Medigap

Tuesday, 17 October 2023

5 Essential Tips for Snowbirds: Mastering the Seasonal Migration

The allure of the Snowbird lifestyle is undeniably captivating. Yet, navigating the challenges of this lifestyle requires careful planning and consideration, particularly when it comes to healthcare, travel, and lifestyle adjustments. This article will explore five tips to help Snowbirds make the most of their seasonal journey.

What is the snowbird lifestyle?

The Snowbird lifestyle is a unique and appealing way of life many retirees embrace. It involves migrating from colder regions to warmer, sun-soaked destinations for part of the year, typically during winter. Snowbirds seek to escape the harsh winter weather in their home states by temporarily relocating to more temperate climates, often in southern states like Florida, Arizona, or Texas.

This seasonal migration allows them to enjoy the best of both worlds, experiencing the comforts of home in their primary residence while basking in the relaxation and adventure offered by their secondary, warmer abode. The Snowbird lifestyle is characterized by flexibility, outdoor activities, social engagement, and a pursuit of a healthier and more enjoyable retirement.

Tip 1: Mastering Medicare on the move

One of the primary concerns for Snowbirds is ensuring seamless healthcare coverage while traveling between states. Medicare, the federal health insurance program for retirees, provides coverage across the United States, including Washington D.C., Puerto Rico, Guam, the U.S. Virgin Islands, and the Northern Mariana Islands. As a US citizen or legal resident of at least five consecutive years, you can see a doctor in another state as long as they accept Medicare patients.

However, it’s crucial to understand the three categories of Medicare acceptance:

Participating provider: These providers accept Medicare assignment, agreeing to accept Medicare reimbursement as full payment.
Non-participating provider: While they accept Medicare patients, they don’t accept Medicare reimbursement as full payment, potentially charging up to 15 percent more than the Medicare-approved amount. Some Medicare Supplement Insurance plans cover these excess charges.
Opt-out provider: These providers have chosen to opt out of the Medicare program entirely and don’t accept Medicare insurance. If you visit an opt-out provider, Medicare won’t cover the services you receive, even if they’d typically be covered.

Snowbirds should verify their healthcare providers’ participation status and potential out-of-pocket costs when seeking medical care in different states.

Tip 2: Travel and accommodation hacks

Finding affordable and convenient accommodations is a key consideration for Snowbirds. Whether you prefer RV parks, vacation rentals, or extended-stay hotels, there are numerous options to explore. Websites and apps dedicated to Snowbird travel can help you discover suitable destinations.

To make your life easier, keep a travel checklist to ensure nothing is forgotten during transitions between homes. Utilize travel apps for planning and staying organized, and consider the benefits of packing light to reduce the hassle of moving between states.

Tip 3: Embracing a healthy lifestyle

Maintaining a healthy lifestyle while on the move is essential for Snowbirds. Engage in regular physical activity and focus on a balanced diet to ensure your well-being. Many Snowbird destinations offer opportunities for outdoor activities like hiking, swimming, and golfing.

Additionally, it’s crucial to have a healthcare plan in place. Some Snowbird-friendly destinations provide easy access to medical facilities, but it’s wise to research healthcare options before your travels. Carry important medical records and prescriptions with you, and know how to reach medical professionals in emergencies.

Tip 4: Financial planning for seasonal living

Managing finances effectively is another critical aspect of the Snowbird lifestyle. Establish a budget for your primary and secondary residences and travel expenses. Use online banking and financial apps to monitor your accounts while moving.

Consider setting up automatic bill payments to ensure bills are paid promptly, preventing any lapses in services. Additionally, explore options for managing investments, taxes, and insurance across different states. A well-thought-out financial plan will help you enjoy your Snowbird lifestyle without financial stress.

Tip 5: Staying connected and social

Maintaining social connections is vital for a fulfilling Snowbird experience. Engage with local communities and fellow Snowbirds by participating in social activities, clubs, or volunteering opportunities. Joining online forums or social media groups can also help you connect with like-minded individuals.

