Go Ask Alice Articles
Question: I get so much junk mail!! I am turning 65 in the next year. How do I know what is important Medicare related mail, and what is junk?
We all have fallen short to deceptive advertising. It is no surprise when I tell you the Medicare Market is a huge target of direct mail ad campaigns.
An easier way to answer this question is to focus on what you should be looking for.
Your Medicare Card- (Only if you are already taking Social Security) This is the only way it will magically end up in your mailbox. The envelope will have the Department of Health and Human Services written in the corner.
If you are not taking Social Security and you are not sure what to do: our office helps people navigate the Medicare Maze and the do’s and don’ts.
Extra Help from Social Security for your Prescription Drugs form.
This form is blue and white. On this form you fill out income related questions to see if you qualify for partial to full help with prescription drugs. My advice is for everyone to fill the form out. Give it a shot. I have seen several people end up qualifying for the extra help, and none of us could explain how or why they ended up qualifying.
Other than the above two items, everything else will essentially be some form of advertisement. We always tell all out clients to bring their pile with them. We help them to sort through the items to be kept and the items to be tossed.
IMPORTANT-Medicare does not send out postcards that you should fill out and return for more information. Filling out those cards will guarantee in several weeks you will be getting a call from an Insurance Agent.
Question: I am 75 and I never enrolled in a Medicare Part D plan. I just found out about the PACE/PACENET plans available to seniors age 65 and older. I was told with this program, I should have a Medicare D plan. I don’t want to get a penalty for never enrolling in Medicare Part D. I guess my hands are tied now, and I can’t enroll now in Pace correct???
You are happily wrong. This year the Pace/Pacenet plans have had some big changes. When you enroll in a Pace “partner” Medicare part D plan, penalties for late enrollments will be paid for you by the state. If you never enrolled in a Medicare Part D plan, you can now. The Pace program will continue to pay your late enrollment penalty as long as you qualify for the program. If anyone needs help applying for the Pace/PaceNet programs we can lend you assistance with the process.
Alice, what is the importance of Short-term care insurance? Is it true that it’s really expensive?
Answer: Short term care insurance is very important. As we get older and ailments increase, we all would prefer to receive our care at home. No one wants to think of being in a nursing home or assisted living facility. Did you know that 51% of long-term illnesses last less than 1 year? So why not have insurance that will allow you to get your care in your own home? You won’t have to worry about not having someone at home with you to care of you. The short-term care insurance will give you just that; someone to come into your home and care for you. Your sickness will not burden your working children who have a family and may not be able to take off work to care for you. Short-term care insurance is much more cost effective than you think. Your premium can be as low as $50 per month. While you are healthy is the time to buy short-term care insurance. Don’t wait until you think you’ll need it because then you can’t get it!
Who should consider short term care insurance? It is very important to have especially if you are single. Think about the reality of who is going to care for you if you have a knee replacement and need to come home and you live alone. Or if you have a disabled partner, you may want to look into this as well. How are they going to take care of you when they have their own disability and can’t lift? Short-term care insurance would eliminate all your worries and fears.
Why to consider short-term care insurance:
It is much more cost effective than long-term care insurance and still provides you with excellent coverage.
You want your care at home versus a nursing home or assisted living facility.
You don’t want to worry about who will take care of you or if you can afford to go in a nursing home.
Alice, I thought I had a good part D plan. Recently, I went to the Pharmacy and had to pay over $200 for an inhaler for bronchitis. Alice is it the cost of the medication, or do I need to explore other Part D options this fall?
The answer to that question may be that both issues need to be addressed. I find people do not really understand their Medicare Part D plans until they need to fill an expensive medication. Many Part D plans have a deductible to meet before a Tier 3-5 medication will drop in price. Often people get the false impression that their medication is not covered when in fact they are in the deductible phase of the drug plan. When you don’t take any, or just a few Tier 1 or 2 medications, having a low monthly premium with a deductible makes sense. Just remember that you are saving a lot on monthly premium. You might have to take a hit to your wallet, in the event that you have to take a random Brand name medication.
