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How to get Medicare Part D drug coverage?

Generally it is a good idea to get drug coverage when you are first eligible because if you do not, you may pay a late enrollment penalty. You can only avoid a late fee if you either take advantage of the Extra Help program or have other credible prescription drug coverage from a union or employer.

If you do not know if you are going to be assessed a penalty, Medicare will let you to know what the penalty is and what amount you need to pay for your premium. Typically, the penalty is then paid as long as you have a Medicare drug plan. Therefore, it is important to know the deadline of enrollment and do so on time in order to avoid penalties.

There are two ways for you to obtain prescription drug coverage. One way to do this is through a Medicare Prescription Drug Plan Part D, which adds drug coverage to the original Medicare; some Medicare Private Fee-for-Service plans; Medicare Medical Savings Account plans; or some Medicare Cost plans. The second way to get coverage is through a Medicare Advantage Plan Part C where patients get all of Medicare Part A (hospital), Medicare Part B (medical), and Part D (prescription drugs) in this plan. Those who enroll must have Part A and Part B to be in a Medicare Advantage Plan (MA-PD).

Here are the four ways to join a drug plan:

• enroll on the Medicare Plan Finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx
• enroll on the individual plan’s website
• fill out a paper enrollment form
• call the plan of choice
• call 1-800-MEDICARE (1-800-633-4227)

Note: Joining a Medicare drug plan, may impact your Medicare Advantage Plan (Part C) and you will revert back to Original Medicare if you join a Medicare Prescription Drug plan (Part D) and if your Medicare Advantage Plan included coverage for prescription drugs.

What happens when a person reaches the Medicare Part D deductible?

It is important to understand that not all patients have an annual deductible, so the observations in this post refer only to those who do pay a deductible. Once that deductible limit has been reached, what usually happens is that the patient then has to pay a co-insurance or co-payment for every prescription. Co-payments are typically a fixed dollar amount. Co-insurance payments have the individual pay a percentage of the total cost of the drug.

Medicare Part D also has what is referred to as catastrophic coverage. If a patient’s annual out-of-pocket reaches $4,950 (2017), only a small co-payment or co-insurance amount is paid for all covered drugs for the balance for the year.

If you qualify as low income Medicare Part D has an Extra Help provision that may help an individual or family reduce drug costs even more. Those who qualify do not pay more than $3.30 per covered generic drugs or $8.25 for a brand name covered drug.

Want to find your level of possible Extra Help? Visit the Medicare website at: https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html

How much is Medicare Part D?

Medicare Part D costs vary greatly from one individual to the next. Expenses, per person, change in response to the drug used, the drugstore filling it out, the type of plan and if the person qualifies for Medicare’s Extra Help program. The Extra Help program helps people with low incomes pay prescription drug program costs like premiums, deductibles and co-insurance fees.

Medicare Part D costs vary because all the Part D plans have their own terms and rules for the policies offered. All plans are required to offer minimum coverage that then can be built on with additional offers. For example, some plans will provide tiered systems where only some brand-name drugs are less expensive.

Nonetheless, there are some common features to be found in all Part D Medicare Plans. For instance, most individuals pay a monthly premium that increases with the person’s salary. All patients do not pay the monthly premium and this is applicable when it comes to deductions. Many Part D Medicare plans charge an annual deductible prior to coverage becoming effective. Deductibles are different for each plan. For 2017, Medicare has stated the maximum deductible is $400.00.

What does Medicare Part D cover?

Medicare Part D requires clients to buy plans from a private insurance company. That means that each insurer offering Part D has its own list of covered drugs, the plan formulary.

In order for each insurance company to be able to provide information to potential and existing clients, they break the drugs into various tiers with differing costs. Thus, the drugs in the lowest tier generally have a lower co-insurance or co-payment cost and vice versa — higher-cost drugs usually have a higher co-insurance or co-payment price. There is an exception to this rule, however, if a doctor wants a patient to take a drug in a higher tier, it is possible for patients to obtain the drugs at an affordable price.

The formulary usually stays the same during the year, but it is possible for a plan to change coverage providing it follows Medicare’s rules and regulations. Patients affected by such a change must have at least 60 days’ notice before changes go into effect. Additionally, a refill request must be honored, plus the patient is offered a 60-day supply under the previous plan before changing to the new plan.

Interested in finding out what drugs are covered in your area? Check out Medicare’s plan finder tool at: https://www.medicare.gov/find-a-plan/questions/home.aspx

What is not covered by Medicare Part A and Part B?

Medicare Part A and Part B does not cover every medical procedure. If you find that some of the services you need are not covered under Medicare, you will need to cover the remainder yourself. If you have supplemental insurance or additional Medicare plans, they may offer the necessary coverage.