Technology is crucial in staying connected with loved ones, especially when you’re away from family and friends. Video calls, messaging apps, and social media can bridge the gap, allowing you to share your experiences and keep close ties.

FAQs

What is a Snowbird?

A Snowbird is typically a retiree who temporarily migrates from colder regions to warmer destinations during winter, seeking to escape cold weather and enjoy a more pleasant climate.

How do Snowbirds manage their healthcare coverage?

Snowbirds must carefully choose Medicare plans that provide coverage in their home state and their winter destination. Depending on their specific needs and preferences, they can opt for Original Medicare, Medicare Advantage plans, or Medigap plans.

Can Snowbirds maintain consistent healthcare coverage while living in two states?

Yes, they can. Original Medicare and Medigap plans offer nationwide coverage, ensuring access to healthcare services in both states. Some Medicare Advantage plans also offer travel benefits, allowing Snowbirds to receive care while away from their primary residence.

Are there specific considerations for Snowbirds regarding prescription drug coverage?

Snowbirds should select a Medicare Part D prescription drug plan that covers their medications and is accepted at preferred pharmacies in both states. It’s essential to ensure seamless access to prescription medications while on the move.

What other tips can Snowbirds benefit from for a smooth seasonal transition?

Snowbirds can enhance their seasonal journey by maintaining a checklist of essential documents, securing their homes during their absence, and exploring local activities and social opportunities in their winter and summer residences.

Find Medicare plans to cover your snowbird lifestyle

The Snowbird lifestyle offers a unique opportunity to enjoy the best of both worlds—escaping winter’s chill while embracing warm, sun-soaked destinations. You can make the most of your Snowbird journey by mastering Medicare on the move, making smart travel choices, prioritizing a healthy lifestyle, planning your finances diligently, and staying socially connected. With these five essential tips in mind, embark on your seasonal migration with confidence and preparedness, savoring every moment of your adventure.

Review Medicare plan options in your area by filling out our online rate form.

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Thursday, 21 September 2023

Understanding Medicare Coverage for the RSV Vaccine

As the leaves start to fall and the temperatures cool down, autumn brings many joys, but it also signals the beginning of cold and flu season. During this time, taking proactive steps to protect your health is essential. One crucial measure is staying up-to-date with vaccines. In this article, we will delve into the RSV (Respiratory Syncytial Virus) vaccine and its coverage under Medicare, focusing on how it can safeguard the health of Medicare beneficiaries during the fall and winter months.

What is the RSV Vaccine?

RSV, or Respiratory Syncytial Virus, is a common virus that can lead to lower respiratory tract disease. It can affect individuals of all ages but poses particular risks to infants and older adults. The RSV vaccine is designed to prevent these serious infections, making it an important tool for maintaining good health, especially during autumn.

RSV Season and Risks

RSV season typically kicks off in the fall and peaks in winter. During this period, the virus can spread more easily, increasing the risk of infection. Infants and older adults are particularly vulnerable to severe RSV-related complications, such as pneumonia and bronchiolitis, making vaccination a crucial preventive measure.

Medicare Coverage for the RSV Vaccine

Medicare covers recommended vaccines for seasonal illnesses through Part B and Part D.

In a recent development, the RSV vaccine has been approved by the Food and Drug Administration (FDA). This vaccine is now covered by Medicare Part D, provided it is recommended by the Advisory Committee on Immunization Practices (ACIP). Currently, ACIP recommends the RSV vaccine for adults aged 60 and over.

How to Access the RSV Vaccine with Medicare

If you’re eligible for the RSV vaccine and have Medicare Part D, you can access it at no additional cost. However, if your pharmacy attempts to charge you a copay or deductible for the vaccine, don’t hesitate to ask for assistance.

