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Prescription Coverage

Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
Read more . . .


Thursday, December 3, 2015

Important Things You Need to Know About Medicare Part D

 

This year, a relative of mine had two issues that affected her prescription plan.  First, she was diagnosed with an illness and prescribed new drugs.  Second, she forgot to pay her Medicare Part D premiums and lost her prescription coverage.  How do you choose a Medicare Part D plan?  How do changes in medication affect the Part D insurance plan a participant might choose?  

Medicare Part D is the health insurance that covers prescription medication for outpatient drugs.  Part D is a fairly recent addition to the Medicare Alphabet, having been added in 2006.  This plan seems incredibly confusing, and it can require some research to determine the best plan for each individual.

Medicare Part D is a federally subsidized drug benefit.  The participants will pay a monthly premium to an insurance company that has contracted with the government.  In 2015, the average premium is around $33.15 per month.  After a participant has paid the deductible $320.00, the participant will pay 25% of the cost of the drugs until the total cost of the prescription drugs has reached $2960.  The federal government pays $2,220 of this amount and the participant will pay $760.  

But how to choose a Medicare Part D plan?  Medicare has a pretty powerful program online that can help you make the decision.  Go to www.medicare.gov/find-a-plan.  It will ask you to enter the zip code of the participant, and then will ask for all of the medications the participant is taking, the dosage of the medications, and the number of pills purchased each time.  It will also ask for the pharmacy where the participant usually purchases the drugs.  Once all of that information is entered into the find-a-plan site, the site will spit out a list of plans with comparative information including the cost of premiums, the annual drug deductible, the estimated annual drug costs, and the rating of the plan based on 3 out of 5 stars assigned by Medicare. Medicare sometimes assigns a 5-star rating for a Part D insurance plan that will be indicated by a yellow star with a 5 in the middle next to the Medicare Part D plan.   Once you have entered all of the information, you can compare the costs of the various plans.  Of course, the information is only valid if all of the drugs in the correct dosages are entered into the system.  Be sure to check to see whether the cost of the drugs will go up during the year.  Usually, the cost of the prescription drugs goes down once the deductible is met, and goes up again when the participant hits the donut hole at $2960.

The participant will have to go to a pharmacy in the plan’s network in order to get the lower price you expect to pay. 

Not everyone needs a Medicare Part D plan.  Some retirees may have coverage under their retirement plans, veterans who qualify for free or reduced price medications may not need the coverage. That is called “creditable coverage.”  If you do need it, though, and don’t sign up for it when eligible, you will be charged a penalty when you do finally sign up.  The penalty is at least 1% for every month you delay enrolling past the Initial Enrollment Period.

 

 

 

 


Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Friday, November 15, 2013

Veterans Eligible for Both VA Healthcare and Medicare? Who Pays What?

Eligible for both VA and Medicare? 

Who pays what?  Do I need insurance if I’m eligible for VA healthcare?

You’ve been approved for VA Pension or Compensation, and you will be receiving healthcare and prescription drugs at the VA facility.  You also have Medicare part B and Medicare part D.  Do you need both? 

Medicare Part A pays for inpatient hospital care for up to 90 days per benefit period, skilled nursing care partial pay for up to 100 days each benefit period, home healthcare for up to 100 days, and hospice care.

Medicare Part B pays for doctor’s visits, ambulance services, preventive care services, and durable medical equipment, as well as many other services.

Medicare Part D pays for outpatient prescription drugs.

For veterans that qualify, the VA provides care in VA healthcare facilities, as well as contract care in other facilities when the VA cannot provide the required care.  The VA authorizes care at non-VA facilities when necessary medical services are not routinely available at a VA facility, or the VA determines that the services can be obtained more economically outside the VA.  The non-VA care must be authorized by the VA in advance.

Unless the veteran has other healthcare, or his or her healthcare is being provided by the spouse’s employer, once he or she turns 65 she must enroll in Medicare Part B and D.  If she does not enroll at age 65, when and if she finally enrolls, she will have to pay a Part B and/or a Part D premium penalty which increases for every year she does not enroll in the programs.

The veteran may want to enroll in Part B in order to receive healthcare services from Medicare approved providers that provide services he may not be able to receive in a VA facility.  In that case, it is important to enroll at age 65. 

If the veteran is eligible for prescription medications from the VA, he may choose not to enroll in Medicare Part D.  VA prescription coverage is considered “creditable”, meaning it is as good, or better, than Medicare Part D coverage.  What that means for the veteran is that he can delay enrolling in Part D and not suffer a penalty.  However, if the veteran loses his prescription coverage, he has 63 days to enroll in a Part D plan or he will be penalized. 

When deciding whether or not to enroll in Part D, the veteran should consider if he will get all of his prescriptions from the VA.  The VA will only provide coverage of the drugs the veteran receives from the VA.  A veteran is eligible for the prescription benefit if he or she is enrolled in and receiving health care from the VA.  The prescriptions must be written by a VA health care provider, or a VA-authorized provider.   A VA health care provider will review prescriptions written by a private health care provider to determine whether the VA can rewrite the prescription and dispense it from a VA pharmacy.  Most prescriptions can be mailed to the home, or can be picked up at the VA pharmacy.  Depending on what priority category the veteran is in, he or she may have a co-pay for each prescription received.  Co-pays for prescriptions are between $8.00 and $9.00 per prescription.


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