Pat’s 2019 Medicare, Medicare
Supplement, Medicare Advantage and
Prescription Drug Plan Information
The objective of this summary is to help you select the best medical plans by highlighting the key factors you need to consider before deciding on the appropriate coverage for you.
Please call me with any questions.
CLARIFICATION OF MEDICARE COVERAGES
Part A: Hospital, Skilled Nursing Facility, Hospice
Part B: Physicians, Lab tests, X-rays, Ambulance, Durable Medical Equipment, Out Patient
Part C: Medicare Advantage Plans. Most are HMO’s.
Part D: Prescription Drug Plans (PDP’s)
It’s that time of year when you need to REVIEW your STAND ALONE PART D PLAN and decide whether or not you need to make a CHANGE. The FALL OPEN ENROLLMENT STARTS OCTOBER 15, 2018 and ENDS DECEMBER 07, 2018. After that you cannot make any changes in 2019 except under certain circumstances. Your coverage will begin January 1, 2019. There are 30 plans available in California for 2019.
PRESCRIPTION DRUG PLAN CHANGES AND INFORMATION
- Most premiums have increased as well as co pays. Deductibles range from $0-$415.
- Your premium can be affected by your income level.
- Some vaccines are covered by Part D, including Shingles (get the shot at your pharmacy) and some vaccines are covered by Part B. (Flu shots)
- Premiums range from $12.40 to $112.00 per month. Premiums will be higher for individuals making more than $85K or couples making more than $170K.
- Prescription drug coverage phases are: the ‘Initial Coverage Limit’, the ‘Coverage Gap or ‘Donut Hole’ and ‘Catastrophic Coverage’.
- The Initial Coverage Limit for 2019 is the first $3834 of prescription drugs that you and your plan paid. If you exceed $5100, the Coverage Gap
- During the Coverage Gap or ‘Donut Hole’ you pay 25% of brand name prescription drugs and 37% of formulary generic prescription drugs until your out of pocket costs reach $5100. After reaching $5100, the Catastrophic Coverage
- Under Catastrophic Coverage you pay a small co-pay for each drug until the end of the year.
- Note: the Coverage Gap (Donut Hole) will close by 2020 due to the Affordable Care Act. Then we pay 25% of brand and generic drugs.
THINGS TO CONSIDER WHEN CHOOSING A PRESCRIPTION DRUG PLAN
- The cost of your prescription drugs plus your premium determines the Estimated Annual Cost.
- If a drug plan has PREFERRED Network pharmacies, their drug costs may be much less than if you use a NON-PREFERRED pharmacy with that plan. More plans are connected to pharmacies.
- If you are on a brand name drug, ask your Doctor about trying a generic.
- Don’t assume if a plan doesn’t have a deductible or has a low deductible, that it is the plan that is the least expensive for you.
- All plans change some formulary prescription drugs that they cover annually. Changes from preferred to non-preferred and changes to tiers a drug is on. Examples of different charges—Advair highest charge $170 and lowest $21.
- Prescription drug prices can change at any time. A prescription drug can be dropped from a drug plan but the drug plan must give you notice and an option for another drug.
- If your 2018 Prescription Drug Plan isn’t available for 2019, the drug plan carrier will notify you and may transfer you to another plan. Whether they transfer you or not, you should redo your drug comparison to verify which plan is the best one for you.
- Some prescription drug manufacturers give discounts for cancer drugs and other expensive drugs..
- Many brand name drugs will require pre-approval by the drug plan in order to be covered. Call the health plan to find out if yours needs pre-approval. Your physician will then have to contact the prescription drug plan. If your drug is denied call the plan to appeal.
- Some people on low income prescription drug plans (LIS) will be reassigned to a different plan. Call Social Security (1-800-772-1213) to be sure you are on the best plan for you or have someone do a comparison for you. The 2019 low income levels are—Single—between $12600 and $18210, Married—between $24690 and $25150.
- Your Supplemental provider may offer a Part D Plan (PDP) that covers your prescription drugs but it may not be the least expensive and best plan for you. It is advisable to do a comparison with all the prescription drug plans.
