Medicare Solutions Blog

Although the 2013 Medicare premium and deductible increases announced on Friday are smaller than what was originally predicted, the increase in premiums is coming at a time when additional Medicare cost-cutting or smaller Social Security cost of living adjustments are possible.

According to the Centers for Medicare and Medicaid Services (CMS) report, the Part A deductible for hospital coverage — which is the amount a person must pay for a hospital admission before Medicare kicks in — will rise 2.4% to $1,184 from $1,156

The Part B Annual Deductible for Medicare eligible physician services, outpatient hospital services, certain home health services and durable medical equipment will rise $7 to $147.

High income seniors, who already pay additional surcharges on top of the standard premium will see additional hikes ranging from $42 to $230 per month.   Most low-income beneficiaries will have their premiums paid by Medicaid.

If you are looking to enroll in a Medicare plan, give us a call today at 1-877-614-2333.  A licensed Medicare expert will assist you in selecting a Medicare plan that best fits your financial and health care needs!

If you have been affected by Hurricane Sandy, or rely on help with making your healthcare decisions from friends or family members who live in the affected areas, you may make an enrollment request after the Medicare Open Enrollment deadline of December 7.  In order to do so, however, you must contact 1-800-MEDICARE (1-800-633-4227) and ask for assistance. (TTY users should call 1-877-486-2048.)

CMS (Centers for Medicare and Medicaid Services) will review each request on a case-by-case basis to determine what action is appropriate for your situation.   Your new coverage will start January 1, 2013 if you sign up by the end of December.  If you sign up after December 31, in most cases you will be enrolled in your health or prescription drug coverage plan for 2013 for the first of the month after you make the enrollment request.

If you don’t plan to change your Medicare plan for 2013, you need not worry about the December 7 deadline as you will automatically be re-enrolled in your existing plan.

Please contact us at MedicareSolutions where a licensed Medicare sales representative can explore with you options that would best fit your needs.  Call us today at 1-800-328-7305!

Hospital Indemnity Plans are insurance products designed to help individuals and families with the high costs of healthcare.   They cover some of the costs associated with a hospital stay and may provide extra coverage that your health plan won’t cover.  These plans provide a daily benefit for each day you are hospitalized; paid without regard to the hospital expenses incurred.

Hospital Indemnity Plans are generally considered to be a supplemental coverage, providing a set cash amount per day, such as $50, $200, $500 etc. payable directly to you.  For example, if you are hospitalized for 5 days and the daily benefit is $200, then you are eligible for $1,000.

While plans vary, generally the cash received may be used to help pay for out-of-pocket hospital-related expenses that include deductibles, co-pays, travel, transportation and hospital incidentals, such as parking.  Cash payouts may also be used for household expenses as a result of hospitalization, outpatient surgery, or post-hospital skilled nursing facility stays.

Because it’d be difficult to cover all your hospital expenses with a $100 or even a $200 per day indemnity plan, you may also need supplemental benefits—reimbursement for deductibles and coinsurance payments—which may be covered under a Hospital Indemnity Policy.

Hospital Indemnity Policies are frequently available directly from insurance companies.  These policies offer many options on benefits and terms, so make certain to ask questions to find the correct policy to meet your needs.  If you purchase a Hospital Indemnity Policy, review it frequently to determine if you need to increase your daily benefits to keep pace with rising health care costs.

If you have any questions on whether a Hospital Indemnity Plan or Hospital Indemnity Policy would be right for you, please contact us at MedicareSolutions where a licensed Medicare sales representative can explore with you options that would best fit your needs.  Call us today at 1-800-328-7305!

If you’re looking for a way to keep all your health information in one place, you should consider creating a Personal Health Record (PHR) —  a health record where data and information related to your care is maintained by you, the patient.

The intention of a PHR is to provide a complete and accurate summary of your  medical history using your computer.  You, or someone assisting you, control the health information in your PHR and can access it at any time with Internet access.    Secure technology is used to protect your information with a unique user ID and password.  You control who can see your information and nobody can get access to it without your permission.

Why Create a PHR?

There are several reasons to create a PHR, including:

•  PHRs make it easier to find information about your recent health services and conditions and share it with your providers, caregivers and family members.
• PHRs help providers get the information they need quickly which will better enable them to treat you in an emergency situation.
• PHRs can save you time by reducing the number of forms you need to fill out and can save you money by avoiding duplicate procedures and tests.
• Some PHRs even enable you to refill prescriptions, schedule appointments and e-mail your doctor.