As autumn arrives and the cold and flu season approaches, safeguarding your health becomes paramount. The RSV vaccine, now covered by Medicare Part D, offers a powerful defense against respiratory infections. By staying informed and taking advantage of Medicare’s vaccine coverage, you can protect yourself and your loved ones from the seasonal health challenges that lie ahead.

FAQs

Does Medicare cover RSV vaccines?

Medicare Part D provides coverage for the RSV vaccine when the Advisory Committee on Immunization Practices (ACIP)recommends it. The ACIP government agency offering guidance on vaccine recommendations. Currently, ACIP recommends the RSV vaccine for individuals aged 60 and above.

Who is eligible for the RSV vaccine?

Individuals aged 60 and older, as well as infants and children under 19 months, should consult their healthcare provider to assess whether RSV vaccination or preventive treatment suits their specific needs.

How much does the RSV vaccine cost?

The new RSV vaccines follow comparable guidelines, and their cost per shot typically ranges from $180 to $295. Since the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices endorsed the RSV vaccine, individuals with private insurance can access it without copay.

How long does the RSV vaccine last?

Individuals 60 and above should get the RSV vaccine to protect themselves throughout the entire RSV season. Therefore, it’s advisable to receive the vaccine as early as possible. Moreover, early data indicates that the RSV vaccine may only need to be administered every other year for continued effectiveness.

Find Medicare coverage for all your individual needs

Finding Medicare coverage is easy, but with so many options to choose from it can be time-consuming. Call us or fill out our online rate form to view and compare plans in your area. We can even connect you with a licensed agent who specializes in Medicare. These agents have tools to narrow the options down based on your needs.

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Dual Special Needs Plans (D-SNP) and Dual Eligibility

Once individuals retire and begin living on Social Security benefits, they typically have a lifestyle change and must be a little tighter with spending. However, many beneficiaries’ income drops below the poverty level, and they also become eligible for Medicaid. Below, we’ll discuss the Medicare Special Needs plans for dual enrollees of Medicare and Medicaid.

What is a Dual Special Needs plan?

These D-SNP plans are Medicare Advantage Special Needs plan options designed to work with and benefit enrolled beneficiaries who qualify for Medicare and Medicaid. These plan options provide coordination of benefits between both Medicare and Medicaid, as well as providing comprehensive healthcare coverage. Since these plans work with dual enrollees, they coordinate the benefits, resulting in $0 copays for qualified individuals and even additional benefits that can help increase the quality of living of the plan member.

Benefits of a Dual Special Needs plan

As mentioned above, when a Medicare beneficiary enrolls in a full D-SNP plan, the plan coordinates with Medicaid to pay all costs for services included in the coverage. This is a huge help for Medicare beneficiaries with low incomes. However, these plans include many plan extras that impact their lives.

While not all plans and areas have the same plan extras and benefits, some of the benefits that may be available in your area may include the following:

Gym memberships
Transportation benefit to plan approved locations
Over-the-counter allowance benefits for items such as toothpaste, vitamins, aspirin, and some medical supplies
Utility payment assistance
Healthy food allowance
Flex card benefits
Dental
Vision
Hearing

While many Medicare Advantage options may offer some of the above benefits, the allowance amounts are usually higher for the Dual Special Need plans.

D-SNP enrollment qualifications

To enroll in a Dual Special Needs plan, beneficiaries must be enrolled in both Original Medicare and Medicaid. In addition, they must live in the coverage area for the plan. There are some D-SNPs for members with partial Medicaid status. However, there will be costs when using the partial plans. When Medicare beneficiaries qualify for Medicaid, they’ll also have full Extra Help and a Medicare Savings Program. These programs help cover the costs of prescription drugs and their Medicare premiums.

Companies that offer Dual Special Needs plans

While many Medicare Advantage companies offer D-SNP Medicare options, The largest companies that provide this coverage include UnitedHealthcare, Humana, Wellcare, Aetna, Cigna, and Anthem. Many smaller regional companies also include these Medicare Advantage plan options, but the ones above, on average, have great reviews on their Dual Special Needs plans.

