Tag Archives: medicare insurance plans

Medicare to Negotiate Part D Drug Prices

You may have seen the recent news that Medicare has announced the first 10 drugs they will begin negotiating drug prices directly with the drug manufacturers.  While this sounds like good news, it has some limitations.  Firstly, they won’t announce the prices until September 2024 and won’t be in effect until January 2026!  That is a long time to wait and for only 10 drugs.  But, I guess we have to start somewhere.  Also, a recent improvement has already been introduced that caps many diabetic related drugs to $35.  This has already had a big impact on drug costs for the millions of diabetics in the US.  The other factor is that most people don’t know that drug prices are already being negotiated by the Part D drug plans (and PBM’s).  These are some very large national companies with significant negotiation leverage.  The way the government makes it sound is that there are no negotiations or competitive environments, allowing the drug manufacturers to charge whatever price they want. That is not the case.  Because of the complications involved with drug pricing in today’s world, there are some who think we will be unpleasantly surprised by the outcome, or at least be underwhelmed.  The biggest feature that will help people who have high Part D drug costs will be the $2000 out-of-pocket maximum that will be a part of Part D drug plans beginning in 2025.  That is good news!

If you want to read more about the new Medicare drug negotiations, I have linked an article below: 

https://www.hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html#:~:text=The%20negotiations%20with%20participating%20drug,in%202022%20for%20these%20drugs.

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.

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

We do not offer every plan available in your area.  Currently we represent Anthem, Aetna, Humana, UnitedHealthcare, Wellcare and SilverScript organizations which offer 58 Plans in your area (Richmond Metro). Please contact Medicare.gov or 1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.

MEDICARE REDUCES COST OF PART B PREMIUM AND DEDUCTIBLE FOR 2023

As predicted a few months back, Medicare has just announced there will be a rare reduction in the Part B premium cost and the Part B deductible effective Jan 1st, 2023.  The Part B premium will reduce from current $170.10 to $164.90 and the deductible from current $233/year to $226/year!  While both of these factors tend to increase over time, some years they remain flat and are now seeing a reduction.  As previously noted, one of the big reasons for the reduction is lower than expected Alzheimer drug costs to Medicare. 

In addition, there is expected to be a larger than normal Social Security Cola increase.  The combination of these factors will lead to larger than normal net increases in monthly income for most seniors. 

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.

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

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

2022 Medicare Part B Premium and Deductible Amounts Announced

Medicare finally announced the 2022 Part B costs late Friday afternoon.  The key numbers are the monthly Premium and the annual Deductible.  The Part B premium that most people pay will go up 14.5% from $148.50 to $170.10.  (Higher income people must pay an income surcharge called, Irmaa.  These amounts as well as the thresholds increased also.)  The Part B deductible increased a similar percentage from $203 to $233. 

These increases were more than projected just a couple of months ago.  The primary drivers for these increases were medical inflation and potential coverage of a new, hi-cost Alzheimer drug.  While these increases seem large, people on Social Security will still see a net increase due to the Hold Harmless provision that insures people’s Cola increase will cover the Medicare Part B premium increase.

As usual, I will post all of the key Medicare cost share amounts next month.  If any questions about how these apply to you, contact me.

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.

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

New 2021 Medicare Costs at a Glance

Happy New Year!  As I do every new year, I wanted to post the key, new Medicare numbers that will be in effect for 2021.   These are the key changes to Medicare’s premiums and coverages.

  • Part A deductible – Will be $1484 up from $1408 (per 60 day Benefit Stay)
  • Part B Deductible – Will be $203 up from $198 (Annual deductible)
  • Part B Premium – Will be $148.50 up from $144.60
  • Part D Maximum Deductible – Will be $445 up from $435 (Some plans don’t have a deductible and most have a “hybrid” deductible.)
  • Part D Premium National Average – Will be $33.06 up from $32.74 (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.

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 B Announcements and Open Enrollment (AEP) for 2021

Medicare has just announced the Part B costs for 2021.  While these costs tend to go up over time, they don’t necessarily go up every year.  Beginning January 1st, there will be a slight increase in the Part B Deductible from current $198 to $203.   The standard Part B premium costs will go from current $144.60 to $148.50 per month for most people.  I say most people because high income earners have to pay a surcharge depending on their tax return two years prior.

