Medicare Part D Archives - Secure Medicare Solutions

Choosing a Medicare Part D Plan – What Is Involved?

June 4, 2018 by Garrett Ball · Leave a Comment

When you enroll in Original Medicare, you have two ways to get your drug coverage – you can enroll in a:

1) prescription drug plan (PDP), otherwise known as Part D, as a stand-alone plan

2) Medicare Advantage Plan (Part C), which includes a prescription drug plan, commonly known as an “MAPD” plan. If you join a prescription drug plan while you are enrolled in a Medicare Part C plan, you will be disenrolled from that plan and return to original Medicare.

Please note that if you do not join a drug plan when you are first eligible, you may have to pay a late penalty. There are, however, two instances that can exempt you from paying the penalty

You have other creditable prescription drug coverage, i.e. through an employer or union
You are currently receiving “Extra Help” – You may be eligible if you meet certain income and resource limits. In this case, Medicare will help pay some of the costs of your prescription drug plan.

You must enroll in a drug plan which is run by an insurance company or any other private company. They also need to be approved by Medicare.

3) Once you choose your drug plan, you can enroll by

– going to www.Medicare.gov and enrolling on the Medicare Plan Finder

– going on the plan’s website

– calling the plan directly

When you sign up, you will have to give your Medicare number and effective dates for Part A and Part B.

How Do I Find a Medicare Part D Plan?

The best way to find a prescription drug plan is to follow the steps listed below:

Go online to Medicare’s website: www.medicare.gov/find-a-plan. You will then see a section, “Find Health and Drug Plans”
You can either use the general search option by putting in your zip code and then click “find”. Or for a more personalized search, you can enter your Medicare information. More than one county may come up and in that case, just select your county
On the following page you will have to answer two questions
Then click on “Continue to Plan Results.”
You will see a box where you can enter your medications and dosages. If you have no more drugs to enter, then simply click on “My Drug List is Complete”.
Choose your preferred pharmacy (from the list or by zip code)
Then click on “Continue to Plan Results”; check “Prescription Drug Plans”; and “Continue to Plan Results, again.
The results are sorted from the lowest to the highest estimated annual cost (taking into consideration the medication premiums, copays and deductibles that you currently take and the pharmacy where you buy them. You can compare up to three plans at a time, which are printable.

Why Should I Compare Medicare Part D Drug Plans?

It is important for you to compare all the PDPs available to you to make sure you are getting the most value for what you will be paying. Most seniors are on a budget, having to live on a fixed income and certainly want to find the best plan that is as inexpensive as possible. Cost effectiveness is the #1 aim here. The #2 in order of importance is that the drug company you choose provide the highest quality customer service and professionalism, along with excellent ratings and reputation. Each plan’s benefits may vary regarding their copays, deductibles and premiums. Most of the drug plans have deductibles but some do not.

It is advantageous to compare also because although a plan may have no deductible, they may charge more for your medications and ultimately not come out as the cheapest plan.

When comparing plans, you also should take into consideration the “Donut Hole” (coverage gap). The Donut Hole is the portion of the plan where, after a certain point, you will be responsible for 100% of the costs of the medication). Some plans will give you a discount (Donut Hole Discount). In 2018, the Medicare Part D plan coverage gap begins once you and your plan have spent $3750 on medications. After this point, you pay no more than 35% of the drug plan’s covered costs for brand-name prescription drugs. However, some plans may have higher savings, and that’s why you should do a comparison. For more information on the Donut Hole, contact Medicare or go online at www.Medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html.

If you have chosen a PDP and you decide later that you would like to change it, you may only switch plans from October 15 to December 7 each year. That said, there are special circumstances during a Special Enrollment Period, i.e. you are moving out of your plan’s service area; you are leaving your employer’s/union health coverage plan, etc. Please note that if you have Medicare and Medicaid, you may change your prescription drug plan at any time during the year.

Filed Under: Part D · Tagged: compare medicare part d, enroll in part d, how to pick a part d plan, Medicare Part D, medigap plans

Going on Medicare? The Turning 65 Checklist

April 9, 2014 by Garrett Ball · 2 Comments

Turning 65 and going on Medicare is one of, if not the, largest insurance transition that most people make in their lifetime. There is a bevy of information “out there” and in your mailbox, and it can all get a little overwhelming if you allow it to. This checklist is composed with that in mind.