FAQs

What is a D-SNP?

Dual Special Needs Plans (D-SNPs) are a category of Medicare Advantage (MA) plans designed specifically for eligible individuals for both Medicare and Medicaid. These plans offer specialized healthcare services tailored to the unique needs of dual-eligible beneficiaries. In addition to comprehensive medical coverage, D-SNPs provide essential care coordination and supplementary wrap-around services to enhance the overall quality of care and support for eligible individuals.

What are some distinct advantages of a (D-SNP )?

A DSNP plan provides a unified solution for beneficiaries by encompassing coverage for hospital services (Medicare Part A), medical healthcare needs (Medicare Part B), and prescription drugs (Medicare Part D), all within a single plan. In addition to this comprehensive coverage, DSNP plans may offer access to essential social services to streamline the coordination of a beneficiary’s Medicare and Medicaid benefits.

What is the difference between eligibility for a D-SNP, I-SNP, and a C SNP plan?

It’s important to remember that D-SNPs are designed for individuals eligible for Medicare and Medicaid, I-SNPs are tailored for those residing in long-term care facilities, and C-SNPs are intended for individuals facing significant health challenges or disabilities. This is precisely why a Medicare Advantage Plan can be incredibly convenient, as it offers specialized options to suit the specific needs of different beneficiary groups.

What are the features of a DSNP?

D-SNPs usually include the following:

Care coordination.
$0 monthly premiums.
Over-the-counter quarterly benefits.
Dental, vision, and hearing benefits.
Transportation benefits.
Gym memberships.

Benefits can vary based on location and plan selection.

What happens to members who lose their eligibility for the D SNP due to a change or loss?

The timeframe for regaining eligibility varies depending on the specific plan, typically 30 days to six months. If you do not reestablish your eligibility within this period, you will be disenrolled from the SNP. Within ten days of discovering that you no longer meet your SNP’s eligibility criteria, you should expect to receive a written notice from your plan.

Find a Dual Special Needs plan that fits your needs

If you need help with Medicare plans in general or have Medicare and Medicaid and are trying to figure out which plan has the most benefits for you, we’re here to help. Call us or fill out our online rate form to view and compare plans in the area. We can help answer questions and even put you in touch with an agent that specializes in Medicare plans in your area.

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Tuesday, 5 September 2023

Understanding Medicare Costs: Your Comprehensive Guide

Medicare health insurance covers Americans 65 and older with specific disabilities and health conditions. Many people assume that Medicare has no cost, as they have been paying Medicare taxes for years. However, there are costs associated with Medicare, and we’ll discuss different costs that vary depending on your coverage and situation.

The basics of Medicare costs

Medicare isn’t a one-size-fits-all situation, as everyone’s needs are different. Some people will prefer to stay on Orignal Medicare. Others may want to add a Medicare Supplement and Part D plans, while some beneficiaries may want a Medicare Advantage program. The one thing in common is regardless of which option you choose, they don’t replace you Original Medicare premiums.

Medicare’s 4 parts have different costs associated with them. While most people pay the standard costs, individuals with larger incomes may have to pay an income-related monthly adjusted amount or IRMAA.

Medicare Part A

For most Americans, Medicare Part A will have no costs, as they or their spouses have paid Medicare taxes for at least 10 years. Medicare Part A has a standard premium of $506 for Americans who paid Medicare taxes for less than 30 quarters and a premium of $278 for those between 30 and 40 quarters in their lifetime. Beneficiaries who met the 40-quarter requirement through their or their spouse’s work will receive Medicare Part A at no monthly cost.

In addition to the premiums, costs are associated with using Medicare Part A benefits and services. Part A costs include:

Recurring deductible – $1,600
Inpatient hospital for days 61-90 – [GCBB#part-a-inpatient-coinsurance-days-61-90]
Inpatient hospital for days 91-120 – [GCBB#part-a-inpatient-coinsurance-days-91-120]
Inpatient skilled nursing facility days 21-100 – [GCBB#part-a-snf-copay-days-21-100]

Medicare Part B

Most Medicare beneficiaries will pay a standard Medicare Part B premium of $164.90. While most Americans will pay this standard premium, those with low income, could qualify for a Medicare Savings Program that pays the premium for them. In addition, Americans with higher incomes pay Medicare Part B IRMAA premiums.

