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Prescription Drug Plan

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.


Thursday, December 6, 2012

The Importance of Getting Vaccinations

              It is that time of season again! While we fret over  getting gifts for our children or doing more cleaning than we have done all year because the in-laws are coming, we are forgetting one imporatant thing this holiday: our health. I am sure you have seen the advertisements Pharmacies and Drug Stores put out about getting the flu vaccine, but how imporant is it?

              The CDC says that, 'Influenza is a serious disease that can lead to hospitalization and sometimes even death.'  Even I have to admit, I did not think that the Flu was serious enough to cause death, but in reality it does. In fact, over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. That is not a small number. It is especially important that our Seniors get the vaccination because during a regular flu season about 90 percent of deaths occur in people 65 years and older.

               The CDC has named this week (December 2-8th) as National Influenza Vaccination Week. It is a national observance that was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond.

As we prepare for this holiday season, may we give the most imporant gift of all, the gift of good health.

The US Department of Veteran Affairs has some helpful tips and links for our seniors.

http://www.va.gov/health/NewsFeatures/20121203a.asp


Sunday, December 4, 2011

Medicare: Treat it as Part of Your Financial Plan

 


Medicare changed things up a bit this year by scheduling open enrollment early.  Because Medicare is in the news, I’ve been getting a lot of calls from clients to ask me about Medicare. While most people understand that they can become eligible for Medicare when they turn 65, they wonder about the types of Medicare plans available, and what plan they should choose.  Today, we’ll talk a little bit about the basics of Medicare, and about how to choose a Medicare Part D prescription drug plan.

Here is the basic Medicare alphabet:

Medicare Part A covers hospital insurance that can help pay for inpatient care at hospitals, skilled nursing facilities, hospice, and home health care.

Medicare Part B covers medically-necessary service such as doctor’s services, outpatient care, home health services, and some other services.  You will pay a premium to be covered by Part B.

Medicare Part C is a Medicare Advantage Plan.

Medicare Part D is the prescription drug coverage.

In order to become eligible for Medicare, you must be age 65, or you must have been receiving Social Security Disability benefits for 24 months.  Most people who are on Social Security or Railroad Retirement benefits will automatically get Medicare Part A and B starting on the first day they turn 65, or when they have completed the full 24 months after beginning to receive Social Security Disability.  One exception is that if you have ALS – Lou Gehrig’s disease- you are eligible for Part A and B in the month your disability begins.

Every year, for those who are qualified for Medicare, there is an open enrollment time when you have the ability to sign up for a new Medicare Part C or Part D plan. 

Normally, the open enrollment period begins in January.  However, this year the open enrollment period began on October 15 and ends on December 7.  If you want to know when to enroll in Social Security Part A and Part B, and when to enroll in Part C and Part D here is a handy chart:  http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf

Medicare Part D is probably the most confusing of the Medicare Alphabet Programs.  Medicare Part D is the program that offers prescription drug coverage to those who are qualified for Medicare.  In order to get the drug coverage, an eligible person must join a plan.  The plans are run by private insurers or other private companies approved by Medicare.

Medicare Part D is available if you are otherwise-eligible for Medicare A & B.  If you don’t enroll in Part D when you become eligible, you might have to pay a slight penalty when you do join at a later date.  You can enroll in two basic types of plans:  Medicare Prescription Plans or Medicare Advantage Plans.  The Medicare Advantage Plans are usually HMO’s or PPO’s that give you all of your Part A and B coverage, and in addition may give you drug coverage.  If you choose another Part D plan while already enrolled in a Medicare Advantage Plan that offers a drug plan, you may become disenrolled from your HMO or PPO plan and returned to regular Medicare.

How can you choose the right Medicare Part D plan?  The plans are run by private insurance plans, or private companies, and the cost of the plan is generally based on the prescriptions you use, the “formulary” of the plan, and whether you go to a pharmacy that is within your plan’s network.  The formulary is the list of drugs that a Medicare plan covers.

The Medicare.gov website is full of information about the plans that are available, and is also full of advice on how to choose a plan.  To choose a plan, you can enter your zip code and your prescriptions in the formulary finder on Medicare’s website.  http://plancompare.medicare.gov/pfdn/PlanFinder/DrugSearch.  The plan finder will then give you a list of providers and will tell you the cost of the plan and the cost of the drugs.  You can then call the providers with any questions you might have.

Erica Dumpel, with Czajkowski Dumpel & Associates, Inc. http://cdainc.net/ an experienced healthcare plan advisor, emphasizes that you should research the plans on a yearly basis.  If you have a number of prescriptions, hunting down the right plan can take a lot of time – but can also save you a significant amount of money each year. 

If you miss this year’s open enrollment period, or if you decide not to change plans, be sure to put a reminder on your calendar to review your plan again next year.  In fact, I recommend that you schedule a yearly financial and legal checkup, which should include a thorough review of all of your insurance premiums, co-pays and prescription costs.

Will you start treating your Medicare Plan as part of your Financial Plan?

 

 

 

 

 

 

 

 


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