Going on Medicare Part A

_____ If you are already receiving Social Security, you should receive your Medicare card 2-3 months in advance of the 1st day of the month of your 65th birthday. (If you are not receiving Social Security already, you should sign up for Medicare actively by going online to sign up for Medicare or by calling Social Security at 800.772.1213)

_____ Medicare Part A is automatic and premium-free if you have qualified for it by paying Medicare taxes while working (or if your spouse has).

Going on Medicare Part B

_____ Decide whether you want to enroll in Medicare Part B. Typically, this is based on whether you have insurance through an employer or former employer that would enable you to “delay” Part B.

_____ Do not turn down Medicare Part B unless you are planning to use employer-based insurance instead. There is a hefty penalty for signing up for Part B late (unless you have other creditable coverage).

_____ If you are receiving Social Security already and receive a Medicare card in advance of your 65th birthday, it should show that you are automatically signed up for Medicare Parts A & B. If this is the case, do nothing.

_____ If you are not receiving Social Security already but you want to be enrolled in Medicare Part B, you should sign up for Medicare actively by going online to sign up for Medicare or by calling Social Security at 800.772.1213.

Going on Medicare Secondary Insurance

_____ Understand the differences in Medicare Supplement plans (also called Medigap) and Medicare Advantage. This page may help: Medigap vs. Medicare Advantage.

_____ Compare plan options in an unbiased way. It is advantageous to use an independent agent or broker to assist with this. This does not cost you anything and can help with understanding the plan options.

_____ If choosing a Medigap plan, understand that the coverage, claim payments, and doctor acceptance are all standardized. The primary comparison factors are price and company reputation.

_____ If choosing a Medicare Advantage plan, understand any plan limitations and co-pay obligations, as well as checking to ensure your doctor will accept the plan/is in-network.

Going on Medicare Part D

_____ Decide whether you will take Medicare Part D, which is the part of Medicare that covers prescription drugs.

_____ If choosing not to take Medicare Part D when first eligible, understand the Medicare LEP (Late Enrollment Penalty) that applies to Medicare Part D. This applies if you do not have other creditable drug coverage and opt not to take Medicare Part D when first eligible.

_____ Compare Part D plans. This can be done very easily on Medicare’s website, http://medicare.gov.

_____ Choose a Part D plan that is low in overall annual costs based on your current medication needs, with the understanding that there is an annual election period, during which you can change Part D plans.

If you have questions about going on Medicare or would like a customized comparison of plan options, you can reach us at Secure Medicare Solutions or by calling 877.506.3378.

Filed Under: Medicare News, Medigap Plans · Tagged: comparison, going on medicare, how to compare medigap plans, how to sign up for medicare, medicare, medicare part a, medicare part b, Medicare Part D, medigap, supplement, supplemental, turning 65

Frequently Asked Question of the Month – What are the Enrollment Periods Associated with Medicare?

August 10, 2010 by Garrett Ball · Leave a Comment

Answering questions is a big part of my job. Many people on Medicare have the same general questions. In this section, I answer a question that I’ve recently been asked, for everyone’s benefit:

What are the enrollment periods for the various types of Medicare plans?
This is a very common question that can be easily answered; however, there is a lot of misinformation out about this (through other agents) and just through misconceptions. The easiest way to look at it is to break it down by type of plan:

Medicare Supplement (Medigap): There are NO set enrollment periods. You can enroll/disenroll at any time, as long as you have Medicare A & B.

Medicare Advantage: Medicare Advantage has a set enrollment period of Nov. 15-Dec. 31 each year. Then, you can also make some changes between Jan. 1-Mar. 31 (some restrictions apply – each case is different).

Part D: Part D is the same as Medicare Advantage. The annual enrollment period is Nov. 15-Dec. 31 then there is an additional enrollment period Jan 1-Mar. 31. During that additional period, you can neither drop or add coverage, only switch Part D plans.

