Tag Archives: Medicare Open Enrollment

Medicare to Negotiate Part D Drug Prices

August 29, 2023 David Higgs

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.

2022 Medicare Part B Premium and Deductible Amounts Announced

November 14, 2021 David Higgs

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

Medicare Part B Announcements and Open Enrollment (AEP) for 2021

November 17, 2020 David Higgs

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 Open Enrollment – AEP

September 30, 2018 David Higgs

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. 1^st 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.

National Check Your Meds Day and AEP

October 13, 2017 David Higgs

A pharmacy trade group association has declared Oct. 21st, National Check Your Meds Day. I think this is a great idea especially with Medicare’s Annual Election Period (AEP) right around the corner beginning Oct. 15th and ending Dec. 7th each year.

Many people and especially seniors, take a large number of medications. While many are needed, many are not needed as they are duplicates doing double duty with other medications that do the same thing. The worst case scenario is some of the medications can be lethal when taken with other medications. You would think this can’t happen because the doctor should know better. Unfortunately, many times the doctor does not know what else someone is taking. Some people have several doctors treating different medical conditions and not aware of other prescriptions.

So, everyone that is taking more than several medications should take advantage of this special day to proactively have them all checked. It is as simple as taking all of your prescriptions (the actual bottles) to your pharmacy for a review. They can tell you if there are any potential problems and perhaps check with your doctor about any issues raised.

This is good timing because you should also check your Medicare Part D drug plan for any changes. Your Annual Notice of Change booklet from your Drug plan will alert you to the plan changes effective the coming Jan. 1st. Also, your prescriptions could have changed and worth taking a look at your options.

This is what I do for clients day in and day out. Let me know if I can answer any questions. David Higgs

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.

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.

CMS Finalizes 2017 Medicare Advantage Payment

April 6, 2016 David Higgs

CMS has just released their 2017 Medicare Advantage plan capitation rate. On average, the payment will increase by .85%. You may recall that Medicare Advantage plans, also known as Medicare Part C, are one way Medicare Beneficiaries can get their Medicare. This shifts the risk and responsibility for a Beneficiary’s Medicare claims from Medicare to the private insurance company offering the Medicare Advantage plan.

This slight increase probably means most plans will not have to change their benefits much. We will know in October when all 2017 plans will be published. The increases fluctuate from year to year. If you want to know more about this news story, click on the link below.

http://www.bloomberg.com/news/articles/2016-04-04/u-s-increases-2017-medicare-advantage-rates-less-than-expected

If you have questions about Medicare coverages or the difference between Medicare Advantage plans and Medicare Supplements, contact me at: David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com website.

Private Exchanges and Choices In Medicare

February 3, 2016 David Higgs

Many Retirees and other Medicare eligible beneficiaries will be directed to a Private Exchange to select their health plan benefits. Typically, large employers and some large Benefits firms are getting into the Private Exchange arena. The latest entrant is the financial services firm, Fidelity, who has announced this as a strategy. A Private Exchange is similar to the Affordable Care Act Marketplace Exchange which was designed for people under 65. An Exchange is merely a website that lists a person’s options and allows enrollment. By itself, an Exchange is OK but there are some things anyone contemplating their options via an Exchange should be aware of. I have reviewed some of the Exchanges and found a few common issues:

The Exchange is going to be limited to a few plans from a few carriers. This means that there may be other options which could be lower cost that won’t be available.
The people staffing the inbound phone lines are sometimes not experienced, independent Benefits professionals. Their knowledge can be limited to the training received for that call center role.
Some of the information on the Exchange is either out dated and/or inaccurate.
In many cases where the beneficiary is an employee, the employer contribution will only apply if the employee obtains their benefits through the Exchange. This could mean an employee must limit themselves to the Exchange options even though there may be better options available.
The Exchange experience is not very personable. You are dealing with someone you don’t know in an unknown location.

So what is the alternative? People like me usually allow you to avoid these pitfalls. As an independent agent, I represent most or all of certain types of available plans. For example, I represent all of the Medicare Advantage plans in Central Virginia and 7 of the largest, national Medicare Supplement companies. In most cases, I can meet face-to-face and establish a better environment when making such important decisions and, at no cost to the client.

If you have questions about your Choices In Medicare, contact me at David@ChoicesInMedicare.com or visit our website: www.ChoicesInMedicare.com

2016 Medicare AEP Opens Oct. 15th Through Dec. 7th

October 14, 2015 David Higgs

It’s that time of year again for Medicare beneficiaries. The 2016 AEP, or Annual Election Period, is the one time per year when Medicare beneficiaries can change their Medicare Advantage Plan or Part D drug plan without needing a special election period. People who have a Medicare Supplement policy do not have to do anything with their policy unless they want to change their prescription plan. The AEP begins Oct. 15th and runs through Dec. 7th.

Keep in mind this is also the only time the insurance companies can make changes to their plans. If they do, they will send the member an Annual Notice of Change (ANOC) describing the changes for the upcoming year to be effective on January 1st.

If beneficiaries have questions or want to make changes, they should contact their insurance carrier or agent.

Or, they can contact David Higgs of Choices In Medicare at David@ChoicesInMedicare.com with questions.

Helping seniors transition to Medicare