Part B IRMAA chart

The Income Related Monthly Adjustment Amount is based on your income from two years prior.

Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount in 2023
$97,000 or less	$194,000 or less	$0.00	$164.90
$97,000 to $123,000	$194,000 to $246,000	$65.90	$230.80
$123,000 to $153,000	$246,000 to $306,000	$164.80	$329.70
$153,000 to $183,000	$306,000 to $366,000	$263.70	$428.60
$183,000 to $500,000	$366,000 to $750,000	$362.60	$527.50
$500,000 or above	$750,000 or above	$395.60	$560.50

In addition to the Medicare Part B premium, beneficiaries of Medicare Part B are responsible for the following cost-sharing.

Annual deductible – $226
Part B Coinsurance – 20% of the Medicare-approved amount
Part B Excess charges – 15% over the Medicare-approved amount

Medicare Part A and B coverage chart

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals
Skilled nursing facility care
Hospice care
Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers
Outpatient care
Home health care
Durable medical equipment
Some preventive services

Medicare Part C

Part C is also called Medicare Advantage. Private companies contracted by Medicare provide these plans. They must cover at least the same items and services covered by Medicare Part A and B, and in many cases, Medicare prescription drug coverage. They also can include over-the-counter benefits, and additional coverage and services, like transportation, gym memberships, and dental coverages that aren’t included in Original Medicare.

Medicare Advantage plans have their cost-sharing. The premiums, copays, deductibles, and coinsurance amounts will vary depending on your chosen plan, location, and insurance carrier. Im many areas these Part C plans will have low to no premium.

Medicare Part D

Medicare Part D is the prescription drug coverage for Medicare. Like Medicare Advantage, private companies contracted with Medicare offer these plans. These plans must be as good or better than the Centers for Medicare and Medicaid Services’ standard model. The average Medicare Part D premium is $31.50. Like Medicare Part B, there is an IRMAA for the Medicare Part D premiums.

Medicare Part D IRMAA

The Income Related Monthly Adjustment Amount is based on your income from two years prior.

Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-related monthly adjustment amount for 2023
Less than or equal to $97,000	Less than or equal to $194,000	$0.00
Greater than $97,000 and less than or equal to $123,000	Greater than $194,000 and less than or equal to $246,000	$12.20 + Plan Premium
Greater than $123,000 and less than or equal to $153,000	Greater than $246,000 and less than or equal to $306,000	$31.50 + Plan Premium
Greater than $183,000 and less than $500,000	Greater than $366,000 and less than $750,000	$70 + Plan Premium
$114,000 to $1Greater than or equal to $500,000	Greater than or equal to $750,000	$76.40 + Plan Premium

Medicare Supplement

Medigap or Medicare Supplement plans add insurance to Original Medicare to help cover the cost-sharing amounts left over to the beneficiary. They have higher monthly premiums and have ten plan options to choose from with varying levels of coverage. The great thing about this additional coverage is that it allows all the freedoms as keeping Original Medicare, with the highest levels of cost-sharing protection.