Filed Under: Uncategorized · Tagged: medicare advantage plans, medicare advantage quotes, medicare enrollment periods, medicare enrollment questions, medicare insurance, medicare open enrollment, Medicare Part D, medicare part d quotes, medicare supplement enrollment, Medicare Supplement plans, Medicare supplement quotes, medigap enrollment, medigap plans, medigap quotes, Open Enrollment

2010 Medicare Changes – New Deductibles, Premium Increases Affect Everyone on Medicare

December 11, 2009 by Garrett Ball · Leave a Comment

The Center for Medicare & Medicaid (CMS) recently announced the 2010 Medicare changes, which will have some affect on all Medicare beneficiaries. Despite the fact that there is no cost-of-living adjustment for Social Security for 2010 (for the first time in 20+ years), there are some significant changes to Medicare deductibles, plan premiums, etc that you should be familiar with.

New Medicare Deductibles
This is the area that affects the largest number of Medicare beneficiaries. The Medicare Part A deductible is increasing from $1060 (2009) to $1100 (2010), and the Medicare Part B deductible is increasing from $135 (2009) to $155 (2010). For those that have Medigap policies, which cover these deductibles, you will not have increased out of pocket costs at the doctor or hospital, obviously. However, if you do not have a Medigap plan to fill in these Medicare deductibles, you will pay these higher amounts beginning in January 2010.
Part B premium increase
In many cases, the Medicare Part B premium is NOT increasing for 2010. If you currently are paying the standard Part B premium (in most cases, deducted from your SSI check) of $96.40, your premium will likely stay the same.
However, if you are new Medicare Part B enrollee (as of 1/1/2010) OR if you have an income over $85,000 (individual) or $170,000 (married couple), you will likely pay a higher amount. For those new to Medicare Part B, the new standard premium is $110.50, which is a 15% increase from the 2009 Part B premium.
Changes to Medicare Supplement plans
The Medicare Supplement (Medigap) changes do not actually take effect until June 1, 2010; however, when they do, they will provide some new options and mark the end to some old options. Some plans, such as Plan J, will not be available to NEW applicants, whereas two new plans, M and N, will begin (Medicare Supplement Plans M and N). For a full outline of the new standardized plan chart, visit Medicare Supplements chart.
Changes to Medicare Part C (Medicare Advantage plans)
As you have probably already seen, if you are on a Medicare Advantage plan currently, the MA plans have changed a good bit for 2010. In most cases, premiums have gone up and there have been some reduction in benefits with some plans. Additionally, some of the major players in the MA marketplace have pulled out of the MA market. This is plan-specific and does not apply to all plans, but it makes it more important than ever to know what you have and know what else is available in your county.
Changes to Medicare Part D
The Medicare Part D premiums have changed, in nearly all cases, for 2010. In doing so, the plan that was good for you in 2009, may not be as good for you in 2010. Again, this is plan-specific, and the only way to get an accurate picture of how this affects you individually is to do an analysis of your current plan against other options.

Overall, the changes to Medicare for 2010 will be disconcerting to some, causing an increase in out of pocket costs. However, for those with a Medigap plan and who stay on top of their Part D coverage to ensure they have the best possible plan for their unique situation, the impact of these changes can be minimized.

For a full analysis of options available to you, visit Medicare Insurance Quotes.

Filed Under: 2010 plans, Medicare News, Part D, Rate Changes · Tagged: 2010 Medicare, 2010 Medicare Advantage plans, Medicare Part A Deductible, Medicare Part B deductible, Medicare Part D

South Carolina Medicare Part D Enrollment Period Fast Approaching

September 17, 2009 by Garrett Ball · Leave a Comment

Medicare Part D is easily the most confusing and troublesome part of Medicare. From the varying co-pays to the “donut hole” to the way that plans can change their formularies in the middle of the year, it can be very frustrating.

One of the frustrating aspects of the program for many seniors is the once-a-year enrollment period (Nov. 15-Dec. 31). This is the only time of year (unless you are aging in to Medicare or in a special enrollment period) that you can sign up for a new plan or drop an old plan. This short period of time, coupled with the fact that it falls around the holidays, can make this a hectic time for seniors wishing to re-evaluate your Medicare Part D drug coverage.

Secure Medicare Solutions has developed a solution to this dilemma to ease the pain and headache of comparing, selecting and enrolling in a Medicare Part D drug plan.

The Medicare web site (http://www.medicare.gov) offers a way to compare all of the plans in your zip code based on your specific medications. While it would be nearly impossible to get all of the formularies from the companies and do this yourself, the web site synthesizes all of the information in one place so you can have a ready reference of what your co-pays would be with specifc plans (based on your current medications).

