Tag Archive for Medicare

The Donut Hole- Medicare Part D

Donut Hole- this coverage gap occurs when you and your Medicare drug plan have spent a set amount of money for covered drugs and you begin “out-of-pocket” paying for your prescription drug costs until you reach the catastrophic coverage point in which your Medicare drug coverage plan will begin again. In the case of 2015, once you and your Medicare drug plan have spent $2,960 on covered drugs, the coverage gap will start. You will not reach catastrophic coverage until you have spent $4700 out-of-pocket for the year.

In order to counterattack high costs during the coverage gap, the Affordable Care Act includes benefits to help make your prescription drug coverage more affordable once you are in the “donut hole”.

These are the four benefits you will receive:

  1.  A discount on covered brand-name drugs when you buy them at a pharmacy or order them through the mail.
  2.  Some coverage for generic and brand-name drugs
  3.  Additional savings on brand-name and generic drugs
  4.  Maintaining the 50% discount the manufacturers offer and increasing their Medicare drug plans cover.

If you would like to find out more about the donut hole, click this link: http://www.medicare.gov/Pubs/pdf/11493.pdf

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-771-3966 where a licensed sales agent will immediately assist you.

Be Informed: Some Services Are Not Covered By Medicare

It’s important to be in the know when it comes to what Medicare will and will not cover. Some might be surprised to learn that there are several basic services Medicare won’t cover without very specific circumstances. For example, here are a few services often required by older patients, which they might generally have difficulties getting Medicare to pay for:

Dental care. Routine dental care isn’t covered. That means cleanings, fillings and tooth extractions, in addition to dentures. In some cases, Part A may cover certain services administered during a hospital emergency.

Hearing aids/exams. Medicare Part B doesn’t cover routine exams; nor will it cover hearing aids or the exams used to select and fit a hearing aid.

Foot care. Although the treatment of foot illness is covered, routine foot care, including corn and callus removal and preventive maintenance, are not covered by Medicare.

Eye exams. Aside from basic vision check-ups as part of preventive care, Medicare won’t cover routine eye exams for eyeglasses/contact lenses. In some cases, preventive and diagnostic services may be available to Part B recipients. This could cover tests for glaucoma and macular degeneration exams. Those with diabetes may be eligible for an annual exam for diabetic retinopathy.

Eyeglasses. Medicare doesn’t cover eyeglasses, despite the fact that many senior citizens need them. For those who have had cataract surgery that involves the implanting of an intraocular lens, Part B will contribute to the cost of one pair of eyeglasses or set of contacts.

Cosmetic surgery. Unless it’s needed due to illness or injury (post-mastectomy breast reconstruction, for example), Medicare doesn’t cover cosmetic surgery.

Acupuncture. This traditional form of Chinese medicine is not covered.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Medicare vs. Medicaid

Many people get confused about the difference between Medicare and Medicaid. In one sentence, Medicare is a federal government-sponsored healthcare program developed for seniors over 65, while Medicaid is for low-income families and is managed by both state and federal governments.

Getting more in depth, Medicare is an insurance program. Medical bills are paid from trust funds in which those covered by the program have paid into throughout their working careers. It is primarily for people over the age of 65, no matter their income, but also serves younger disabled people and dialysis patients. Medicare beneficiaries pay part of the healthcare costs through deductibles. They also have small monthly premiums for non-hospital related costs. This program is also based on the federal level of government, meaning it is more or less the same everywhere in the United States and is run by the Centers for Medicare and Medicaid.

On the other hand, Medicaid is an assistance program. Medical bills are paid from federal, state, and local tax funds. This program is designed to help offset expensive medical costs for low-income people of all ages. These program beneficiaries do not usually pay for the costs at all; however, a small copayment may sometimes be required. Another major difference is that although it is a federal program, it is also a state program meaning the program varies in every state.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

The Truth about Generic Drugs

There is a lot of debate about whether or not brand-name drugs are better than generic drugs and if they are of the same quality. However, there shouldn’t be because according the U.S. Food and Drug Administration (FDA) they require generic drugs to have the same quality and performance as brand name drugs. When a generic drug is approved, they must pass high standards within identity, strength, quality, purity, and potency.

In terms of production, generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name. For example, there have been 38 published clinical trials that compared a generic heart drug to its brand name and every study proved they are the same.