Medicare Supplement plan chart

PLAN	A	B	C	D	F	G	K	L	M	N
Part A Hospital Coinsurance	X	X	X	X	X	X	X	X	X	X
Hospital Reserve Days	X	X	X	X	X	X	X	X	X	X
3 Pints of Blood	X	X	X	X	X	X	50%	75%	X	X
Part B Coinsurance	X	X	X	X	X	X	50%	75%	X	*Copays
Hospice Coinsurance	X	X	X	X	X	X	50%	75%	X	X
Skilled Nursing Facility			X	X	X	X	50%	75%	X	X
Part A Deductible		X	X	X	X	X	50%	75%	50%	X
Part B Deductible			X		X
Part B Excess Charges					X	X
Foreign Travel Benefit			X	X	X	X	X	X	X	X
Preventive Care Coinsurance	X	X	X	X	X	X	X	X	X	X
Out of Pocket Limit	None	None	None	None	None	None	$6,940	$3,470	None	None
*Copays are $20 per office visit, and $50 per ER visit if not admitted to a hospital A checkmark indicates 100% coverage for the specified benefit

Medicare cost FAQs

How is Medicare Part B cost calculated?

The adjustment hinges on the adjusted gross income (AGI) you reported on your tax return from two years ago. Your modified adjusted gross income (MAGI) is computed by adding your AGI to any supplementary income you may have. Most beneficiaries will pay the standard premium.

What is the out-of-pocket maximum for Medicare?

Original Medicare doesn’t have a maximum out-of-pocket. In essence, your bills can continue rising without any stop in sight. However, enrolling in a Medicare Advantage, or Medicare Supplement plan can assist and limit the amount you’d be responsible for paying.

Which part of Medicare is usually free of cost?

Most Medicare beneficiaries will not have to pay for Medicare Part A. Some areas may have Medicare Advantage plans with no additional cost.

What are the four parts of Medicare, and what do they pay for?

Part A delivers hospital and inpatient care coverage, while Part B offers coverage for outpatient and medical services. Part C presents an alternative approach to accessing Medicare benefits (see below for details), and Part D ensures prescription drug coverage.

Why do doctors not like Medicare Advantage plans?

Most physicians are cautious about Medicare Advantage as these plans shift patients’ financial risk to the doctor. Medicare Advantage plan providers typically offer an upfront payment to the doctor based on the patient’s diagnosis.

Find a Medicare plan to help with Medicare costs

With so many options, medicare costs can be confusing and complicated, but we’re here to help. Simply fill out our online request form, and we can compare the top companies and connect you with an expert in your area to assist you with helping you find the plan and options to fit your needs and situation best. Don’t delay. Get help today!!!

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Friday, 25 August 2023

Shining Light on Medicare Star Ratings

From Medicare Advantage Plans to Part D prescriptions, the choices can be overwhelming. That’s where the guiding light of the Medicare star rating system steps in, offering you a compass to navigate this complex terrain. Imagine having a tool that simplifies your decision-making and ensures you choose the best plan tailored to your needs.

Understanding the significance of Medicare star ratings

Medicare Advantage and Part D prescription drug plans are subject to Medicare’s star rating system. Medicare Advantage plans provide another avenue for your Original Medicare benefits. These plans can include prescription drug coverage and plan extras not included under Medicare Parts A and B.

Part D prescription drug plans are stand-alone coverage added to Original Medicare and/or Medicare Supplement plans. These Medicare options are subject to the star rating system used to determine the program’s quality.

Translating the Medicare star rating system

Medicare assesses plan performance across various measurements, encompassing quality of care and customer service. This evaluation results in ratings ranging from one to five stars, where five signifies the standard of excellence, and one denotes the starting point. Plans receive ratings for each category, culminating in a star rating that rates the plan’s performance. This Medicare star rating equips you with a powerful tool for comparing plan performance across the board.

Medicare engages in a yearly review of plan performance. This process leads to the release of fresh star ratings every fall. Consequently, plan ratings are subject to change from one year to the next, ensuring a current and dynamic assessment. However, it’s essential to remember that while star ratings offer valuable insights, ensuring a plan’s coverage and costs align with your specific needs remains important.

The criteria behind Medicare star ratings

There are several factors that CMS considers when giving star ratings. Below are the criteria Medicare uses for Medicare Advantage plans, and Part D drug coverage

Medicare Advantage plans earn their ratings across five categories:

Staying healthy: including screenings, tests, and vaccines.
Managing chronic (long-term) conditions.
Plan responsiveness and care.
Member complaints, challenges accessing services, and the decision to switch plans.
Health plan customer service.