The alternative is a Medicare Part D that does not have a deductible. Well you guessed it, plans without deductibles for all Tiers are generally more expensive. It is the old law of they get you coming or going. We find that some people hate deductibles and don’t mind the idea of paying more for a “what if” scenario to have that medication covered with a co-pay or co-insurance right away. Other people would rather pay less premium and cover that occasional Tier 3-4 medication out of their pocket. It is a personal preference.
The new Shingles vaccine Shingrx is covered under Medicare part D and is a Tier 3 medication and subject to any deductible. This shot is given twice and costs around $145 each time which would be applied towards your deductible. If you are considering this shot, it may make sense to switch your Medicare Part D plan this fall in the Annual Election Period.
Feel free to contact our office for more in-depth information regarding your own Medicare Part D questions.
Alice please help me, I just got put on Nexavar which they told me costs $18,670 per month. I can’t afford this can you please help!
Bayer pharmaceutical company just hiked the price of two of their cancer drugs by $1k per month and unfortunately Nexavar was one of them. Nexavar is used to combat kidney, liver and thyroid cancers. Bayer’s other medication Strivarga is used to treat colorectal, liver and gastrointestinal cancers and now costs $16,860 per month.
James is on Medicare and has a Part D plan. Fortunately, there is cost containment when you have Medicare Part D. Unfortunately, the out of pocket cost for a year’s worth of medication would be approximately $7000 on the average Medicare Part D plan. This amount of money is a lot for the average family to be able to afford. The recent increase by Bayer was an exceptionally bold move. This was the second price increase for the two cancer drugs in six months.
It was also interesting that this price increase came after President Trump presented his blueprint to lower drug costs.
I am aware of only two options to help pay for the high costs of these types of drugs.
Bayer and other pharmaceutical companies offer numerous programs for patients who cannot afford their medications. Patient assistance is handled through your Dr.’s office.
Cancer Insurance is a great way to help people with the high costs that are associated with cancer. Cancer policies will give you a lump-sum cash benefit paid directly to you. Cancer insurance is extremely affordable. For example, someone age 64 could purchase a policy giving them $10,000 for around $23 a month.
Knowing that cancer costs are rising and the second most common cause of death, our office always recommends a cancer insurance plan.
Stay tuned and engaged for the next column in two weeks which will address President Trump’s 6 key proposals to combat rising drug costs.
For help and further clarification please feel free to call our office.
The Medicare Prescription Pharmacy that I use will no longer be a “Preferred Pharmacy.” What happens now?
This does happen and brings up so many questions about your Medicare Prescription Drug Plans. It does not seem fair to change things related to your drug plan mid-year. To answer your question, yes, the Medicare Prescription drug plan can change the Preferred Pharmacy status mid-year.
A Preferred Pharmacy is one that Buddies up with the Medicare Part D plan to offer the best prices. A small example….
The most popular Humana Part D plan buddies up with Walmart.
Silverscripts buddies up with CVS, Weiss, Lewisburg Pharmacy, and Shade Mountain Pharmacy in Snyder and Union counties.
Envisions buddies up with CVS, Giant, Lewisburg Pharmacy, Weiss, Shade Mountain, and Trutt’s Pharmacy.
You will not be maximizing the benefit available to you through your Medicare Prescription drug plan by using a Standard Pharmacy. To make sure you are getting the best price available for your covered drugs, choose a Preferred Network Pharmacy to fill all your medications.
Transferring your prescriptions is easy. You can contact your preferred pharmacy directly and they will help you.
Don’t forget the change time is fast approaching. You can change your plan October 15th-December 7th. If you require more assistance, please contact our office.
Recently CMS announced that Medicare is about to pass another milestone once it hits 60 million beneficiaries this year. Unfortunately, with more enrollees, comes more problems with Medicare Fraud.