How Can You Create a PHR?

Many providers, health plans and private companies offer PHRs; some are even available at no cost.  Several independent companies will even create and maintain PHRs for you, and with permission from you, they may be able to get your health information from your doctor or health plan directly.  If your doctor or health plan doesn’t offer a PHR, check what is available from other companies by visiting www.myPHR.com.

Key Items to Put in Your PHR

It’s important to keep track of several key items relating to your healthcare, including:

• Vaccinations.  Keep track of the flu shots and vaccinations you receive and share this with your doctor.  This is especially important if you have more than one doctor.
• Medications.  By recording your medications and updating the list regularly in your PHR, you can discuss your medication with your doctor and adjust your prescriptions, if necessary.
• Routine Check-Ups.  As you go to your doctors, dentist and any health care provider, keeping track of your medical progress and conditions is vital.  By keeping track of items such as blood pressure, weight, cholesterol, vision, hearing and other important items, it gives your doctors a record of your health history.
• Early Screenings.  Many health care plans now include preventative screenings for a number of illnesses.  Record when you had these screenings and the results.  This will provide your doctor with the information necessary to determine if you need additional treatment.

There are many easy ways of keeping your personal health information through technology or even on paper.  Use whatever way makes you feel comfortable and make certain to routinely share this information with your health care provider.

Let MedicareSolutions help you find the Medicare plan that will best fit your needs.  Our licensed agents are here to assist you and tell you about plans available in your area. Call us today at 1-800-328-7305!

As a provision of the Affordable Care Act, the government is using a five-star rating system to help you identify high-quality Medicare plans.  To rank the plans, a mix of information reported by insurers, consumer surveys, and Medicare records on more than 55 topics for plans covering health and drug services is compiled.  If you’re actively shopping for a Medicare plan, the government’s website, www.medicare.gov, offers a friendly rating system from one to five stars to rank each plan.

The good news for consumers is that the performance of Medicare Advantage plans is improving.  This year, there are a dozen Medicare Advantage plans with a five-star rating when compared to 9 in 2012.   In addition, 97 plans received a 4 ½ star rating, which means that 68% of Medicare beneficiaries will have access to a plan with a rating of either four or five, a 17% increase from 2012.

In addition, 26 Medicare Part D drug plans have received either four or five star ratings; that’s twice as many highly-rated plans as were available this year.

Unlike previous years when plans were allowed to maintain their Medicare Advantage status despite poor quality ratings, CMS (Centers for Medicare and Medicaid Services) has proposed a rule that will give it the authority to terminate poor-performing Medicare Advantage and Part D plans that fail to achieve at least a three-star rating for three consecutive years.

To encourage you to switch to a five-star Medicare Advantage and/or Part D drug plan, members are allowed to enroll throughout the year rather than only during the seven-week Medicare enrollment period ending December 7, 2012.

To check the ranking of your current plan or look for a higher ranked plan, refer to www.medicare.gov.

If you’re currently an Empire BlueCross BlueShield Medicare Advantage member in New York or an Anthem Blue Cross member in California, you may have recently been contacted by Anthem with news that your Medicare Advantage Plan has been cancelled.

Nearly 30,000 New York members and 2,500 California members were notified that their plans were not being renewed after January 1, 2013.  Because CMS (Centers for Medicare Services) does not permit automatic migration of plans, if you’ve received a non-renewal policy notice and would like to enroll in a new Medicare Advantage (MA) or Medicare Supplement plan, you must submit a new application for the plan you select.

NEW YORK

Similar to many carriers, Empire traditionally makes changes each year which may include the addition or deletion of plans.

For 2013, several Empire BlueCross BlueShield or Empire BlueCross plans have exited entire counties.  You will need to select a new plan if you find your Empire plan on the list below:

• Empire MediBlue Plus HMO has exited Rensselaer County
• Empire MediBlue Select HMO has exited Dutchess County
• Empire MediBlue Freedom III PPO plan has exited Clinton, Columbia, Delaware, Dutchess, Essex, Fulton,  Manhattan, Montgomery, Nassau, Orange, Putnam, Queens, Rockland, Suffolk, Sullivan, Ulster, and Westchester counties.
• Empire MediBlue Essential HMO has exited Nassau, Rensselaer, Rockland and Ulster counties.
• Empire MediBlue Freedom II PPO plan has exited Delaware, Dutchess, Greene, Kings, Manhattan, Nassau, Orange, Putnam, Queens, Rockland, and Westchester counties.
• Empire MediBlue Freedom I PPO has exited Clinton, Dutchess, Essex,  Manhattan, Orange, Putnam, Queens, Sullivan, Ulster, and Westchester counties.