If you are reading this and you are an existing customer (Medicare Supplement or Medicare Advantage) of Secure Medicare Solutions, we perform this analysis for you at no charge. This is a once-a-year service to you. Please either email Garrett directly with your medications or contact us on the Medicare Insurance Quotes form, putting “Part D” in the “Comments” box. You will need to also send your medications and dosages so that we can perform the analysis for you.

If you are NOT a current customer of Secure Medicare Solutions, but you would like to take advantage of this offer, we can help. Please contact us the same way as was listed above – on the Medicare Insurance Quotes form, putting “Part D” in the “Comments” box. We will be happy to help you re-evaluate your current coverage and the 2010 plans once they are released (usually October/early November).

Filed Under: Part D · Tagged: Medicare drug coverage, Medicare drugs, Medicare Part D, Part D, South Carolina Medicare Insurance, South Carolina Medicare Supplement

Health Care Reform – How Will It Affect Medicare?

July 22, 2009 by Garrett Ball · 1 Comment

Even if you wanted to, you cannot escape the talk of health care reform these days. It is everywhere in printed, online and television media. As a leading, independent resource for Medicare and Medicare insurance news, Secure Medicare Solutions has closely examined both sides of how the proposed bill will affect those on Medicare. Our goal is to give you an unbiased look at how some of the proposed changes will affect you and your Medicare and/or Medicare insurance.

Proposed Reform: Better Pricing for Part D Drugs
How it Affects You: This is a proposed change to assist in regulating the pharmaceutical industry and controlling drug prices. Medicare Part D aims to do this by negotiating better overall prices for Part D drugs, which should, over time, reduce the Part D premiums and co-pays that Medicare-eligible individuals have to pay. Some headway has been made on this already, with the pharmaceutical industry agreeing to a 50% cut for those that reach the dreaded “donut hole” (details for this are still pending).

Proposed Reform: Reduce Medicare Payments to Private Insurers (Medicare Advantage)
How it Affects You: If you have been paying much attention to the health care debate, you have heard the Medicare Advantage program mentioned numerous times. The projected change is to base the payments to these private insurers on an average of the plans’ bids, rather than the system now which is a standardized government-set amount. For those on Medicare Advantage, this reduced funding will, most likely, lead to an increase in premium and/or reduced benefits. For everyone on Medicare, it should lead to the ability to reduce the Medicare Part B premium.

Proposed Reform: Link Payments to Hospitals to Hospital Performance
How it Affects You: The idea to link hospital payments for Medicare patients to hospital performance has been around for a while, and it is a major part of the proposed health care reform. It’s intention is to increase overall hospital efficiency and give hospitals an economic incentive to “do right” by the patient. Some feel that this will lead to greater efficiency at hospitals, while others believe it will lead to greater dishonesty and fraud within the system. If it is a part of any legislation that is passed, we’ll find out for sure!

Proposed Reform: Standardization of Payments to Skilled Nursing Facilities/Long-term Care Facilities
How it Affects You: This provision of proposed legislation is intended to cut waste in the current Medicare system by measuring actual costs to come up with a more uniform system for reimbursing these facilities through Medicare. It remains to be seen if this will affect the quality of care received if in one of these facilities; however, the overall goal is to reduce waste in this part of the system and reduce the cost of Medicare to all Medicare-eligible individuals.

Proposed Reform: Reduce/Regulate Fraud, Waste and Abuse in the Medicare System
How it Affects You: This is the proposed reform that most everyone can agree upon. There have been many ideas tossed around as to how to do this. One of the primary ways that this is projected to be accomplished is higher scrutiny of health care providers and hospitals. Additional pre-payment reviews will be implemented, particularly on doctors/hospitals that order a significant amount of high-risk or high-cost procedures. Over time, this is intended to reduce the cost of Medicare (Part B premium, etc) to the individual.

Regardless of which side of the debate you come down on, it is obviously important to keep an eye on how it will all play out and how it will affect you. At Secure Medicare Solutions, we will do our part to keep you updated on any changes. You can always get updated information and follow along with us at Secure Medicare Solutions: An informative Medicare Insurance and Medicare Supplement Blog.

Filed Under: Medicare insurance news, Medicare News, Part D, South Carolina Medicare Advantage plans, South Carolina Medicare Supplements · Tagged: Health care reform, Medicare Advantage, Medicare Part D, Medicare Supplements