using their Plan Finder (www.medicare.gov/find-a-plan) you can enter your medications and preferred pharmacies, review all plan options, and enroll online. Medicare also has a new demonstration video to walk you through the process step by step. See the video link on the Medicare home page.
  • Call 1-800-633-4227 – Medicare representatives are available 24/7 to provide free analysis, recommendations and enrollment over the phone.
  • www.q1medicare.com – Best private website on the subject of Medicare Part D. This site has the most information available with tools to compare plans and enroll online.

 

If you have friends and family entering Medicare, be sure to pass along our information. We love and appreciate your referrals!

Will a Repeal of Obamacare Affect My Medicare?

Will a Repeal of Obamacare Affect My Medicare?

“Will a repeal of Obamacare affect my Medicare?

I have been asked this by a number of concerned clients in response to the recent headlines from Washington.

First, to clear up any confusion, Medicare does not fall under Obamacare (ACA Law), or vice versa. These are two entirely separate government programs designed to serve two different groups of people with minimal overlap. To elaborate, Medicare provides insurance to Americans sixty-five and older or those with disabilities. It provides access to contracted providers nationwide and has its own cost mechanisms and eligibility rules. In contrast, Obamacare created marketplaces through which eligible consumers (those who are not Medicare eligible) can purchase insurance from insurance companies. Income based subsidies are possible for those who qualify and eligibility is determined by state residency and enrollment guidelines.

So, back to the question, would a repeal affect Medicare? I think more indirectly than directly. There are provisions in Obamacare that do affect Medicare, most notably Part D, the prescription drug program and specifically the Coverage Gap or “donut hole” within the drug plan design. A full repeal could negatively impact Medicare Part D beneficiaries and increase their share of cost. President Trump has not addressed this specific provision but only reiterated his personal wish to preserve Medicare and keep it functional.

Of the recent GOP reform plan that never came up to a vote, a change to the Coverage Gap provision was not one of them. The bigger question I think is, will major changes to one government healthcare program indirectly impact the economies of an entirely different government healthcare program. The answer is, maybe, or even probably, but how exactly cannot be determined at this time. Significant changes to Medicare are looming, but due to its own economic challenges. More on that in future issues.

Medicare Part D Special Edition

Open Enrollment for Medicare Prescription Drug Plans (Part D) starts October 15 and runs through December 7, 2016. During this time, you can enroll in a new plan for the 2017 calendar year. This will be welcome news to many who are considering changing to a more affordable plan for the coming year.

Current Medicare Part D enrollees will likely have received, or will soon receive, a renewal packet from their existing plan carrier. This packet will describe any changes to their current plan for next year. These changes may include premium increases, adjustments in covered drugs, revised copays, coinsurance or deductibles, drug restrictions, network pharmacy changes, and more. I encourage you to read this information carefully to understand how these changes will impact your out-of-pocket costs for 2017.

To review all plans, the Medicare Plan Finder is an excellent tool that ranks plans based on your personal drug needs. The webpage includes a step-by-step video to guide you through the process of evaluating and choosing a plan.

For those who would like our assistance in sorting out options, making recommendations, and assisting with enrollment, we will again be offering our fee-based consulting service. Please read our Part D Annual Lettercomplete the 2017 Prescription Drug Form and follow the instructions. For a better understanding of Medicare Part D, please visit our webpage, Medicare Part D.

The Question Column: Part D Plan Highlights

Q:  This year’s Medicare Part D Prescription Drug program open enrollment runs from October 15 through December 7, 2016. Can you give us some background and highlights about the program?

A:  Here are a few important highlights about the program. 

Medicare Part D is voluntary. You are not required to enroll in a plan. If you do enroll, there are no restrictions on pre-existing conditions. This means you can’t be refused coverage based on your health, no matter how many medications you take or how expensive they are. You can change plans every year to meet your changing prescription drug needs.

All plans have four standard benefit levels. For 2017, Medicare has set the benefit level parameters as follows:

  1. The Deductible ranges from $0 – $400. The deductible can’t be higher than what Medicare allows. Plans are free to offer a lower deductible and many plans do. Some have no deductible at all.
  2. The Initial Coverage level is the period after the deductible is met. During this period, the plan provides benefits in the form of coinsurance or copays until you and the plan have spent $3,700 in total prescription drug costs.
  3. Once you and the plan have spent $3,700, you leave the initial coverage level and enter the Coverage Gap or “Donut Hole” until you reach the yearly out-of-pocket threshold of $4,950.  Though very few plans provide benefits during the coverage gap, there are substantial discounts* provided for brand name and generic medications by the plan and drug manufacturers.
  4. The last level is Catastrophic Coverage, which starts after your out-of-pocket drug expenses reach the $4,950 threshold and runs through the remainder of the calendar year. In this stage, your drug costs are reduced to very low coinsurance or copays until the end of the calendar year.

In 2017, Part D enrollees will receive a 60% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole; however, the additional 10% paid by your Medicare Part D plan will not count toward your out-of-pocket. Enrollees will pay a maximum of 51% co-pay on generic drugs (49% discount) purchased while in the coverage gap. Only the 51% copay paid will count toward your out-of-pocket.

A Few Warnings:

  • There is no guarantee that the plan you choose will cover the medication prescribed to you during the plan year and, with few exceptions, can you change plans during a plan year for that year.
  • If you choose not to enroll in Part D plan but decide to enroll later, you may be penalized by not enrolling when you could have. Though the penalty isn’t much to start, it increases the longer you are without coverage and remains for as long as you have a drug plan.
  • In addition to the penalty, deciding to enroll later means waiting for the next annual open enrollment period (October 15 – December 7, 2017) to enroll for a January 1, 2018 start date.  This means you could be without prescription coverage for many months and find you may suddenly need it.

These are just some of the many important features about the Medicare Part D program. You can learn more about Part D and how OnlyHealthInsurance assists our clients by clicking here.

A Closer Look: Avoiding the Medicare Part D Donut Hole

If your share of costs spike during a plan year, it may mean you have reached the Coverage Gap, or “Donut Hole”. This would be the result of reaching the Initial Coverage level threshold for total drug costs ($3,700 in 2017). Here are a few suggestions to delay, or avoid, reaching this gap during the next plan year:

  • Research the medications you are taking and discuss generic or lower cost brand name alternatives with your doctor(s).
  • Obtain your plans formulary drug list and bring it to doctor visits. If drugs are prescribed, you can review those covered by your plan with your doctor and consider generic alternatives. Formulary lists have drugs in alpha order and by classification for easy look-up.
  • Consider a different pharmacy. The competitive model on which the Part D program was designed allows for price discounting by plan sponsors. Prices may vary significantly from one pharmacy to another.
  • Choose an appropriate plan. With over twenty plans available, each with different drug formularies and pricing, it’s a good idea to evaluate plans every year to stay current. Medicare’s Plan Finder tool allows you to enter your medications, dosages, and quantities, as well as your preferred pharmacies. You can save your work using a plan ID and password date for future access.

You can evaluate your plan options by visiting Medicare’s webpage, Medicare Plan Finder. On the same webpage you’ll find a Video Overview on how to complete a plan search, compare plans, and enroll in one that best meets your needs.

You can also contact us and we’ll do the research and prepare recommendations for you. To learn more about our Part D consulting services, please contact us by phone 415-898-0212 or by e-mail at phild@onlyhealthinsurance.com.