No one from Medicare will be calling you to verify your new Medicare numbers! There have been several reported cases of an individual calling claiming they were from Medicare. These people tried to obtain personal information.
I also want to be very clear, no one from Medicare will be calling you or stopping by at your house, to sign you up for Medicare Supplement plans.
Are you turning 65 in the next year? You will get the most mail you have ever gotten in your whole life. If you fill out any reply card it is likely a solicitation of some kind. Someone will call you. If you put your information into an online site for information, be prepared to receive many calls a day. Many of our clients report that they receive 20+ calls a day. I recommend a face to face meeting with a representative that offers many different companies and can compare them. And again, no one from Medicare will stop at your house to try to sell you insurance.
This week’s Medicare tip involves just a simple question. Did you know that you could pay lower prices for your prescriptions at the pharmacy, by just asking what the available cash price is? Under a little-know Medicare rule, you could pay less, but only if you ask. Please call us if you would like help with your Prescription drug questions. At our agency we are committed to empowering people with the information they need to make informed prescription and health insurance choices.
Alice, after looking over my Social Security Statement at tax time, I noticed that I was getting charged for my Part D drug plan when I had previously qualified for a Low-Income Subsidy and received my coverage for $0 premium. Can you please tell me what I need to do to get the $0 premium coverage back again?
Upon research, we find that once enrolled into a Part D drug plan, many enrollees never review their Part D drug plans and just “go with the flow”.
More than 12 million Part D enrollees (29%) receive low-income subsidies. These additional financial subsidies, also called “Extra Help,” pay Part D premiums for eligible beneficiaries, as long as they enroll in PDPs designated as premium-free “Benchmark” plans.
So, what went wrong for you?
Failing to be educated on your Part D drug plan premium and how you are paying for it.
When reviewing your end of year Social Security statement, don’t just look only at the bottom line deposit. Read each item that is being subtracted from your monthly Social Security deposit.
Every Fall you need to take a look at your Part D drug plan and re-evaluate it. If you are unsure or unable to do this on your own, then you need someone knowledgeable to help you.
Your current Part D drug plan no longer meets the Medicare “Benchmark” status, therefore, you are paying a premium. With some due-diligence you could have a $0 premium plan with the same low co-pays.
Fortunately, you do not have to wait until the fall Annual Election Period to enroll in a “Benchmark” plan. Please give our office a call for education and enrollment assistance.
Alice, I heard that Medicare Supplements C and F are going away. I currently have plan F, what do I need to do?
I would first like to give you a little background on why Medicare Supplement plans C and F are going away. Congress signed and changed the law in 2015 that affected various aspects of health care, including Medicare Supplement plans. The new law starts on January 2020 and only affects newly eligible Medicare beneficiaries. Please continue to read if you currently have plan F.
If you already have plan F, you can keep it. But the truth is you may not want to keep it. Plan F has been the most popular plan for a very long time and has the largest amount of enrollees. Plans C and F cover the annual part B deductible. The Part B deductible is not one of the biggest health-care costs under Medicare. In 2018 the Part B deductible is $183.
New people enrolling into Medicare Supplement coverage should consider buying Medicare Supplement letter G. Letter G covers everything letter F covers, except the $183 Part B deductible. The great news is letter G is significantly less expensive than letter F.
There could be some bad news if you currently have Medicare Supplement Plan F.
It is speculated that plan F premium rates will be increasing at a higher rate than other plans. After 2020 when plan F is no longer enrolling new clients, the population of plan F members will be not adding younger healthy people. Each letter plan is individually rated based on the costs for that particular plan. Without new members enrolling, it is thought that the claims cost will drive up the premiums for plan F.
So what is the takeaway? If you are just enrolling now, avoid letters F and C. If you currently have letters F or C, consider switching to another letter if possible. Your health will come into consideration when switching so don’t wait if you think you want to look into other options.
For help and further clarification please feel free to call our office.