If your plan is not being renewed, you will have a one-time Special Enrollment Period (SEP) from December 8, 2012 – February 28, 2013 to enroll in a plan.  If you don’t select a plan by December 7, you may use the SEP from December 8 – December 31 to select a new plan with an effective date of January 1, 2013.

CALIFORNIA

Last year at this time, Anthem cancelled their state-wide Medicare Advantage plan and instead offered 13 regional plans.   This year, 10 counties will be impacted by Anthem BlueCross LPPO plan changes, including:  Alameda, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Clara, Sonoma, Stanislaus and Ventura counties.

In seven of these ten counties, Anthem is introducing new PPO products.  In Alameda, Santa Clara and Stanislaus counties, however, the PPO plan will exit with no PPO replacement; CareMore plans will be available to members in these counties

Be reminded:  If you are currently in an Anthem BlueCross Medicare Advantage plan, and you want to stay in Medicare Advantage, then you must sign up for another Medicare Advantage plan (from either Anthem or another insurance carrier).  If you do not sign up for a new plan, then you will automatically be enrolled in original Medicare.

At MedicareSolutions, we recognize that a change in your plan may be confusing and uncomfortable.  To save you time, our licensed agents are available to you – at no charge – to assist you in selecting the Medicare plan that best fits your financial and health care needs.  Call us today at 1-800-328-7305!

If you’ve been enrolled in a Part D plan for a number of years, now is the time to review it and make potential changes without penalty.    Even if you’re happy with your current coverage, it’s wise to evaluate your plan and determine if another would better fit your needs.

When reviewing plans, look to compare the following:

Premiums

Despite the news from the Center for Medicare and Medicaid Services (CMS) that premiums for basic Prescription Drug Plans (PDPs) offered in 2013 will remain flat, there is a significant fluctuation in premiums when enhanced plans are factored in.  CMS expects the average 2013 monthly premium for basic prescription drug coverage to be $30, which is basically unchanged from 2012.   Average Part D premiums for current plans, however, will increase by 6%, according to Avalere Health, a Washington D.C. consulting company.  Some of the more popular plans from years past will have higher premiums, so it’s worthwhile to search for a new plan to avoid sometimes significant premium hikes.

The Humana Walmart-Preferred Rx Plan, for example, will increase costs by 23% to $18.50 per month.  To balance increased premiums on several plans, there are also new low-cost options including AARP’s MedicareRx Saver Plus, which has premiums averaging $15 a month.

Out-of-Pocket costs

In looking at the overall cost of your plan, it’s important to factor in potential out-of-pocket expenses.  In 2013 Medicare Part D plans are allowed to charge deductibles – a set amount you must pay for services before your insurance kicks in — of up to $325.  Even after you’ve met your deductible, you may have additional copayments or coinsurance charges for covered drugs.  Many times you’ll have to decide whether it’s worth paying a higher premium in exchange for a smaller deductible and copayment.

Covered Medications

Each Medicare Part D plan has a list of medications, both brand and generic, that the insurance covers called the formulary.  Prescription drugs are often grouped into tiers of covered drugs that have different out-of-pocket costs.  To see whether your copays might change or if there are any formulary changes, you should go to medicare.gov to the “Plan Finder” and enter the drugs you are taking.  By switching to a new Part D plan, you may save a significant amount of money.

Restrictions

Some Part D plans require prior authorization before you can fill a certain prescription and may have quantity limits regarding how much medication you can get at one time.  You may also be required to try lower-cost drugs before the plan will cover a more expensive prescribed drug.  So, if there’s a specific drug you need, it’s worthwhile doing pre-work to determine which plan covers it and how much it will cost.

In addition, most plans have a network of pharmacies they want you to use in order to get the best prices.  If you go to a pharmacy that’s not in your plan’s network, you may have to pay more for your prescriptions.  Make sure your preferred pharmacy is in your plan’s network.

Donut Hole Gap

A Part D plan will stop paying for a portion of your medications once a pre-set spending limit is met.  At this point, you have reached the “donut hole” and are responsible for paying 100% of your drug costs.  Seniors who reach the donut hole gap in prescription drug coverage in 2013 will get 52.5% off the cost of brand-name drugs and 21% off the cost of generic drugs, up from 50% and 14% in 2012.  If you know you’ll need a number of prescriptions, it may be worth the cost of the extra premiums to have the gap coverage.