Part D plans, on the other hand, undergo rating evaluation in four distinct categories:

Drug plan customer service.
Member complaints, challenges accessing services, and the decision to switch plans.
Member experience with the drug plan.
Drug pricing and patient safety.

Identifying excellence and addressing low-performance

As mentioned above, a 5-star rating is the top rating available; plans with a 4-star and higher rating are considered above average, while plans under a 3-star rating are considered poor-performing. If a plan has a 5-star rating, beneficiaries can enroll in that plan outside of the Annual Enrollment Period. For plans underperforming for at least three years, the beneficiaries enrolled in those plans are notified by Medicare and have a Special Enrollment Period for a one-time use outside of the AEP.

Navigating plan enrollment and the 5-star Special Enrollment Period

If a Medicare beneficiary lives within a coverage area of a 5-star plan, they qualify for the 5-star Special Enrollment Period. It allows them to enroll in the 5-star plan once a year between December 8 and November 30. The new plan will start at the beginning of the month after enrollment is complete.

Utilizing the Medicare star ratings

While the Medicare star rating is an important metric that shows the plan’s overall performance, that doesn’t necessarily mean that the plan is the best for your situation and needs. Your individual needs and wants must be met by the plan you choose. Reviewing your Medicare Advantage, or Part D plan regularly is wise and allows beneficiaries to ensure they have a plan that meets their needs. Star ratings help complement other decision-making factors.

FAQs

What do Medicare star ratings mean?

Medicare employs a Star Rating System to gauge the performance of both Medicare Advantage and Part D plans. The evaluation encompasses several categories, appraising the quality of care and customer service provided by the plans. These assessments result in ratings spanning a scale of one to five stars, where five signifies the pinnacle of performance and one denotes the starting point.

What are the 5-star rating categories for CMS?

For the 2023 overall star rating, a careful selection process considers 46 hospital quality measures publicly disclosed on Medicare.gov. These measures are categorized into five groups: mortality, safety of care, readmission, patient experience, and timely and effective care.

What are the four main categories of star rating measures?

The Medicare Star Rating System operates by evaluating key aspects, including:

Maintaining well-being.
Effectively managing chronic conditions.
Responsiveness and care of the plan.
Addressing member concerns, challenges with accessing services, and decisions to switch plans.
Quality of health plan customer service.

What are the benefits of being a 5-star Medicare plan?

5-Star plans excel in performance and stand out in customer service. These plans go the extra mile to ensure members have easy access to essential information, experience fewer grievances, and consistently deliver superior customer satisfaction compared to lower-rated plans within their market.

How is Medicare star rating calculated?

The star ratings attributed to Medicare Advantage plans hinge on a comprehensive evaluation of 38 quality measures distributed across five significant categories: screenings, tests, and vaccines; management of chronic conditions; member experience; handling of member complaints; and the provision of exceptional customer service.

Get help reviewing Medicare plan options

Finding the right plan for your needs doesn’t have to be complicated. Use our online rate form to review your area’s top plans and companies. Let us help you make the decision quick and painless.

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How the Medicare Part D 2024 Changes Will Impact Beneficiaries

The Medicare Part D program provides beneficiaries coverage for prescription drugs filed at the pharmacy. Reviewing this coverage annually is wise as plans and details change annually. From premiums and drug costs to covered drugs and authorizations, it’s wise to know about the changes to make an informed decision about your Medicare drug coverage.

Medicare Part D changes for 2024

In 2024 there will be a major change to the standard model for Medicare Part D from one of the provisions of the Inflation Reduction Act. The cost-sharing portion of the catastrophic coverage phase will be eliminated. This means that once a Medicare beneficiary completes the coverage gap (Donut Hole) phase, they’ll have $0 costs for their prescription drugs for the remainder of the year. This is good news for beneficiaries that take expensive prescription drugs.