Many people wonder why brand name drugs are so much more expensive though, actually around 80% to 85% more expensive than the average cost of a generic drug, and try to argue that because they are more expensive they’re better. This is not the case at all. This price increase is due to a lot of the pharmaceutical companies’ marketing and advertising campaigns, which creates for high competition within the marketplace giving them the ability to raise drug prices.

It also of concern that generic drugs are not as safe. However, the FDA is actively monitoring and engaged in making sure that they are safe.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Below is a great chart provided by the FDA that gives facts about generic drugs.



How to control retiree healthcare costs

Retirement is supposed to be a time of freedom from decades worth of hard work throughout your career and a point in your life where you feel financially secure. However, over the years we have seen healthcare costs rise dramatically, obscuring the image of a stress free retirement. According to an article by Fidelity, a couple retiring in 2013 is expected to need $220,000 to cover health care costs in retirement. While this is a big chunk of change for anyone to undertake, there are several ways you can manage your health care costs and feel comfortable as you approach retirement.

The first way in which you can manage these healthcare costs is knowing what is available to you in terms of health insurance coverage. You need to know what you need, where you can get it, and the cost of the coverage your looking into. Once you figure out your options you can start to answering these questions.

If you don’t have employer-based insurance, Medicare, a government-based insurance program is a great option to look at. There are four different parts (A,B,C,D) and you automatically qualify for Part A at the age of 65, which is hospital insurance, if you paid Medicare taxes throughout your career. The second part, part B includes outpatient care and is paid by a monthly premium. Lastly, part C and D are supplemental coverage plans that fill in the gaps not covered by A and B and include prescription drug coverage.

A second way in which you can manage your healthcare costs is deciding whether or not your going to be retiring early, or before the age of 65 when you start qualifying for Medicare. If you do retire early some of your options include: Medicaid if you qualify, paying to continue your employer based insurance, or purchasing an individual policy.

Due to the fact healthcare costs are one of the biggest expenses people now face it is a good idea to factor in these expenses into your income planning. According to an article in Fidelity, current retirees are now spending more on health care than they do on food. You can start figuring these numbers in your budget once you know how much the options your looking into cost. Its also a good idea to take into account your current health status and your family’s history of health as this information will help you determine what health issues you may encounter as you get older.

Another great way to counteract these upcoming healthcare costs is by setting up a health savings account or HSA by annually setting money aside for future expenses. These accounts are not subject to the if you don’t use it, you lose it rule making them very accountable. As a result, there are many ways to prepare and be ready for the healthcare costs you are about to encounter.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Citing: Fidelity Viewpoints. “How to tame retiree health care costs”. Medicare Solutions Blog. Admin. May 15, 2013. May 20, 2013.







Not Signing Up for Medicare Part B? You May be Headed for a Penalty


Even though I said we’d be talking about Part D this week, I just wanted to add a bit more on Part B and the potential penalty for not signing up when eligible.

What is the Part B late enrollment penalty? If you don’t sign up for Part B when you’re first eligible, (see the prior post for information on enrollment) you may have to pay a late enrollment penalty that may increase your premium by as much as 10% for each 12-month period that you could have had Part B, but didn’t. Unlike the penalty for Part A, there is no end to the Medicare Part B late enrollment penalty. You will carry this penalty for as long as you have Medicare Part B.

You may be able to delay enrollment in Medicare Part B without being subject to a late enrollment penalty if you have group health coverage through you or your spouse’s employer or union. You may then qualify for a Special Enrollment Period for Medicare Part B and avoid a late penalty.

It’s important to note that if you are covered by a COBRA or a retiree health plan, this is not considered to be coverage based on employment.  As a result, you will not qualify for a Special Enrollment Period and you must sign up for Medicare when you are eligible to avoid paying a higher premium.

For more information on the late enrollment penalty, review the 2013 Medicare & You booklet that can be found on the Medicare.gov website:  http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf


If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Understanding Medicare – Part B

Part B
– If you have qualified for Part A, then you’re qualified to receive Part B. In fact, if you’re getting Social Security, you’ll be automatically enrolled when you turn 65, or if under age 65, have certain disabilities. You can opt out. If you’re not getting Social Security, and want Part B, you must apply. You can enroll in Part B a few different ways; call Social Security, visit the Social Security website, or apply in person at your local office.

