So you’re at the doctor’s office for a check-up, but something’s amiss.  The doc says you need to start taking a medication to treat the new issue at hand.  What should you do? Do you run to the pharmacy and fill the prescription? Depending on the situation, that may be necessary.  But if it isn’t particularly urgent, we have a few recommendations that can hopefully save you time and money.

#1 – Address your health concern naturally 

This isn’t always the correct route, but the first question you should ask your doctor is, “Could I fix my issue with changes to my eating habits and lifestyle?”  If the doctor agrees this is an appropriate first step, then go for it.  But only with your doctor’s approval. If the issue is more serious, then move on to #2.

#2 – Inquire about alternative prescription drug options 

Doctors have their favorite prescription drugs to address certain issues.  But there is typically more than one medication available to treat each condition.  Your doctor might prescribe a generic drug or a brand name drug. Brand name drugs typically cost more than generics, so you want to be extra careful if you’re prescribed a brand name.

Since your doctor doesn’t know the price of every drug and how your insurance plan covers your particular prescriptions, you need to ask for a few alternative drugs when prescribed a brand name drug.  Because if you don’t, you may be in for a big surprise – and a big bill – when you pick up your prescription at the pharmacy. So don’t accept whatever is prescribed to you, especially when it’s a brand name drug.  Consider a generic drug to save you money…as long as your body responds well to the drug and your doctor is okay with it. 

#3 – Compare drug pricing at GoodRx.com

GoodRx.com has become very popular in the past few years.  GoodRx has cash discount deals for prescriptions at many pharmacy chains.  Sometimes it’s actually less expensive via GoodRx than through your Part D prescription drug plan!  And if that’s the case, here’s what you need to do: Show your pharmacist the GoodRx coupon for the particular drug, which you can print at www.goodrx.com or pull up the GoodRx app on your smartphone.

The discount will be applied and you’ll pay the necessary copay like normal.

Please note, you CANNOT use both GoodRx and your Part D prescription drug plan.  It’s one or the other. If you are buying a few prescriptions through your Part D plan and others through GoodRx, be sure to complete two separate transactions at the pharmacy.

When you’re on Medicare, you need to be a little more resourceful when it comes to your prescription drug costs.  But we’re here to help guide you along the way. Contact us for assistance.

Reference Links

www.medicare.gov

www.goodrx.com

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

Last week, we walked through how to access your Medicare Claim Number beyond your Medicare card. But what if you lose your Medicare card entirely?  Can you request a new one? Can you print a copy online?  

Yes, you can request a new one AND actually print one too!

A step-by-step video guide is available below, via our YouTube Channel.

How To: Request a New Medicare Card Online (via www.socialsecurity.gov)

Login to your My Social Security online account at either www.ssa.gov or www.socialecurity.gov.  On the home page, there is a right-side Navigation bar (see below).

Click on “Replacement Documents”.  There, you’ll see a place to request a replacement Medicare card.

How To: Print a Copy of Your Medicare Card Online (via www.medicare.gov)

To print your Medicare card, you actually need to log in to a completely different online account on www.medicare.gov.  Once you are logged in, you’ll see a yellowish-orange section that says “Your Medicare Card” (see below).  

Just below it, you’ll want to click on “View or print your Medicare card”.  The next page will prompt you to re-enter your online password. After entering your password, you’ll now see an image of your Medicare card (front and back).  You can either print the card or save it as a PDF document.

Now you can access your Medicare card on demand. We are here to help uncomplicate every step of the Medicare process. Check out our blog page and YouTube Channel for more informative posts or contact us for direct, personalized support. 

Reference Links

www.medicare.gov

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

First thing’s first: what is a Medicare Claim Number? Your Medicare Claim Number is the mix of letters and numbers on the front of your Medicare card.  If you have Original Medicare, you use this card to file all Part A and Part B claims.  

But over the years, I’ve known plenty of people who misplace their Medicare card. But don’t stress: you can still quickly and easily access your Medicare Claim Number to show proof of coverage. 

You can access your Medicare Claim # very easily via your My Social Security online account at www.ssa.gov or www.socialsecurity.gov.  If you haven’t created an account yet, please do this first.

Once you are logged in, you’ll want to focus on the Benefits & Payments section, as seen in the image below: 

For a more detailed guide on how to navigate the website, click the video link below: 

Visit our YouTube Channel for step-by-step instructions.