Convenience

One final consideration when selecting your Part D plan is convenience.  If you have a Medicare Advantage plan with prescription drug coverage, there’s just one company to contact if there’s ever an issue with your coverage.  If your prescription drug plan is with a different carrier than your other Medicare coverage, it may be more difficult to coordinate benefits between plans.

The Medicare insurance experts at MedicareSolutions are available to help you find a prescription drug plan that fits your needs.  Just tell us where you live and the medications you’re currently taking, and we’ll find a drug plan that works for you.  Call us today at 1-800-328-7305!

As the weather changes, many of us are pulling out warmer clothes and testing them out for size.  Similarly, Medicare’s Open Enrollment Period (OEP), is the time of year when you can review your health insurance benefits and drug coverage plans against others and see which plan fits you best.

To help you determine which health options will best suit your needs and help you through this decision-making process, there are several basic pieces of information you need to know about open enrollment, including:

•  OPEN ENROLLMENT DATES:    This year, OEP takes place between October 15- December 7, 2012.

• CHANGES YOU CAN MAKE TO YOUR PLAN:   During the OEP, you may make any of the following changes:

•  Switch your current Part D drug plan or Medicare Advantage plan to another carrier
• Change from traditional Medicare plus a Part D drug plan to having a Medicare Advantage plan that includes both medical and drug coverage
• Change from a Medicare Advantage plan to traditional Medicare (and add a Part D drug plan if you don’t already have drug coverage).

• REASONS TO COMPARE YOUR CURRENT MEDICARE ADVANTAGE PLAN OR PART D PLAN WITH OTHER PLANS AVAILABLE:

• Premiums and/or deductibles may have changed
• Coverage for medical services or drugs may have changed
• Copays for your medical services or drugs may have changed.

• STEPS TO TAKE IF YOU KEEP YOUR CURRENT MEDICARE PLAN.
  If you decide to stay in the same Part D or Medicare Advantage plan you had in 2012, you don’t need to do anything since you will automatically be re-enrolled in the plan for 2012.

• WAYS TO SIGN UP FOR A DIFFERENT MEDICARE PLAN.
  There are different ways to enroll in the different parts of Medicare.  Part A and B are government run, so you’ll need to contact Medicare directly (1-800-MEDICARE) for Part A if you don’t qualify for automatic enrollment.  Part B of Medicare is elective, meaning enrollment is not automatic.  If you are looking to receive medical benefits through Medicare Part B you must contact Social Security directly (or use the Social Security Online Benefit Application on their website to enroll).Part C, Part D, and Medicare Supplement Insurance are different since these types of plans are offered through private insurance companies.  You can apply directly through the carrier of your choice, or use the help of a Licensed Medicare Specialist to do the research and help you apply.    If you choose to contact our Medicare Specialists at MedicareSolutions, your service will be free of charge.  We’ll even walk you through the application process and make sure your enrollment is quick and easy.  Call us today at 1-800-328-7305 to get expert advice!

•  THE DATE WHEN NEW COVERAGE FOR A DIFFERENT PLAN BEGINS.
  If you sign up for a different plan at any time during open enrollment, your coverage will begin on January 1, 2013.  Enrollment in your new plan automatically cancels your current coverage at midnight on December 31.  If you change from a Part D drug plan to a Medicare Advantage plan, this automatically cancels your coverage under traditional Medicare and you will receive your Medicare benefits through the Medicare Advantage plan beginning  January 1.

•  WHAT TO DO IF YOU MISS THE DEC. 7 DEADLINE.
  You may switch plans after open enrollment ends only in special circumstances — such as if you move outside of your current plan’s service area or move into or out of a nursing home. You can also switch plans at any time of the year if you qualify for low-cost drug coverage under Part D’s Extra Help program. If you’re in a Medicare Advantage plan, you’re allowed to switch to the traditional Medicare program (and a Part D drug plan) during a special “disenrollment” period that runs from January 1 to February 14. Finally, you can switch any time during the year into a Part D or Medicare Advantage plan that has earned Medicare’s top five-star quality rating, but only once a year.

• REASONS TO USE THE DISENROLLMENT PERIOD
  If you’ve made a mistake when you make a change  from a Part D drug plan to a Medicare Advantage plan, you can switch back during a “disenrollment period” that runs from January 1-Feburary 14, 2013.

For assistance in selecting a new Medicare plan that best fits your financial and health care needs, call MedicareSolutions today at 1-800-328-7305 and a licensed sales representative will assist you with a plan that best meets your needs.