- Sometimes you can get a double dose of a pill and cut it in half. The cost of the drug is often determined by the number of pills you buy, so this might lower your drug cost. Check with your physician or your pharmacy.
- Use only one pharmacy so they can monitor if your combination of drugs is safe for you.
- If your plan was discontinued call me for options.
COMPARISON AND ENROLLMENT INFO
- You can do your comparison and enroll on the phone or on line. I use medicare.gov or call Medicare, 1-800-633-4227.
- When using Medicare.gov use the lowest Estimated Annual Cost to determine the best plan. This is the total of: the premium + co-pays + deductibles you might pay for the year.
- When you do a new comparison, and your current plan is still the best one for you, you do not need to do anything. The current plan will continue.
- When you first enrolled with Medicare, if you didn’t sign up for a Part D prescription drug plan, you will have a 2% penalty for every month you didn’t sign up. If you don’t take any prescription drugs, to avoid an additional penalty, sign up for one of the least expensive plans either $12.90 a month—Envision Rx Plus or Welcare Value Script–$15.00.
- Not all plans have Mail Order and those that do may save you a little or a lot of money or can be much more costly than using the pharmacy and getting a 90 day supply. Always check both ways.
- If you can’t afford a Prescription Drug Plan, call Social Security (1-800-772-1213). You may qualify for extra help.
- Veterans can enroll in a Part D plan at any time without a penalty.
MEDICARE, MEDICARE SUPPLEMENTAL (MEDIGAP) PLANS, AND MEDICARE ADVANTAGE PLANS–Fall Annual Open Enrollment: You can choose between Original Medicare, Medicare Supplement and Part D, or a Medicare Advantage Plan
NEW MEDICARE DEDUCTIBLES AND PREMIUMS:
Deductibles: 2019: Part A: $1364, Part B: $183 Skilled Nursing $$170 — day 21 to day 100.
Premiums: 2019: Part B: $131 if already on Medicare or $135 up to $460, depending on your income, when you enrolled in Medicare, and if your premium is deducted from your Social Security check.
SUPPLEMENTAL PLANS (MEDIGAP)
- Medicare does not pay 100% of your medical bills. Supplemental plans pay for all or some of what Medicare doesn’t pay for Medicare covered charges. A Medicare Supplement allows you to go to any Physician in the US that is a Physician that accepts Medicare.
- There are Medicare Supplements for people under 65 who are on Medicare Disability.
- Most Medicare Supplements cover foreign travel. (Ask your plan).
- Plan F is the most comprehensive coverage because it pays 100% after Medicare for all Medicare covered services. That means no deductibles, co-pays or surprise charges. However, plan G might be better in some cases. Suggest you call me or an agent to be sure.
- Supplements can be the most cost effective Medicare Advantage Plans if you have numerous medical expenses, you also get more doctors to choose from with a Supplement.
- You can switch supplemental plans in your birthday month to a plan with equal or less coverage than what you have without health questions.
- Be sure to get a plan that has Skilled Nursing co-pay coverage.
- When you are first going on Medicare and deciding which Medicare Supplemental company, I suggest you go with the lowest premium. The plans are the same with all companies. After the first year you need to reevaluate the plans each year to compare options and premiums.
- You have six months after your Part B effective date to sign up for a supplement and not have health questions.
MEDICARE ADVANTAGE PLANS (MAP)
Medicare Advantage Plans (MAP’s) are a Health Maintenance Origination (HMO).
- Placer County only has 8 HMO’s. All but one have drug coverage. Kaiser has three including one that is Medicare/Medical, Secure Horizons has three and Healthnet two. Note: Sutter is pushing Secure Horizons to its members, although it’s not clear to me that they have enough doctors. Note: Some of the drug coverages have deductibles
- For HMO’s your Medicare is locked into the plan’s network so you can only use the HMO’s providers.
- Premiums range from $18.30 to $166.
- The out of pocket maximum is between $3400 and $6700. The maximum only applies to medical deductibles and co-pays, not prescription drugs co-pays.
- MAP’s do cover disabled Medicare Beneficiaries under 65.
- Some MAP plans have co-pays for Chemo and Radiation and can be very costly.
