Tag Archives: Medicare plan changes

Why Step Therapy When You Have Already Proven Need?

December 17, 2017 David Higgs

Many times in meetings with my Medicare clients, they are concerned about having to go through Step Therapy again if they change plans. I usually then give a quick reminder of the beneficial reasons for Step Therapy that will lower costs for all involved, including my client.

A recent article by Dr. Harry Gewanter went deeper into the pros and cons of Step Therapy. The good news is generally about 80% of people who have already gone through Step Therapy are able to avoid having to repeat Step Therapy with the help of their doctor. The other 20% of the time is still a problem which is getting more attention. The 2018 Virginia General Assembly will hopefully be addressing this next year. A link to Mr. Gewanter’s article follows:

http://www.richmond.com/harry-l-gewanter-let-doctors-and-patients-decide-the-best/article_7f629382-6fca-5c13-be68-76765afe4af5.html

Based in the Richmond, Va area, David Higgs of Choices In Medicare specializes in helping seniors transition to Medicare. He can be reached at email: David@ChoicesInMedicare.com or go to website: www.ChoicesInMedicare.com

Medicare Part D Drug Plan Premiums Lower for 2018!

August 4, 2017 David Higgs

Here is something you don’t see very often. CMS who oversees Medicare has projected that the average Medicare Part D Drug Plan premium is expected to decrease in 2018! Based upon the bids by insurers for their 2018 Drug Plans, the national average premium is about $1.20 less than 2017 national average of $34.70.

This is in spite of the fact that Medicare Drug costs are rising faster than other Medicare costs primarily due to high-cost specialty drugs. So, while this is not a lot, it is a change in the trajectory which is good.

You can read more about it at the article linked here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-08-02-3.html

Part B Penalty Waiver for ACA Medicare Eligibles

June 9, 2017 David Higgs

In February, I blogged about the confusion many seniors encounter regarding the decision to move to Medicare if they are on an Individual health plan under the Affordable Care Act (Obamacare). I noted that even though they can keep their ACA plan, it is rarely beneficial to do so.

The other issue noted was that people on an ACA plan that are also eligible for Medicare, must elect Part B. If they do not do so, they will be subject to the Part B penalty. Very recently, Medicare has announced they will allow people who were impacted by this situation to apply for a waiver. The deadline is September 30th to get this in.

If you want to read more about this issue, you can see a related article at the following link: http://khn.org/news/feds-to-waive-penalties-for-some-who-signed-up-late-for-medicare/

Medicare and Home Health Care Coverage Change

April 28, 2017 David Higgs

Many of my Medicare clients ask if Medicare covers home health care. The short answer is yes, but it has some restrictions. In the past, one of those restrictions was that the patient’s medical condition would be expected to improve as a result of the home health care. As a result, that meant that many beneficiaries who have a permanent condition would not be eligible for home health care coverage because their situation was “permanent”.

This restriction has recently been modified to include beneficiaries whose condition would not improve, but would also not worsen. Beneficiaries who have a condition that can be maintained so that it does not get worse can now be eligible for home health care under Medicare. There are other restrictions and you can read more about how Medicare covers home health care at the following link to Medicare’s website at: https://www.medicare.gov/coverage/home-health-services.html

New 2017 Medicare Costs at a Glance

January 3, 2017 David Higgs

With the hectic Medicare Open Enrollment period ended, I wanted to post the key, new Medicare numbers that will be in effect for 2017. These are the key changes to Medicare’s premiums and coverages. As I predicted, CMS did not increase the Part B premium as initially indicated and came in just under a 10% increase.

Part A deductible – Will be $1316 up from $1288 (per 60 day Benefit Stay)
Part B Deductible – Will be $183 up from $166 (Annual deductible)
Part B Premium – Will be $134.00 up from $121.80 (Will not apply to existing 2016 beneficiaries who have it taken out of Social Security)
Part D Maximum Deductible – Will be $400 up from $360 (Some plans don’t have a deductible)
Part D Premium National Average – Will be $35.63 up from $34.10 (Is used to determine Part D Penalty)

Feel free to contact me if you have any questions or need assistance with selecting a Medicare Plan. I don’t charge any fees nor increase your cost.

Causes of Drug Price Increases and What Can You Do About it?

September 21, 2016 David Higgs

We are all affected by drug price increases. There are many reasons for this phenomenon but several factors have been more significant. While we all want to know why this is happening, we also want to know what can we do.