When you click the link that says “Get a Benefit Verification Letter,” a new window will open.  This new window is a letter summarizing the benefits you received from the federal government.  It will show your Social Security benefit information, as well as your Medicare Part A & Part B start dates and Medicare Number (also known as the Medicare Claim Number). You can print the letter or even save it as a PDF document for easy access anytime without having to go online. 

In our next post (How to Get a Replacement Medicare Card Online), we show you how to get a copy of your Medicare card online.  You can also view our YouTube video associated with the post HERE.

Reference Links

www.ssa.gov

www.socialsecurity.gov

My Social Security account login

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

In every Medicare consultation we have with a Medicare beneficiary, dental coverage pops up.  Good dental care and hygiene is an indicator of your overall health, so it’s understandable that most people want dental coverage while on Medicare.

Unfortunately, Original Medicare doesn’t cover most dental services.  Not the usual dental care you are used to, such as cleanings, fillings, crowns, x-rays, implants, etc.  Medicare Part A (hospital) does pay for certain dental services when you’re in a hospital, but that would only be in very limited situations.  Think: mouth and jaw reconstruction after an accident.

So how should you address this?

Cash Pay

Some Medicare beneficiaries go this route by paying cash, which typically comes at a discounted rate for dental services.  Many dental offices provide a discount of at least 10% for not having to run the claim through an insurance carrier. Check with your dentist’s office to see if they offer cash discounts or potentially their own dental coverage program.

Stand-Alone Dental Insurance Plan

You can always purchase a dental insurance plan at any time while on Medicare.  There are many dental insurance plans available, but you’ll want to confirm that your dentist is in-network with any plans you’re considering. Talk with your dentist first to narrow down your search.  For more support, you can work with an independent insurance agent like Medicare Mindset. We can help you find which plans have your dentist in-network.

If your dentist doesn’t accept any insurance, there are few dental plans that work well in these situations.  Basically, the plans will allow you to submit the claims for any dentist you want to see, which will then be reimbursed for allowed services up to a maximum limit each year.

Keep in mind:  It’s pretty common to see waiting periods for certain dental services when you initially purchase a stand-alone dental insurance plan.  For instance, a 6- or 12-month waiting period could be required for major services like crowns and extractions.

Dental Insurance Plan Inside a Medicare Advantage Plan

Medicare Advantage plans, which can combine Medicare Parts A, B, and D into one plan, do have the ability to provide extra benefits for dental services that Original Medicare doesn’t cover.  Always confirm this in the plan’s Summary of Benefits document.  

You’ll see these plans in two variations:

Built-in dental plan with no additional premium

You might receive one or two no-cost teeth cleanings per year, a set of x-rays, or a fluoride treatment.  There won’t typically be an additional premium for this option, but the coverage is lacking for any major dental services.

Optional supplemental benefit dental plan with a premium

If you prefer a more comprehensive dental insurance plan, some Medicare Advantage plans will include Optional Supplemental Benefits at an additional premium each month.  This could help beef up your dental coverage to a higher level…and sometimes include no waiting periods! Again, verify the offerings in the plan’s Summary of Benefits document.  

In both variations, the plan could use a specific dental network of providers, so be sure to check your dentist’s participation in the network.  

You don’t have to navigate dental care alone.  Please contact us with your dental insurance questions.  We can guide you in the right direction.

Reference Links

www.medicare.gov

Medicare Dental Services

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

Like we discussed last Monday, a Part D prescription drug deductible resets every January 1st.  But there’s more to Part D coverage than just the deductible.

The four phases of Part D are:

  • Deductible
  • Initial Coverage Level
  • Coverage Gap (Donut Hole)
  • Catastrophic

If you have significant prescription drug copays, you could experience all phases of Part D in a calendar year.  This means your drug pricing can be four different amounts for the same drug throughout the year. It can be very frustrating when your prescription costs change so much, especially when you don’t understand why they change, when they change, and how much to expect to pay when you get there.

 

Let’s start with Phase 1.

 

Deductible

During this phase, the policyholder pays 100% of their prescription costs until they spend $415 on prescriptions.  This maximum is for both the Part D deductible in a stand-alone Part D prescription drug plan as well as a Medicare Advantage health plan that includes Part D coverage. The assumption here, and in the other phases, is that the prescription being purchased is on the Part D prescription drug plan’s formulary (list of covered/allowed drugs).  The Part D prescription drug plan can be set to the full $415 deductible, something less than that, or include no deductible at all.

