3 Things You May Not Know About Medicare Part D

Along with falling leaves, dried cornstalks and carved pumpkins, October ushers in Medicare Open Enrollment season (Oct. 15- Dec. 7). So as you get ready to greet trick-or-treaters, you might also want to brush up on your Medicare benefits.

Many people take at least one prescription medication every day, so Medicare Part D prescription drug coverage and costs may be a top concern. Here are 3 things you may want to consider as you review your current Part D coverage, research different plans or estimate your drug costs for 2015.

1. Split-tier deductible plans: If your Part D plan has a deductible, you pay the total cost of your drugs until you reach the deductible amount set by your plan. Some plans may have a deductible for only specific drug tiers. For example, your plan may have a deductible for higher-tier drugs and no deductible for lower-tier drugs. In this case, your plan coverage for a lower-tier drug would start with the first prescription you fill, but you would pay the total cost of higher-tier drugs until you reached the deductible amount. Then your plan coverage would kick in. It’s important to understand a plan’s drug formulary, tier system and cost structure in order to estimate and compare costs.

2. Coverage gap (donut hole) costs: You may know about the coverage gap and that you pay more for your drugs if you enter it, but did you know your costs in the gap are going down? In 2015, you will pay 45% of your plan’s cost for covered brand-name drugs and 65% of your plan’s cost for covered generic drugs (down from 47.5% and 72% in 2014, respectively). Not everyone will enter the coverage gap because their drug costs won’t be high enough. But if you do, you can look forward to more savings in 2015.

3. Extra Part D premium amount: You might pay an extra amount in addition to the plan premium for Part D coverage if your income is above the limit set by Medicare. The income limit is $85,000 for single individuals and married individuals filing separately or $170,000 for married couples filing jointly. The extra amount you may pay will vary depending on your reported income, but it would be the same for any plan (though each plan sets its own base premium and these can vary). The extra payment may be deducted from your Social Security, Railroad Retirement, or Office of Personnel Management check along with other premium payments, or you may be billed if you don’t get any of these benefits.

Remember, you can change your coverage choices during Open Enrollment, Oct. 15 – Dec. 7. Making changes is easy. Usually you can simply enroll in a new drug plan, if you choose to do so. You will automatically be dis-enrolled from your previous plan. If your previous plan was a Medicare Advantage (Part C) plan that includes drug coverage, you will be dis-enrolled from that plan and will get your coverage through Original Medicare instead. In this case, you may also want to consider a Medicare supplement insurance plan to help with some of the costs that Original Medicare doesn’t pay.

For more information, contact Modern Insurance Marketing, Inc. and/or Senior Choices NW with all of your questions about your coverage.  We'll make it easy for you and save you a whole lot of hassles!

6 Things to Know about Fall Open Enrollment

October 15 to December 7 is when ALL people with Medicare can change their Medicare health plan and prescription drug coverage for 2014. Information on 2015 plans is available now at Modern Insurance Marketing, Inc. (MIM) and our subsidiary Senior Choices NW (SCNW). 

Fall Open Enrollment is the time of year when you can change your Medicare coverage. You can do this by joining a new Medicare Advantage plan or by joining a new stand-alone prescription drug plan (PDP). You can also return to Original Medicare with or without a stand-alone Part D plan from a Medicare Advantage plan during this time. Listed below are six things to keep in mind while you are deciding on your Medicare coverage.

1. Fall Open Enrollment occurs from October 15 to December 7 of every year.    

• If you enroll in a plan during Fall Open Enrollment, your coverage starts January 1.

• In most cases, Fall Open Enrollment is the only time you can pick a new Medicare Advantage or Medicare Part D plan.

• If you have Medicare Advantage, you can also switch to Original Medicare. To get Medicare drug coverage, you can must join a stand-alone Part D plan at this time. A Medigap policy helps pay Original Medicare costs, but you may be limited in your ability to buy a Medigap during the Fall Open Enrollment period, depending on where you live. 

2. Review your Current Medicare Health and Drug Coverage. 

• If you have Original Medicare, take a look at next year's Medicare & You handbook to know your Medicare costs and benefits for the upcoming year. If you are unsatisfied with your Original Medicare coverage, you can make changes to your coverage during Fall Open Enrollment. Changes made to your coverage will take effect January 1 of the next year.

• If you have a Medicare Advantage plan or a stand-alone Part D plan, you should receive an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) from your plan. Review these notices for any changes in the plan's costs, benefits and rules for the upcoming year. If you are disatisfied with any changes, you can make changes to your coverage during Fall Open Enrollment. Changes made to your coverage will take effect January 1 of the next year.

• Even if you are satisfied with your current Medicare coverage, take action and look at other Medicare options in your area that may better suit your individual needs in the upcoming year. For example, even if you are satisfied with your current Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage (Part D) could lower their costs by shopping among plans each year.  For example, another Part D plan in your area may cover the drugs you take with fewer restrictions and charge you less.

3. Help is out there. 

• If you want to join a stand-alone prescription drug plan (PDP) , use the Plan Finder tool on Medicare.gov. The Plan Finder tool compares plans based on the drugs you need, the pharmacy you go to and your drug costs.
• If you want to join a Medicare Advantage plan, call 800-Medicare to find out what plans are in your area. When you receive the list of plans, check the plan websites to see which best fits your needs.
• After you have researched a plan online, call the plan itself to confirm what you learned. Make sure the plan includes your doctors and hospitals in its network. Confirm that the plan covers all your drugs, and that your pharmacies are in the preferred network. Write down everything about that conversation. In your notes, record the date of the conversation, whom you spoke with, and the outcome of the call. This information may help protect you in case a plan representative gives you misinformation.

• Or easier still, contact MIM/SCNW!  As a leading independent insurance agency in the Northwest, we represent most of the major Medicare Advantage and Medicare Supplement plans offered in the region.  SeniorChoices NW is one of the largest locally-owned Medicare Advantage field marketing organizations (FMO) in the Northwest. We’re committed to providing specialized service to each of our clients by contracting with the most reputable companies to be able to offer Medicare Advantage and Medicare Supplement plans that are the best “fit” for their healthcare needs and budgets. As an independent agency, SeniorChoices NW works with multiple insurance companies. That means we’re able to work with each client individually to find the solution based on their needs and not be limited to just a single insurance carrier.

4. The best way to enroll in a new plan is to call MIM/SCNW at 866-682-1878.

• We understand the critical importance of having access to affordable healthcare, and we want you to be able to shop for healthcare coverage with confidence, knowing your needs are our priority. Our agency does not charge any fees for its services. Our agents receive their compensation from the insurance companies, if and when their clients decide to enroll.

5. If you are dissatisfied with your Medicare Advantage plan, you can disenroll from that plan and join Original Medicare during the Medicare Advantage Disenrollment Period (MADP).  

• The MADP is every year from January 1 to February 14.

6. Understand the difference between the Fall Open Enrollment Period and Open Enrollment for the Health Insurance Marketplaces.

• The Health Insurance Marketplaces (also known as Exchanges) will hold open enrollment for uninsured or underinsured Americans. The Marketplaces are not meant for people with Medicare. People with Medicare should not use this open enrollment period to purchase or change their health care.

• People with Medicare should continue to use the Fall Open Enrollment Period to review and make changes to their health coverage.

At Modern Insurance Marketing, Inc./SeniorChoices NW, we work hard to establish and maintain strong relationships with our clients and our healthcare partners to continue to be a leader in our industry. It is our goal to make obtaining Medicare coverage simple and straightforward. Give us a call toll-free today at 866-682-1878 or fill out our online contact form to learn more about how we can help you get the medical coverage you need at a price you can afford.