Part D and Medicare.gov 2024
Prescription drug plans change annually. There are less plans than ever for 2024. Some plans no longer have a co-pay for Brand name drugs, you may have to pay a percentage of what they actually cost, which will likely cost you more overall than in years past. Follow along with the steps in the video so you can “do-it-yourself”. Reach out to us at Hometown Medicare Insurance Advisors (717) 468-0130 with any questions.
Medicare Explained in 10 Minutes!
As of this post, March 25th, 2020 I could not see people in person for 2 months! Normally I see you face to face at your home, a restaurant, library, my house or wherever. I have been going to meet with people since the lockdown was lifted. I wear a mask and keep my distance. If that is not suitable I will talk to you on the phone, zoom or skype, or communicate via e-mail and text. But just to get things started, this is pretty much my explanation of how it all works as you go ON Medicare. As mentioned, I do have my cheat sheet, which I normally leave with people after explaining things, as it helps you “see” how it all works. Again, this is just a starting point, to help you start to understand the wonderful and confusing world of Medicare. Reach out to me directly at (717) 468-0130.
CLICK ON THE VIDEO
Medicare Explained in 10 Minutes
Had Enough of Joe Namath Yet?
WOW! There was probably a million TV commercials about Medicare during Open Enrollment this past Fall, and I think Broadway Joe was in half of them!
You probably saw more than I did, as I was working 15 hour days in October, November and December, but I heard about it at appointment after appointment. You may have wondered, “What is he talking about? You don’t get all this stuff for free!” And you weren’t about to call an 800 number to find out!
He was referring to Medicare Advantage Plans. Medicare Advantage is Part C of Medicare. It can be considered somewhat of a replacement for Original Medicare, as Medicare itself does not process your claims, the INSURANCE company you signed up with does. As such, the insurance company decides what your out of pocket costs for hospital and medical services will be. Rather than deductibles and co-insurance, like Original Medicare, many Advantage plans have fixed costs for services in the form of co-pays.
“But Joe says everything is FREE!”
I think the idea behind the ads was to get the specific attention of those whose income is low enough to qualify for a particular segment of Medicare Advantage Plans, ones geared for those on Medicaid as well as Medicare. Those with incomes below the Federal Poverty Level for their household size may be eligible for a “Dual Eligible” plan, in which case, many services are at no cost. This may include a fair amount of dental, vision and hearing coverage at little or no cost as well. I’ve been told that only half of the individuals who would qualify for such a plan, actually have one…so the insurance companies are aggressively reaching out to this segment of the Medicare population.
By calling the 800 number to see, “IF YOU QUALIFY,” it opens the door for the agent on the other end of the line to not only see if you fit the strict guidelines for a Dual Eligible plan, it allows them to offer many, many other options to you IF YOU DON’T QUALIFY.
I have nearly 900 clients on a Medicare Advantage Plan. And it’s true, most do not pay a premium for their plan. (probably 90% of my Advantage plan clients pay ZERO premium). They still have to pay for Part B of Medicare, which is $144.60 a month in 2020, but no additional cost for the plan.
Medicare Advantage is one of the main “paths” to take when you are on Medicare. The other main path being Medigap, the insurance that supplements Original Medicare. When I meet with clients, we talk about both approaches. There is no single “right path” that fits everyone. But which one is right for you? I don’t know! That’s why we get together and figure it out!
I don’t have an 800 Number. I have a local number. (717) 468-0130.
And the only thing I can promise you for FREE…is my time. You’ll never pay me anything. And I come to see you. Plus I’ve done it probably 4000 times, so I can’t guarantee a Super Bowl victory, but I feel safe guaranteeing I know what I’m talking about, and a safe bet I know more than Joe Namath!
Did You Google Me?
What’s one of the first things you do when you want to learn more about a person, place or thing? Go to the internet and see what you can find out!If you were expecting a super duper slick and fancy website, sorry! I’m just a simple guy who does one thing, all day, every day…meet with people to explain Medicare itself, and the options that are available with it. I use this blog to introduce myself, give a little bit of info about Medicare, and just try to show you I’m a regular sort of guy.
Good Bye Good Boy
In the Fall of 2010, my daughter Kate, then a 6th grader, wrote the greatest essay of her life. The topic? Why she deserves to have a dog!
Frequently Lori and I lovingly referenced Willie, our gargantuan golden retriever that we had when Kate was just a baby. But we also said it’s a lot of responsibility to have a dog, a lot of work, a lot of money, yada yada yada textbook Parentspeak any Mom or Dad can spew by reflex.
Kate was determined. She wanted a dog! She promised to walk it, feed it, love it yada yada yada, you know, hollow promise Kidspeak. And she wasn’t having the, “We can’t afford it!” speech. She said SHE would pay for it, and pay for his food and toys and whatever else dogs need. She had money saved from working every Saturday at Uncle Davey’s Diner.
We gave in!
At the time my long time NYC soul sister Connie worked for the City coordinating the transport of rescued animals to various shelters through the Tri-State area and beyond. She’d send pictures and background stories on various critters. The younger the better, to enjoy the whole puppy experience.
After a few failed attempts at adoption, a couple of pups had been shipped to PA, probably no more than 9 or 10 weeks old. Two white males with patches of yellow or tan, possibly labs mixed with pit bulls. “Are they pit bulls???” Lori suspiciously inquired. “I don’t think so.” I shrugged unconvincingly.
