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Nov 12

What is the Donut Hole???

Posted on Sunday, November 12, 2017 in Uncategorized

I am frequently asked 3 questions about a mysterious and misunderstood segment of Medicare Prescription Drug (Part D) coverage:

1. What is the Donut Hole?
2. How do I get in the Donut Hole??
3. How do I get out of the Donut Hole???

Whether your Medicare Prescription Drug Coverage is a “stand alone” Prescription Drug Plan or included in your Medicare Advantage Plan, it has the dreaded Donut Hole.

What is the Donut Hole?  Technically it is the “Coverage Gap” in Medicare, just one segment of the 4 Part D Coverage stages:

• Deductible: If your plan has a deductible, you will pay the “Full Cost” of the drug until you meet the annual deductible, though some plans exclude some “tiers” from deductible.
• Initial Coverage: After the deductible has been met, you generally have fixed amounts to pay for your drugs—Co-pays or Co-insurance (percentage of the cost)
• Coverage Gap (Donut Hole)
• Catastrophic Coverage

How Do I Get IN the Donut Hole??

Part D Prescription Drug Coverage works on a calendar year basis, January 1st through December 31st. As you fill prescriptions throughout the year, your plan is keeping track of the “Full Cost” of your drugs. For example you may pay $3, $20 and $47 dollars for three different drugs that actually cost $11.55, $66.23 and $454.81 dollars.
If the FULL COST of your drugs added together in the calendar year reach a certain threshold, (which changes each year), it is $3750.00 in 2018…YOU ARE IN THE DONUT HOLE!!

All Plans have the Donut Hole, and what you pay for drugs changes to a percentage of the “Full Cost” your Part D Plan has for your prescriptions. In 2018 the costs are 44% on Generic drugs and 35% of Brand drugs. (the percentages change each year)

How Do I Get OUT of the Donut Hole???

Stay with me here! Your “True Out Of Pocket” (TROOP) costs must reach $5000.00 in 2018. The 5000 really has nothing to do with the 3750, it is 2 different calculations! The TROOP of 5000 is reached by adding up what YOU actually paid initially, this includes deductible if any, then co-pays/co-insurances in Initial Coverage plus the 44% on generics/35% on brands in the Donut Hole, AND the drug manufacturer of your Brand name drugs contributes 50% of the cost of the Brand drug. If this adds up 5000, then…YOU ARE OUT OF THE DONUT HOLE!!!

Now you are in Catastrophic Coverage. Costs generally go down. For 2018, you will pay the greater of 5% of the full cost of your drugs, or $3.35 for generics, $8.35 for brands. This will continue to the end of the year, and it starts all over again from the beginning on January 1st!

Pretty easy, right? LOL!

Oct 1

Do You Have the Right Part D Plan for 2018?

Posted on Sunday, October 1, 2017 in Uncategorized

A good way to compare Rx costs on your current Part D plan for 2018 is on the official U.S. government site for Medicare:

• Go to www.medicare.gov
• Select the green tab for Find Health and Drug plans
• Enter zip code
• Step 1 Enter Information (about your current type of Medicare coverage)
• Select Current “Drug Plan” (Find your 2017 plan)
• Step 2 of 4. Enter Your Drugs. When finished click “My drug list is complete”
• Step 3 of 4. Select Your Pharmacies. You must select 1, but no more than 2
• On the next page, Step 4, Refine Your Plan Results, the choices are:

o Prescription Drug Plans (with Original Medicare)
o Medicare Health Plans with drug Coverage (aka Medicare Advantage)
o Medicare Health Plans without drug Coverage

Select “Prescription Drug Plans” and it will sort the choices in order for the projected lowest overall costs for all of 2018. “Overall” is the combined total of monthly premiums for the plan, plus the costs to fill prescriptions for all of next year. It will show prescription costs if purchased at a retail pharmacy, as well as through mail order. 2018 data should be on-line as of 10/1/17.

You will receive an Annual Notice of Change (ANOC) from your current plan provider every year at this time. This tells you about any changes for 2018.

Common Reasons for Changing Part D
• Formulary Change: The formulary is the list of drugs your plan covers. Make sure all of your drugs will be covered next year. If they are dropping any of the drugs you take, you would have to pay full price for them next year!
• Changes in the Pharmacy Network: Just because your favorite drug store accepts your plan this year, doesn’t automatically mean they will next year.
• You Now Take Brand Name Drugs: Your Rx list of will change throughout your life. Your current plan may cover your brand, but it may be cheaper on another plan.
• Drug Tier Change: Prescriptions are categorized into “tiers”. Many plans have a 5 tier system that looks like this:
1. Tier 1: Preferred Generic
2. Tier 2: Generic
3. Tier 3: Preferred Brand
4. Tier 4: Non-Preferred Drug
5. Tier 5: “Specialty” Drugs
If some of your drugs have switched tiers, you may pay more for them next year.
• Big Increase in Plan Premium: How much is too much? It’s up to you, but it makes sense to check and see if another plan is significantly more cost effective.