We are also in the Medicare Open Enrollment period (AEP) which will end December 7th.  This affects people with Part D drug Plans (PDP) and Medicare Advantage Plans (Part C) who may want to make a change.  Medicare Supplement Plans are not subject to the AEP.

Any questions regarding these changes or any other Medicare related question can be directed to me at the contact info below.

If you have questions about your Choices in Medicare, please contact me at David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com

Medicare and Telehealth During Covid-19

Telehealth has been around for a while but has recently become  very popular due to Coronavirus concerns.  If you are not familiar with Telehealth, it is basically a doctor visit by video.  People can “visit” with their doctor virtually.  The key benefit during this period is to avoid coronavirus contact for both patient and medical staff.

One big difference is most health insurance plans, including Medicare, will now cover Telehealth services.  Most doctors’ offices are also now able to offer Telehealth.  If interested, people should check with their health plan and doctor’s office to confirm participation.

If want to learn more, a link to an interesting article follows:  https://www.pressofatlanticcity.com/news/local/medicare-expands-telehealth-to-help-keep-seniors-safe-savvy-senior/article_2ac9308a-e337-53f2-973b-62b1b27f4ce0.html

If you have questions about your Choices in Medicare, please contact me at David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com

New 2020 Medicare Costs At A Glance

New 2020 Medicare Costs at a Glance

Happy New Year!  As I do every new year, I wanted to post the key, new Medicare numbers that will be in effect for 2020.   These are the key changes to Medicare’s premiums and coverages.  A highlight is the average costs for Part D drug plans have gone done and the infamous “Donut Hole” (aka Coverage Gap) name no longer applies as costs for people who do reach this stage now only pay 25% of the cost for Brand or Generic drugs.

  • Part A deductible – Will be $1408 up from $1364 (per 60 day Benefit Stay)
  • Part B Deductible – Will be $198 up from $185 (Annual deductible)
  • Part B Premium – Will be $144.60 up from $135.50 (Excluding Irmaa)
  • Part D Maximum Deductible – Will be $435 up from $415 (Some plans don’t have a deductible)
  • Part D Premium National Average – Will be $32.74 DOWN from $33.19 (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.

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 Open Enrollment – AEP

It’s that time of year, again.  We are coming up on the Annual Election Period (AEP) for Medicare.  That means you are going to be seeing a lot of commercials and receiving a lot of mail about making changes.  You may be wondering what you should do, if anything.

So, what do you need to do?  It depends.

The AEP is the Open Enrollment period for Medicare Advantage Plans and Part D drug plans that occurs every year from October 15th through December 7th.  This is the time for those that may want to make changes which will become effective January 1, 2018.  Remember that the insurance companies that offer Medicare Advantage Plans and Part D drug plans can change them from year-to-year.  You will receive a letter from the insurance company called an Annual Notice of Change (ANOC) that will describe any changes they are going to make for the coming year.  If you are happy with the plan and want to keep it, you don’t have to do anything.  Just continue to pay your premium (if applicable) and the plan will remain in effect for 2019.

If your prescriptions have changed, you can update them at Medicare.gov.  Also, if you have any changes in doctors, you can look to see if they participate with your plan.  All of the new Plan information will be available Oct. 1st in Medicare.gov.  You can’t make any changes until October 15th.  If you want to make any changes or have questions or need assistance, contact me.

Medicare Supplements aka, Medigap policies, are not impacted by the AEP. They are guaranteed renewable as long as premiums are paid.

As always, call me with any questions, any time about your Medicare coverages.  I will help you sort through the info and options.  Thanks, David.

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 and HSA: Part 2

I have blogged before about the issue for people who have any Part of Medicare while they are working and on an employer group health plan that includes an HSA.  In short, you can’t contribute to an HSA account while having even premium-free Part A of Medicare due to IRS regulations.  Medicare-eligibles who are faced with this situation have another element to consider and which I was not aware.  When someone delays enrollment in Medicare due to continuing to work past 65 have another potential surprise.  The Social Security department will make Part A retroactively effective up to 6 months.  This means that even if they knew to delay enrolling in any Part of Medicare while having an HSA, they could still be hit with penalties and taxes for the retroactive credit!

You can research this if you want to learn more.  Or, feel free to call me if any questions about this nuance or anything else related to Medicare.

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

Why Step Therapy When You Have Already Proven Need?

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