A week before Christmas, in Bethlehem no less, we went to see the 2 pups rescued off the streets of Harlem. They were now nicknamed Butterscotch and Creamsicle! Kate picked the one that was getting pestered by his brother, and named him Oliver. Ollie! I think we brought him home in a medium sized piece of Tupperware with a blanket inside. Waiting at home was all the goodies we had waiting, purchased under the supervision of suzi que, legendary local dog Mom
It was great having a dog again! Puppy moments! Tearing ass from room to room spontaneously for no good reason. Chowing food. Chewing toys. Crying in his crate.
Kate was true to her word, mostly. She paid the $150 adoption fee, bought him toys and food and whatever else dogs need. The walking and feeding and cleaning up after it, not so much.
Puppies stay puppies in spirit, but blow up as fast as a clown balloons. 80 pounds of muscle in a matter of months. His stocky build and short snout were all pitty, his webbed feet and taller frame were Lab. His ears were the tie breaker, and he could adjust down or back to keep you guessing.
Barks like a watchdog, cuddles like a lap dog. Beware of Dog! You’ll either be licked to death or take 40 lashes with a wagging tail!
I know, you’re nodding your head. Same for your fur friends too, no matter the size or the breed.
And I’ll bet you know where I’m going with this…something’s wrong.
Starting in February, he just wasn’t himself. Lack of appetite, not interested in walks, sleeping all the time, looking sad.
It’s cancer. Leukemia. We tried to treat it. But the white blood cells were off the chart, and now the red ones barely show up. He’s got no energy. Rather than seek other avenues of treatment, we wanna love him to death.
We’re nearly blind from balling our eyes out.
We’re looking at pics and playing rewind in our mind for all the happy times and bad ones too. The farting, the ball-licking, the nail chomping, the snoring. Eating documents (and homework!) and socks and underwear, and kindles and gaming devices. Barking like we are under attack from terrorists when it’s just the garage door opening!
I guess we’ll have to finish DQ blizzards all by ourselves now. Crinkling a plastic grocery bag won’t have him skipping into the kitchen, ready for a walk. No more races to the stairs when it’s time for bed. No more trembling in fear when it’s time for a “tubby”.
Oh Oliver, you’ve meant so much to all of us. Such comfort, such joy. When no one believes in you, when you don’t believe in yourself, your 4-legged family member lifts you up, makes you smile, let’s you know everything’s gonna be all right.
We’ve arranged for Lap of Love to come Thursday afternoon and do what they do. We don’t want to say goodbye. We don’t. But we know it’s the right thing to do.
Times were tough in Williams house when Oliver came along. It makes me wonder, “Who rescued Who?”
My Favorite Medicare Myth!
There are many myths about Medicare, or maybe just misunderstandings. My favorite, or probably just the one I hear most of all is:
“You have to sign up for Medicare 3 months before your 65th birthday, or you get penalized!”
Oh boy, where do I begin to debunk this myth? As long as you have “creditable” coverage elsewhere, typically from your own employment or your spouse’s employment, there will never be a penalty for signing up for Medicare later, even well past your 65th birthday. So, you do not have to sign up for Medicare. Not even Part A, the “free” part.
When you are approaching the age of 65, you’re mailbox gets stuffed with promotional offers about Medicare Insurance Plans, like Medigap Supplemental Insurance, Medicare Advantage Plans and Prescription Drug Plans. (None are as informative, clever and humorous as mine, of course) The funny thing is, none of these mailings are from Medicare, unless you are already collecting Social Security. That’s right! If you are not yet collecting your monthly retirement benefit from Social Security, you will not receive a single thing in the mail from the Government, telling you what you have to do (or don’t have to do) regarding Medicare! Weird, right?
Myths are widely held beliefs, or false ideas. Medicare has been around for over 50 years. I don’t know who started this one, but it’s spread around for decades, “You have to sign up for Medicare 3 months before your 65th birthday, or you get penalized!” There CAN be a penalty, it’s just that few people end up owing it. If you wait to enroll in Medicare past age 65, for every 12 month period you did not have Part B, and did not have creditable coverage, you will pay 10% more for Part B for the rest of your life. But, as previously stated, the likely reason to delay taking Part B, is because you DO have creditable coverage.
And…NO…you do NOT have to let Social Security or Medicare know that you are NOT going on Medicare at 65.
If you are still puzzled by what you HAVE to do with Medicare as you are nearing 65, call me (717) 468-0130, call Medicare (1-800-MEDICARE) or call Social Security (1-800-772-1213).
Do You Have the Right Part D Plan for 2018?
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.
Yeh, I Probably DO Know Where You Live
Johnny Cash had a song called, “I’ve Been Everywhere,” in which he rapidly sings city after city he’s been to. Well I travel all over Lancaster, Lebanon and Berks Counties, visiting with people to explain the confusing mess of Medicare.
Just in the last 30 days I’ve been to Morgantown, Mohnton, Green Hills, Paradise, Lancaster, Ephrata, Lebanon, Palmyra, Myerstown, E-town, Exeter, Wyomissing, Refton, Willow Street, Manheim, Stevens, Landisville, East Earl, New Holland, Akron, Kempton, Millersville, Holtwood, Fredericksburg, Leola, Lititz, Ronks, Boyertown, Oley, Birdsboro, Kutztown, Columbia, Newmanstown, Mount Joy and Hamburg!
I have friends that are brokers for Medicare Insurance like I am, and they all have plush offices for people to come to. I would be bored out of my mind in an office day after day! I like going to different towns every day. I enjoy meeting clients in their home, petting their dog(s) and cat(s), seeing their family photos, and just getting a better sense of who they are.
How Many Phone Calls About Medicare do YOU Get???
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!