Sep 12

How Many Phone Calls About Medicare do YOU Get???

Posted on Tuesday, September 12, 2017 in Uncategorized

If you still have a “land line” phone in your home, chances are very good that agents or telemarketers from insurance companies will call you repeatedly to pitch their Medicare Insurance product(s) to you. They call from all over the country: Texas, Oregon, Florida, etc.

They don’t leave messages. Do you know why they don’t? They know you won’t call them back!

Over 95% of the time when I meet with people to explain options with Medicare Insurance, it is in their home. I have no problem driving up to an hour from my house in Ephrata to where my clients live, typically somewhere in Lancaster, Berks or Lebanon County. It is not uncommon for such phone solicitations to happen 2 or 3 times in the hour that I am in their house!

Some people, in a moment of weakness, or purely by accident, actually answer one of these calls. Shockingly, some people, some really otherwise intelligent people, buy whatever the person on the other end of the line is selling! Now, some of these agents who solicit over the phone, may actually know what they’re talking about. Some may actually be brokers, and can offer multiple companies as options.

Some.

I feel the decisions to be made about your health insurance for the REST OF YOUR LIFE is a little too important to be made over the phone, with anyone, let alone someone on the other end of an 800 Number.

The phone IS necessary…to set up a time to get together face to face, one on one. I DO NOT SOLICIT BY PHONE, I only use the mailbox. I will certainly call you back, but you’ve got to start the ball rolling by calling me first at (717) 468-0130.

I hope to hear from you soon!

Sep 11

You Look Comfortable!

Posted on Monday, September 11, 2017 in Uncategorized

With a warm smile, that’s what a new client said to me today, “You look comfortable!”

Yes it was another sunny September day in scenic Lancaster County, 10 am, first appointment of the week and I was well rested and ready to go. However I think it had more to do with the contentment and joy in doing what I do. Perhaps some of it is being completely confident in what I do. I meet over 500 NEW people each year. I’ve met with THOUSANDS of people about Medicare insurance. The basics are the same, the presentation is the same, but the people are all different. Each person is an individual, so each time it feels brand new, and it’s fun!

Yes. I AM COMFORTABLE!

May 17

About Brian “Weems” Williams

Posted on Tuesday, May 17, 2011 in About Brian

Brian Weems Williams

Brian Weems Williams

Just in case you’re not sure you’re in the right place…though I tell people I’m from Rochester, I’m really from the lovely town of Honeoye Falls, NY.  (Picture Bedford Falls in It’s A Wonderful Life).   I’m the youngest of 8 children, the baby of Al & Grace’s family.    Two great parents that gave me all I need, but left me wanting more, only because they left this world too soon.

I don’t know that I learned everything I need to know in Kindergarten, but surely by age 10 I knew I loved playing basketball and golf, listening to music and the radio, eating cheeseburgers and making people laugh.  What you love at 10, you love your whole life.

As summer faded in 1980, I traded the only address I ever knew, 14 Maplewood Ave, for the Weinstein Dorm at NYU.  I never moved back.  I probably told you I have a degree in Communications.  I don’t.  I have a Bachelor of Fine Arts degree in Radio, but that sounds like I got a degree in the mail for 500 bucks and 2 Cap’N Crunch Box Tops.  It seems all my time was spent at WNYU.  Radio was my “bombers, my dexys, my high.”  I interned briefly at the legendary WABC and later spent a long time at the subsequently legendary CBS-FM.

What began as the Weems Noise Company in high school, evolved into a long string of dj gigs in the worst and darkest of city dumps with liquor licenses.   With a handful of scratchy 45’s and a milk crate of warped lp’s this young soul rebel plugged his own belt drive turntables into jumbo watt amps and splattered the platters that mattered.  From the basements of forgettable restaurants to bars gone gay, from blarney stones and poser lofts to hotels in Times Square.  Sounds were found and spun round the town.   Friends were made and bonds were formed, but none more fonder than those united as the Empire State Soul Club.  Keep the Faith.

My commercial radio career as was launched playing oldies on the Mighty 1290 WGLI in N. Babylon, LI in the Fall of ‘84.  It was far from mighty…if NYC stations were blow torches or flamethrowers, this was a matchstick.  No worries, I was so sure I’d just be spending a few years in the “the boonies” of small market radio before coming back to glory in the Big City.    As Hurricane Gloria trashed LI in September of 85, the phone rang as the sunny eye blew through.  On the line was a program director from WLAN in Lancaster,PA (wherever that was) looking to hire this oddball known as Brother Weems.    I said “If I live to see tomorrow, let’s do lunch!”