Premium Payments

The monthly premium for Part B is based on your income.  This monthly fee can be deducted from your Social Security check.

There is also a yearly deductible.  For 2013, it stands at $140 per month. Once you’ve paid this deductible out-of-pocket, your benefits will kick in and Medicare will pay 80% of the cost of most Part B services.

Part B is medical insurance for issues that don’t require hospitalization, including preventive care.  You’ll want Part B for coverage that extends to:

  • Doctor visits
  • Outpatient treatment
  • Preventive care services (screenings & checkups)
  • Home health services
  • Durable medical equipment (including diabetes supplies)
  • Ambulance services
  • Mental health services

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Next Installment – Part D

Understanding Medicare – One Plan at a Time

Understanding the Medicare process and enrolling in the plans that are right for you can be a daunting task. In this series of posts we’ll be taking a close look at each of the Medicare plans with the hope of providing the information to make this necessary step of life a bit easier.

Medicare – Part A - Hospital Insurance 

Parts A, B, and D of Medicare all serve a different purpose. Part A provides hospital insurance.  Almost everyone over the age of 65 is eligible to receive it, but some may have to pay for it.


If you qualify for Social Security benefits, you receive Medicare Part A coverage at no cost. If you never paid Medicare tax while working, you are not eligible to receive Part A free of charge but, you still may qualify to purchase coverage.

You are eligible for free coverage and will be automatically enrolled if:

  • You are 65 years old and are receiving Social Security or Railroad Retirement Board  (RBB) benefits
  • You are under 65 and have been receiving Social Security Disability benefits for 24 months(24 month waiting period is waived for sufferers of Lou Gehrig’s Disease (ALS))
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements

In order to be eligible to purchase Part A, you must fall into one of these categories:

  • U.S. Citizen or Permanent Resident and at least 65 years old
  • Younger than 65 years old and your Part A coverage ended because of employment

To sign up to purchase Part A, you should contact the Social Security Administration office three months prior to your 65th birthday and tell them you’d like to enroll. You can also sign-up online at www.socialsecurity.gov/retirement. After enrolling, you will receive your Medicare Card and your coverage will begin the first day of the month that you turn 65. You can sign up during the seven month period that starts three months before your birthday and ends four months after. For information on the cost of purchasing Part A, visit – http://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html

What does it Cover?

As the name implies, Part A – Hospital Insurance covers expenses incurred from hospital visits. Coverage includes:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Inpatient care in a Religious Nonmedical Health Care Institution

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

4 Tips To Help You Save On Prescription Drugs

Medicare Prescription DrugsPrescription drugs can be very costly. Luckily, those who qualify for Medicare have the option to enroll in a Medicare Part D drug plan or a Medicare Advantage plan to help alleviate drug costs. These plans can sometimes cover up to seventy five percent of prescription drug costs. But even with three quarters of the cost covered, prescription medication can still be a serious financial concern. If Medicare already covers some of your prescription drug costs, what can you do to reduce the remaining costs after coverage?

There are a few ways to save on prescription drugs beoynd your Medicare plan’s coverage…

  • First and foremost, see if you qualify for Extra Help with drug costs. If you are enrolled in a Medicare drug plan, live in the United States, and have limited resources and income, you may be eligible. Social Security deals with Extra Help claims. They have information regarding eligibility available on their website and you can even apply online.
  • Second, make sure you are making use of generic drugs. They are significantly cheaper and more accessible than many brand names. Generic alternatives to brand name drugs are available throughout the country and will always save you money over regularly priced brand names. Contact your doctor and pharmacist to see what generics will fit your needs.
  • Another way to save some money on medication is to talk to your doctor or pharmacist about free samples. They receive a certain allotment of samples that they can give to patients free of charge. Don’t be afraid to take advantage of this if you find your prescription in sample form. As long as you are not abusing their generosity, most doctors and pharmacists will be happy to help.
  • Finally, many people don’t know that there are coupons available for many name brand drugs. Sometimes finding them can be as simple as a quick search on a search engine. The key to obtaining these coupons is being willing to ask. Ask your doctor, your pharmacists, even try asking the manufacturer directly, either by phone or email. Like the coupons you use at the grocery store, these coupons often have expiration dates. Make sure to be aware of these dates so you don’t miss out on the potential savings.