 

Initial Coverage Level

This is where you begin to get help from the insurance plan.  Drug copay pricing will be based on the drug’s “Tier”. Typically, lower cost generics are Tier 1 or Tier 2, while more expensive brand name drugs are Tier 3 or Tier 4, and certain specialty drugs are considered Tier 5. Some Part D plans even have a Tier 6 category for particular inexpensive generic drugs.

 

Coverage Gap (Donut Hole)

Once your total gross drug costs reach $3,820, you will enter into this next phase. It’s important to note that “gross drug costs” are the combination of your copays plus what the Part D plan has paid on your behalf.  This means you don’t need to spend $3,820 personally to reach the Coverage Gap.

Prior to changes in the law, this is where policyholders used to owe 100% of the gross cost of a prescription.  Since 2010 (as part of the Affordable Care Act legislation), the Coverage Gap (Donut Hole) has been phasing out slowly.  In 2019, policyholders pay 25% of brand name and 37% of generic drugs in this phase. In 2020, Part D plan policyholders will pay at most 25% of the gross cost of both brand name and generic prescriptions, effectively closing the Donut Hole.  

However, this doesn’t mean your drug copays won’t increase in the Donut Hole.  For example, if a brand name drug has a gross cost of $250, and the Part D plan requires a copay of $35 in the Initial Coverage Level, the cost could increase to $62.50 (25% of $250) in the Donut Hole.

 

Catastrophic

To reach the Catastrophic phase, you need to have $5,100 of True Out-of-Pocket (TrOOP) costs.  Here are the items included when calculating the TrOOP:

  • Your copays in the Deductible phase
  • Your copays in the Initial Coverage Level phase
  • Your copays in the Coverage Gap (Donut Hole) phase
  • 50% of the brand name cost in the Coverage Gap (Donut Hole) phase

This may be a bit confusing, but essentially, this means you don’t actually have to spend $5,100 out of your pocket to reach the Catastrophic phase.  Thankfully, your Part D plan will keep track of all this for you. When you have enough drug copays to reach the Catastrophic phase, your copays will be no higher than 5% of the gross cost of the drug the rest of the calendar year.

 

So there you have it — Part D in all its glory!  

 

Keep in mind that once January 1st comes around, everything resets back to the Deductible phase.

 

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

If your Medicare Part D Prescription Drug Plan includes a deductible, you could see an increase in your out-of-pocket costs in the early part of 2019.

At the start of every new year, the Medicare Part D Prescription Drug deductible resets.  

Remember, a deductible is the amount paid out-of-pocket by a policyholder before the insurance carrier pays any expenses on the policyholder’s behalf.  

In 2019, the maximum Part D prescription drug deductible is $415. So, if you purchase a brand name tiered drug (Tier 3, 4, or 5) that has a high gross list price, you may spend more for that drug in the deductible phase of Part D, until you reach $415.

Keep in mind that no two plans are alike. Some plans have no deductible, while others have different combinations (i.e. deductible applies to brand name drugs, but not generic drugs). We’ll go into greater detail describing the different phases of Part D, including the dreaded “Donut Hole”, in our next post.

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.

Photo by Brandon Mowinkel on Unsplash

The Centers for Medicare & Medicaid Services (CMS) recently announced the Medicare premiums and deductibles for 2019 (see official link).  See a summary below…

 

PART A (Hospital)

Inpatient Hospital Stay – You Pay…                 (benefit period ends 60 days after release from care)

  • Deductible: $1,364 per benefit period
  • Coinsurance (days 1-60): $0 per day of each benefit period
  • Coinsurance (days 61-90): $341 per day of each benefit period
  • Coinsurance (60 lifetime reserve days): $682 per day after day 90 of each benefit period

Skilled Nursing Facility Stay – You Pay…                       (3-day inpatient hospital stay required first)    

  • Coinsurance (days 1-20): $0 per day of each benefit period
  • Coinsurance (days 21-100): $170.50 per day of each benefit period

 

PART B (Medical) 

Part B Deductible – You Pay… $185 per calendar year

Part B CoverageYou Pay… Generally 20%, after $185 deductible is met

 

Part B Premiums & Part D High Income Premiums (paid to Medicare)

Those enrolled in Medicare Part B will pay the premiums listed in the table below (based on income).  Higher income earners will pay a Part B IRMAA (Income Related Monthly Adjustment Amount) in addition to the $135.50 base premium.

Those with higher income who are enrolled in Part D Prescription Drug coverage also pay a Part D IRMAA in addition to their monthly premium for a Part D prescription drug plan with an insurance carrier (see table below).