- Some plans include Dental, Vision, or Hearing Services coverage, and some plans give you the option to purchase these.
- A Physician can opt out of an MAP Plan at any time.
- You can disenroll from your MAP between Jan 1 – Feb 14, 2019 and return to Original Medicare and a Medicare Supplement with the option to enroll in a part D plan (PDP).
- Check with you doctors to see if they are part of the plan you are thinking of joining.
- Some plans have dropped the 3 day hospital stay requirement to get covered care in a skilled nursing facility.
- If your MAP plan isn’t renewing you can change to another MAP plan or go back to original Medicare, a supplement and a drug plan. You have until Feb 28, 2019 to do so. You should do it ASAP.
- You can call Medicare or an insurance agent for policy information and they can enroll you in a new plan. Call me for agents names.
PAT’S TIDBITS 2019
- ALS patients can go on Medicare thru disability as soon as they are diagnosed. They also qualify for Medicare Supplements, Part D and MAP plans at that time.
- Medicare now covers 100% of a once a year Wellness Visit. Part of the Affordable Care Act.
- If you got a letter saying you were disqualified from a Part D Special Needs Advantage plan for 2019, you will be automatically disenrolled from that plan. You MUST reapply or enroll in either another Medicare Advantage Plan (MAP), OR a Medicare Supplement and Prescription Drug Plan (PDP).
- Many Preventive Services (Mammograms, PSA, Smoking Cessation Counseling, etc) are 100% covered.
- If you are a Veteran you may qualify for VA benefits. Call 916-780-3290, 800-827-1000 or go to va.gov. You might be surprised by what benefits you can get.
- Not all medical equipment companies are Medicare providers. Call Medicare or go to Medicare.gov.
- If Medicare denies a charge, call the Provider and/or Medicare to see why it wasn’t covered. (Or call me.) Often it was billed incorrectly. Don’t be afraid to ask questions.
- I have been told by some skilled nursing facility providers and PT providers that Medicare usually covers more days and visits than MAP plans!!
- Many companies have turned their retirees over to Exchanges for their insurance and give $ to cover the premiums. Please call me with questions on this.
- With Medicare supplements you pay up front and save later. With MAP’s you save up front and may pay later.
Pat’s Medical Insurance Counseling
221 Feather Ct, Lincoln, CA, 95648 Phone: 916-408-0411 Fax: 916-408-1144
Email: email@example.com, www.patsmedicalinsurancecounseling.com
MY SERVICES–SINCE 1977
I provide comprehensive medical insurance assistance. I start with a FREE phone consultation to help understand your situation and needs. Then, if you want my assistance, I provide the following services for a fee: (I DO NOT SELL INSURANCE)
—DRUG PLANS: I can to a comparison for you using the Medicare.gov program and let you know what plans will cover your drugs, for the least amount of money, using your local pharmacy. I will also explain the difference between the plans.
–MEDICAL INSURANCE INFORMATION: I will review your current medical insurance coverage and talk about your options — a Medicare Supplement or HMO.
–CLAIMS MANAGEMENT: I will manage your medical insurance claims and related issues, including dealing with billing problems, advising you which bills to pay, getting refunds when appropriate and acting as your advocate with the various providers.
—Senior Resource: I can help you find the services you need.
HICAP (1-800-434-0222). This is a state sponsored FREE health insurance counseling program. They counsel on Part D, Medicare Plans and issues. They will do a free Part D comparison and enrollment.
Self Help: If you want to compare drug plans or MAP’s yourself, or have a family member or friend assist you, go on line to www.medicare.gov, or call Medicare (800-633-4227), www.ehealthmedicareplans.com, or call (844-280-7041).
PARTNERS FOR PRESCRIPTION ASSISTANCE can connect you to many pharmaceutical companies that do discounted drugs for those in need, (888-477-2669), www.PPARx.org
EXTRA FINANCIAL HELP information is available for Medicare Part B and Part D Premiums, Drug co-pays, and Supplemental Social Security Benefits (SSI) and many other programs.. Call: 800-772-1213.
Greater Sacramento Specialty Pharmacy. This is a nonprofit association that carries specialty drugs at a low cost. (888-792-3888).