As noted before, this issue arises a lot with my Medicare clients. So, what can my clients do about it? I have blogged before about some easy things to do such as: ask your doctor for samples, shop around different pharmacies, ask for generics, etc. I find the biggest thing to do is to compare your plan options. If you are on a stand-alone Part D drug plan, you should shop each year. If you are on a Medicare Advantage plan, you will need to consider both Plan medical benefits and drug copay costs. Of course, I help my clients each year with these comparisons. It usually starts with keeping drug lists current in Medicare’s comparison site where I can then help decipher the options including all costs (premium, deductible and copays).

A recent article goes into more detail on causes of increases. A link to that article follows: http://khn.org/news/candidates-decry-high-drug-prices-but-they-have-few-options-for-voters/

The main takeaway for me was, people need a good Independent Agent who specializes in Medicare. If you have questions about Medicare, call me, with no cost or obligation. This is what I do and enjoy it.

Medicare Part B Premium Increase for 2017

September 8, 2016 David Higgs

The latest news on Medicare Part B 2017 premium increase is “stay tuned”. Congress is still working on this and the final determination won’t come until October 1st at the earliest. Like last year, there is a strong possibility that the “Hold Harmless” provision will protect existing Medicare beneficiaries who have their Part B premiums deducted from their Social Security check. That will leave the others to take a larger load of the increase.

While a 22% increase is being discussed, my guess is it will be negotiated down like last year. I will keep readers apprised. If you want to read more on this, I have linked an article here: http://www.miamiherald.com/news/business/article100185427.html

If you have questions about Medicare, call me, with no cost or obligation. This is what I do and enjoy it.

When Should You Enroll in Medicare? You Might be Surprised.

August 5, 2016 David Higgs

One of the most common questions (concerns) when I first speak with my clients is regarding if and when they must enroll in Medicare Part B. This arises as they either read about it, heard it from a friend or received correspondence stating they “had” to enroll but gave no clarifications. I also find many should have enrolled and did not know they needed to enroll. There are several key clarifications.

In short, people who become eligible for Medicare while they are working and on their employer’s health plan (or spouse’s) do not “need” to enroll in Medicare if they work for a company with 20 or more employees. If they work for a company with less than 20 employees, they do need to enroll in Medicare because it will be considered primary coverage to their small company’s health plan. Confused yet?

Regardless of whether or not they need to enroll in Medicare Parts A and B, the first thing I help prospective clients with, is to determine if they should stay on their company’s health plan or move to Medicare. This involves comparing the incremental cost to move from the employer plan to Medicare coverages. In most cases, Medicare coverages (including supplemental) is richer coverage than most employer plans.

A recent article just noted that over 750,000 Medicare beneficiaries have made the mistake of not enrolling when they should have and will be paying penalties averaging 30% for the rest of their lives. As a result of complaints, Congress is considering legislation to help address this problem. What is also interesting, is this figure does not talk about the number of beneficiaries who do enroll in Medicare needlessly and are spending potentially thousands of unnecessary dollars. If you want to read more about this, you can follow the link to the article: http://www.philly.com/philly/health/20160803_How_to_save_big_on_Medicare__Know_when_to_sign_up.html

If you have questions about Medicare, call me, with no cost or obligation. This is what I do and enjoy it.

News Update on Mergers (Aetna/Humana & Anthem/Cigna)

July 22, 2016 David Higgs

Lately, there has been a lot of attention in the news to the pending mergers between Aetna and Humana as well as Anthem and Cigna. The latest news is about the federal suits to stop the mergers. The main thing I want my clients to know is that with or without the mergers, their Medicare Plan will remain in place. This will mainly pertain to Medicare Advantage Plans and Part D drug plans. If there are going to be changes, they will occur at the Annual Election Period (AEP) where they can make a change if needed. In addition, if the merger(s) proceed, it will be years not months. As usual, I will help my clients with this.

Feel free to call me with any questions as this process continues. David.

Medicare Advantage Plan Study Shows Lower Avoidable Hospital Admissions

May 26, 2016 David Higgs

A recent study has just been released that shows that Medicare Beneficiaries on Part C Medicare Advantage Plans had about 10% less avoidable hospital admissions than those on Original Medicare. While my clients on Medicare Supplements have more comprehensive coverage than my Medicare Advantage Plan clients, this study is encouraging in showing Medicare Advantage Plan clients also get good medical care and helps stretch their coverage dollars.

If you want to learn more about this study, you can go to the following link: http://www.aafp.org/news/practice-professional-issues/20160517mahospitalization.html

Helping seniors transition to Medicare