The orange-red 72 VW Squareback was packed Clampett style for the exodus from the Greater NY area before dawn on a Tuesday Morning.   By 9am that same morning with a belly full of scrambled eggs and scrapple (whatever that was) , I was moved in to a spacious dirty apartment across the street at the ridiculously low price of 200 bucks a month.   Heck my Salary at ‘LAN was 325 a week!  I was rollin in the dough!!!

Nearly got fired for my antics in the first month.  And the the second month.  And the third month.  Would have, but ratings were too good I guess.  Moved to mornings in 86.   The Weems Team was THE thing to listen to in Lancaster for a long time.  Good things don’t last forever.  Neither do good ratings.  In 1991, after run ins with Hershey Park, The Secret Service and infamous Woolworth’s castration homicide case, I was fired.

I surfaced at Top 40 KXXR in Kansas City for wake-ups.  LOVE that town.  Lasted all but 6 months.  Many memories though.  Halle Berry, Eddie Money, Judy Tenuda.  The Chiefs.  Gates BBQ.  Arthur Bryant’s.  Fired again in Febraury of ‘92.  Not my fault really.  The station changed hands and went Country.  Some survived, some didn’t.  And geez, Brother Weems don’t do Country!

After 6 months “on the beach,”  that’s radio speak for no gig, Brother Weems decided he do Country after all!  Dipped my toe in at WXTU in Philly and cannonballed in at WIOV in Ephrata.  Casey & Brother Weems in the Morning.  With Jeff Werner and his million dollar laugh doing news.  Best job ever.  Became Program Director in 95 and 96.  Worst job ever.  Had a blast with the staff and the listeners for 6-7 years, but was burned out, and thankfully, fired again.

The highlight of the WIOV years was attending the marriage of my Music Director.  The girl at the guest book was blonde and beautiful, with a shy dimpled smile that clutched my heart.  Lori Kowalchick was her name, and she traded in the Polish surname for my WelshIrish one in 1997.   Along came my sweetie, Kate Nicole in 1998, and my Buckeroo, Nathan Joseph in 2002.

After another 6 months on the beach, it was abundantly clear Central PA had had enough of Brother Weems.  Alas I had no marketable skills outside of broadcasting.   There’s only one way to make decent money with no qualifications…sales.  However selling Craftmatic Adjustable Beds  was not the answer.  How it took me 2 months of selling them to figure that out I’ll never know.  Selling cars at Lancaster Nissan for 6 months wasn’t the answer either, but it was fun at times.  Though the hours are ridiculous.

While “taking an up” at Nissan, a customer came in for test drive.  He worked for a mortgage broker and they were hiring.  All I knew about mortgages was…I had one.  That, and it was getting harder to pay it selling cars.

There was lots of learning and lots of cold calls.  Rates were 8% for good customers and double digits for bad ones.  My first loan was a 2/28.  The rate was fixed for 2 years at 12.24.  That was one of them there “sub-prime” loans you might have heard about when the economy crashed in 2008.  My employer, Home Team Mortgage specialized in them.  I stayed almost 5 years and have long-lasting friends from my time there.

I joined Wachovia Mortgage in Lancaster in January 2005.  In the summer of 2008 Wachovia was in trouble from billions in dollars in losses from bad loans they inherited from their purchase of Golden West Capital, and would eventually be gobbled up by Wells Fargo.

In September of 2008 I went back to being a mortgage broker. In the summer of 2009, as I was twiddling my thumbs waiting for my next refi…no one was buying houses…I got licensed to sell health and life insurance. I figured it would bridge the gap until the mortgage business came around again.  Well it didn’t take long to figure out that it is easier to find someone that needs some health or life insurance, rather than a mortgage.  So I “retired” from the mortgage business in April of 2011 to devote all my time to insurance: health, life, accident, disability, long term care and….Medicare.

“Obamacare” turned health insurance upside down.  The first ever enrollment started in 2013 and last until mid-April in 2014! It was not fun as an insurance agent, and I realized it was not what I wanted to do going forward.  Luckily some colleagues said, “Do more Medicare! Don’t just do it doing ‘Open Enrollment’, do it year round. All the baby boomers are turning 65!” I took that advice to heart! Medicare is ALL I do…every day…all year long!

On the family side I  put in 9 seasons in coaching Kate and Nathan in soccer, a sport I neither played nor know much about.  It was  fun being with the kids though, hilarious at times, exasperating at others.  Both kids play(ed) lacrosse.  Another sport that was new to me.  Pretty much love at first sight with this fast tempo game!  I ran the Ephrata Youth Lacrosse program for a few years, and now pitch in on the Varsity level as Nathan is in high school as of this writing.

I still love music, can’t function without it.  Sirius/XM, YouTube, Pandora, I’m always listening to something.  Cheeseburgers are still my food of choice.  Golf is big for me again, as Nathan has been playing for last handful of years.

That’s all for now, as of January 2018.