If your yearly income (MAGI: Modified Adjusted Gross Income*) in 2017 was… You pay (in 2019)
Individual Tax Return Joint Tax Return Married & Separate Tax Return Part B

Monthly Premium
+ IRMAA

Part D

IRMAA

 

$85,000 or less $170,000 or less $85,000 or less $135.50 $0.00
$85,001 to $107,000 $170,001 to $214,000 N/A $189.60         

(135.50 + 54.10)

$12.40
$107,001 to $133,500 $214,001 to $267,000 N/A $270.90

(135.50 + 135.40)

$31.90
$133,501 to $160,000 $267,001 to $320,000 N/A $352.20

(135.50 + 216.70)

$51.40
$160,001 to

$499,999

$320,001 to

$749,999

$85,001 to

$414,999

$433.40

(135.50 + 297.90)

$70.90
$500,000 + $750,000 + $415,000 + $460.50

(135.50 + 325.00)

$77.40

* MAGI (Modified Adjusted Gross Income) = Adjusted Gross Income (1040 line 37) + Tax-Exempt Interest (1040 line 8b)

Each year, the Medicare Annual Enrollment Period (AEP) runs from October 15th through December 7th.  This is the special time frame when Medicare beneficiaries have the option to make changes to certain types of Medicare health insurance plans.  Any changes made during AEP will take effect January 1st of the upcoming year (January 1st, 2019 in this case).

Insurance carriers are required to provide a detailed update each year prior to October 1st on their existing Medicare Advantage Plans and Part D Prescription Drug Plans.  The notice is called the Annual Notice of Change (ANOC). Since these Medicare insurance plans run on a calendar year basis, there are usually changes in plan benefits and features from year-to-year.  This is exactly why the Medicare AEP exists. It provides you with the “option” to change your plan, if it is beneficial.

 

Here are some of the common scenarios that can take place during AEP:

 

Take no action

If you’re happy with your plan(s) and wish to accept the new plan provisions for next year, no action is required.

 

Change your Part D Prescription Drug Plan

If your prescription drug coverage is no longer suitable for you, a Part D drug plan change may be appropriate.  Your current Part D drug plan might change to the extent that it doesn’t cover your particular list of prescriptions as well as before (i.e. plan formulary changes)…or…you may have several new prescriptions causing you to question whether you are still in the right plan…or…the plan premium increases more than you would like.  Either way, you can switch to another Part D drug plan during AEP — with your current insurance carrier, or another carrier.

 

Change your Medicare Advantage Plan

If your Medicare Advantage plan coverage is no longer suitable for you, a Medicare Advantage plan change may be appropriate.  Since many Medicare Advantage plans include both medical and drug coverage, you may consider a plan switch during AEP, if either or both of these changes to your detriment.  Sometimes drug formulary changes can create the need to make a plan switch. Other times, doctors, hospitals and other medical providers may leave your plan’s network. Also, the medical benefits can be impacted from year-to-year.  For example, certain medical services may have increased copayments, or the plan’s medical maximum out-of-pocket limit may increase to a level that is out of your comfort zone. And of course, a premium increase can affect the affordability of the plan.

 

As you can see, there are a multitude of reasons a Medicare Advantage plan switch may be warranted.  And just like Part D drug plans, you can switch to another Medicare Advantage plan during AEP — with your current insurance carrier, or another carrier.

 

Switch from Original Medicare to Medicare Advantage

When you have Original Medicare and a Medicare Supplement Insurance Plan (Medigap), you use Medicare Part A (hospital) and Part B (medical/outpatient) as your primary coverage, and your Medigap plan as your supplemental plan for medical services.  And you usually will also have a Part D drug plan, unless you have creditable prescription drug coverage from another source (i.e. VA benefits). But what if you aren’t happy with your plan coverage, pricing, or have customer service issues?

 

You can switch entirely from this plan setup to Medicare Advantage during AEP.  If you switch to a Medicare Advantage plan that includes Part D coverage in this scenario, this will automatically dis-enroll you from your existing stand-alone Part D drug plan with a January 1st effective date.   However, you will still need to request cancellation of your existing Medicare Supplement plan as of January 1st of the upcoming year.

 

Medicare’s Annual Open Enrollment Period is a critical time for Medicare beneficiaries.  Even if switching plans isn’t beneficial, it’s a good idea to first understand your plan’s provisions for the new plan year, as well as spend some time collecting information on other plans available in your area.  At Medicare Mindset, we are always available to guide you through this important time frame.

 

Neither Medicare Mindset, LLC nor its agents are connected with the Federal Medicare program.