Tag Archives: Part D Drug plan

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.

Thyroid prescription issues

In my daily efforts to assist people in selecting a Part D Drug Plan (PDP), I have many clients who take prescriptions for thyroid issues. It usually comes down to the brand, Synthroid or the generic, Levothyroxine. As the generic has a substantially lower cost than the brand, it is preferred. In many cases, I have clients who fear the consistent quality of the generic. And because of this, they pay substantially more. This causes them to question if they need to pay more.

I came across the article linked below which describes some good strategies to make the generic an easier path. Take a look and see if it helps you.

https://advertiser-tribune.com/news/333873/bones-sometimes-show-up-in-unlikely-places/

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

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

Social Security Errs in Administering Medicare Premiums

The Social Security Administration recently announced that they failed to deduct certain Medicare Plan premiums from beneficiary checks.  Due to a software glitch since about January of this year, they were supposed to deduct premiums for some Medicare Advantage and Part D drug plans and remit to the appropriate carriers.  This affected about 250,000 beneficiaries.   Many of those are now getting bills directly from their Plan carrier.

This is supposed to be a good way to pay eligible premiums for those already drawing Social Security.  I recommend to all of my clients who are drawing Social Security to elect this payment mode.

If you want to read more about this situation, you can click on the link below.

https://amp.kiplinger.com/article/retirement/T039-C000-S004-medicare-premiums-snafu-affects-social-security.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

New 2019 Medicare Costs at a Glance

As I do every new year, I wanted to post the key, new Medicare numbers that will be in effect for 2019.   These are the key changes to Medicare’s premiums and coverages.  A couple of the highlights are that the Part B premium only went up $1.50 and the Part B deductible only went up $2.

  • Part A deductible – Will be $1364 up from $1340 (per 60 day Benefit Stay)
  • Part B Deductible – Will be $185 up from $183 (Annual deductible)
  • Part B Premium – Will be $135.50 up from $134.00
  • Part D Maximum Deductible – Will be $415 up from $405 (Some plans don’t have a deductible)
  • Part D Premium National Average – Will be $33.19 DOWN from $35.02 (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

Make Sure You Pay the Lower Drug Cost

One thing most people are not aware of is that they should always pay the lower cost of either the copay or actual cost of their prescriptions.  As an example, if the actual cost of a drug is $5 and their drug plan’s copay is $10, they should only pay the lower $5 cost.  People can pay the higher cost if they are not aware of the actual cost and if the pharmacy attendant is not paying attention.  It can also occur due to other nefarious reasons.

CMS (who manages Medicare) just announced a renewed effort to insure Medicare beneficiaries get the better deal.  They have told Part D drug plan sponsors they  will suffer compliance actions if they do not comply.

If you want to read more about this issue, you can go to an article linked here:  http://www.healthcarefinancenews.com/news/part-d-plan-sponsors-face-compliance-action-drug-gag-orders-cms-warns

Let me know if I can help with Medicare questions.

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 2018 Medicare Costs at a Glance

With the New Year just starting, I wanted to post the key, new Medicare numbers that will be in effect for 2018.   These are the key changes to Medicare’s premiums and coverages.  As I noted in July, CMS did not increase the Part B premium or Part B deductible for 2018 as expected.  Below are the key, new numbers:

  • Part A deductible – Will be $1340 up from $1316 (per 60 day Benefit Stay)
  • Part B Deductible – Will remain at $183.  Yippee! (Annual deductible)
  • Part B Premium – Will also remain at $134.00 for new beneficiaries. (Will not apply to many existing beneficiaries who had already taken out of Social Security) And does not apply to high income earners.
  • Part D Maximum Deductible – Will be $405 up from $400 (Some plans don’t have a deductible)
  • Part D Premium National Average – Will be $35.02 DOWN from $35.63.  (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

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

National Check Your Meds Day and AEP

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

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