Hopefully these tips can help you save some money on your prescription drugs. If you have any more money saving ideas that have worked for you or someone you know, feel free to share them in the comments. Do you think you could find another way to save money with a Part D drug plan? Let us know!

5 Medigap Myths You Don’t Want To Fall For

Many people are unsure how Medigap plans work in conjunction with original Medicare and there are certainly a few myths that have been created as a result. Medigap, also known as Medicare Supplement, helps Medicare beneficiaries pay the extra twenty percent of copays that original Medicare doesn’t cover. Medigap plans are offered throughout the country by many different insurance carriers. Here are five Medigap myths that you don’t want to fall for.

Myth #1: Medicare Advantage Plans fall under the umbrella of Medicare Supplements.
Fact: Although many people consider both these types of plans when choosing coverage, Advantage plans and Supplement plans are completely different. Medicare Advantage plans offer additional coverage to original Medicare. This coverage could be for things like vision, hearing, or even a gym membership. Medicare Advantage beneficiaries still pay a share of copays, just like original Medicare beneficiaries. Medicare Supplement beneficiaries, on the other hand, do not pay a share of the copay for Medicare approved service and treatment. In fact, Medicare Supplement plans were introduced for that very reason. Medicare Supplement, or Medigap, does not add any benefits beyond original Medicare. It does, however, cover the extra twenty percent of copays that remains after the original Medicare discount.

Myth #2: Like other Medicare plans, you can only change Medigap plans during the annual enrollment period.
Fact: Many people are fooled by this myth because it seems very believable. There are only certain times when Medicare enrollees can select or drop Advantage or Prescription Drug plans, so wouldn’t it make sense that Medigap plans are the same way. In reality, Medigap plans do not have this same constraint. A Medigap beneficiary may change their coverage at any time for any reason during the year. However, it is important to note that there are specific periods of time where you can avoid answering medical questions that could exclude you from a Medigap plan. Open enrollment is the most known of these time periods and it occurs in the six month span after you turn sixty five and receive part B of Medicare. There are also “guaranteed issue” periods that come into play after specific events, like losing coverage from an employer or moving to another state. You can still change Medigap coverage at any point in time during the year, but if you are looking to avoid answering any medical questions, stick to open enrollment.

Myth #3: With Medigap, you can only visit doctors within your plan.
Fact: This is yet another myth where people are getting Medicare Advantage rules mixed up with Medigap. Medigap plans do not require you to use a specific network of doctors, unlike some Medicare Advantage plans. Medigap plans will cover any service that original Medicare covers. That means anywhere your eighty percent original Medicare discount kicks in, so does your Medigap plan. Medigap is good anywhere Medicare is accepted.

Myth #4: A more expensive Medigap plan will save you money in the long run.
Fact: There is somewhat of a grey area in the myth. It is true that spending the extra money on a Medigap plan versus staying with original Medicare will most likely save you money in the long run due to increasing copays. It’s not always true, however, that a more expensive Medigap plan will save you money over a less expensive one in the long run. Plan F is commonly the most expensive plan because it offers the highest amount of coverage. As copays rise, Plan F will cover the most in terms of how many different copays it will cover. What most people might not realize is that those copays could be potentially less than the money saved over choosing Medigap plans with less expensive monthly premiums. If you are looking to save the most money over the long run, choose a Medigap plan that covers what you need and not what you don’t. That way you won’t have to pay extra every month for coverage you may use very rarely or maybe not at all.

Myth #5: You should only buy a Medigap policy from the largest and most trusted providers to make sure all your claims get paid.
Fact: Medigap plans are standardized, so that means there will be no difference in what is covered, how much is covered, and when you receive coverage regardless of who provides your Medigap coverage. A Medigap Plan A will perform exactly the same no matter what insurance company offers it. Prices, on the other hand, are not standardized, so don’t be afraid to search for the lowest price. The cheapest Medigap Plan C will offer the exact same coverage as the most expensive Medigap Plan C.

These five are just a few of the many Medigap myths. Like many others, you will most likely still have questions. That’s where our licensed Medicare experts come in. Our Medicare experts know all the myths and can explain them in simple terms so that you can make the best decision for yourself. If you are looking to enroll in a Medigap plan or any other Medicare plan, give us a call at 1-877-614-2333 to speak with a Medicare expert to get the information you need to make a smart decision.