Medicare Part A and Part B cover hospital stays, outpatient care, medical supplies and more. However, even if Medicare Part A and Part B covers medical procedures, the plans still require a co-payment, a deductible or co-insurance.

Some of the services that Medicare Part A and Part B do not cover are:

• Routine foot care
• Hearing aids
• Exams for fitting hearing aids
• Eye exams for prescribing glasses
• Dentures
• Long-term care/custodial care
• Cosmetic surgery
• Acupuncture
• Most dental care
• Treatment not medically necessary
• Vaccinations/Immunizations
• Prescription drugs taken at home
• Non-prescription drugs

What do the changes to Medicare mean?

The new administration plans to push health care reform, and in the process overhaul Medicare, by eventually implementing what they refer to as premium support. What does that mean for Americans? It means that premium support would increase competition among health care providers, thus offering beneficiaries the choice of where to spend their money when choosing providers.

House Speaker Paul Ryan formulated one of the proposed plans that may replace Medicare. Should the Better Way plan come into being, it would move Medicare away from the current single-payer status. Right now the government pays for seniors’ health care into a system that inhibits health care costs by creating more competition from suppliers wanting the business.

Does this mean Medicare stands the chance of being eliminated? That remains to be seen. There are too many factors for any type of a clear answer to surface. The bottom line with Medicare as to whether it is phased out or replaced with a premium support plan rests on budgetary concerns.

Missing Part D enrollment does not always mean your customer loses out

In many instances, those who miss out on signing up for Part D must look elsewhere to find lower cost drugs. There are exceptions to this general rule of thumb. For instance, your customer may qualify for a Special Enrollment Period. The senior may have moved out of the service area, had other circumstances beyond their control that precluded them signing up for Part D or they were involuntarily dropped from their Medicare Advantage Plan.

When dealing with upset and distraught customers who have missed out on signing up for Part D, always ask for the backstory to see if they may fall under one of the “exceptions.” Taking care of your existing and potential customers and being a respected insurance agent is something earned by going the extra mile for your customers.

Medicare and Medigap: Partners in Policy

While you may realize that you need Medicare insurance as you approach the age of 65, you may not know that you probably also need Medigap insurance to fill in the gaps that Medicare will not handle. It’s confusing to try and figure out how each plan works, so trying think of it like this: Medicare and Medigap are partners in health care, offering seniors plans tailored to suit their personal needs.

Medicare or Medigap policies are not always easy to understand at first glance, but fortunately, plenty of help is available. Before you apply, make sure you find the resources you need to determine exactly what you want and need from your insurance. When you approach the purchase of a policy with a list in hand, you can get what you want for the price you are able to pay.

To learn more about Medicare and review your options visit EZ.Insure today!

Medicare Insurance Policies Work in Tandem

You reach an age to qualify for Medicare, and suddenly, things seem more complex than ever. You have more health challenges to conquer, and you are not sure how Medicare will serve you. In fact, Medicare does not cover everything you need it to cover.

In such a situation, you should check into Medigap plans to fill in those Medicare coverage holes.

It is a bit like playing chess. You need to move your piece (you) to be covered and protected from attack. So, you sign up for Medicare and figure out what you are missing, then act. By signing up for a Medigap plan, you can fill those needs.

It is actually a whole lot simpler than you may think. Medicare does most of the defensive battling for you as primary coverage. Medigap provides the support that makes the whole board work for you.

The ability to tailor your health insurance coverage is appealing to many older Americans. Move wisely. Medicare and Medigap are health partners created to work in tandem to protect you.

Get an instant Medigap quote from Benepath and work with a local insurance expert. Learn more at http://208.112.75.246/.

Medicare and Medigap – Confusing or Custom Fit For Everyone 65 and Over?

It’s been said that Medicare and Medigap supplement insurance is so convoluted people would rather avoid dealing with the issue. Certainly there are a fair number of things that someone who just turned 65, or who is older, does need to know about Medicare and Medigap insurance supplements, but it does not need to be a major exercise in frustration.

The best time to find out how Medicare works is to start doing some research before you reach the age of 65. Ask around, do some reading, speak to an insurance agent. Yes, that’s right. Pick up the phone call an experienced Medicare insurance agent. They know their products inside out and can suggest a custom fit insurance package just for you, including what Medigap supplements work the best with your Medicare coverage.

This saves you endless hours of time trying to determine what might be the best way to go to get everything that you need. It’s far easier than you might think getting the perfect Medicare/Medigap custom insurance coverage that makes sense for you and your spouse.

Get an instant Medigap quote from Benepath and work with a local insurance expert. Learn more at http://208.112.75.246/.