Reviewing current drug coverage

Each year, you’ll receive an annual notice of change (ANOC). This notice will outline any changes in your current plan, including the new premium, copays, coinsurance, and deductible. In addition to cost changes, you’ll also be notified about formulary changes affecting the drugs’ coverage, authorizations, and limitations for the next year.

Comparing the current coverage to other 2024 Part D plans

When comparing the available Part D plan options, many people get hung up on the premiums. The premium is actually the least important factor to consider. It’s wise to compare the annual costs of your prescriptions and the available plans by that metric.

All plans have different cost shares, and the plan with the lowest premium, may not be the best coverage for you. Likewise, don’t assume that a plan with a high premium will be better for you.

Working with a licensed agent will make this process quick and easy. They can access tools that compare multiple plans with your prescriptions and pharmacies to determine plans with the lowest annual costs.

Restrictions

Plans are allowed to apply cost-saving methods to limit their costs. The cost savings methods include quantity limits, step therapy, and prior authorizations.

Quantity limit: Quantity limits limit the number of tablets or capsules that you can review within a specific time period.

Step therapy: Step therapy requires trying less expensive drugs, and stepping up to more expensive drugs if the cheaper alternatives don’t work.

Prior authorization: Prior authorizations require the provider to provide information on why the drug is necessary and request that a prescription be covered for the patient.

Prescriptions savings opportunities

There are situations where the costs of prescriptions can be unaffordable, and everyone’s needs are different. If this applies to you, there are assistance programs that you may qualify for. Next, we’ll go over some of these programs.

Medicare low-income subsidy

The low-income subsidy (Extra Help) program is a federal program that helps cover premiums, copays, and deductibles of prescription drugs. This program is income based and has several levels of protection. You can qualify for this program even if you don’t qualify for Medicaid.

State Pharmaceutical Assistance Program

You can check with your state if you don’t qualify for the federal low-income subsidy program. The State Pharmaceutical Assistance Programs (SPAP) are similar to the federal Extra Help program, but the income levels to qualify could be higher. Allowing individuals with income higher than the federal limits to qualify for help potentially.

Prescription discount programs

Several prescription discount cards are free for anyone, providing discounts for individuals who sign up. Programs such as SingleCare and GoodRx, provide these free programs and resources to help lower your prescription drug costs. Remember that any prescriptions you purchase through a discount program won’t go toward the drug costs to move you through the phases in your Part D plan.

Manufacturer coupons

Some drug companies provide coupons for their drugs for individuals in need. If you have a prescription that is unaffordable and these other programs won’t work for your situation, contact the manufacturer, and see if they have a coupon or assistance for your prescription.

Part D 2024 FAQs

What is the Part D rule in 2024?

Starting in 2024, the IRA will introduce a method to restrict rises in premiums for Part D enrollees. The legislation constrains the rise in the foundational beneficiary premium (utilized for determining plan-related basic premium) to an annual increment of 6%.

What will the donut hole be for 2024?

The maximum limit for the Initial Coverage phase will rise to $5,031 (compared to $4,660 in 2023). Additionally, the maximum limit for the Coverage Gap, also known as the “Donut Hole,” will increase to $8,000 (previously $7,400 in 2023).

What is the out-of-pocket limit for Medicare Part D in 2024?

For 2024, the catastrophic threshold gets established at $8,000. This sum comprises both the out-of-pocket expenses incurred by Part D enrollees and the value of the manufacturer price discount applied to branded drugs during the coverage gap phase.

Get help selecting a 2024 Part D plan

Finding the right drug plan for your needs is easy with the right tools. Fill out our online rate form to view plans available in your area, and even connect with a licensed insurance agent that can help you compare the options quickly and efficiently.

from Medigap.com https://www.medigap.com/resources/how-part-d-changes-will-impact-beneficiaries/
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Friday, 18 August 2023

Refresher for Navigating Medicare Advantage During AEP 2023

During the Annual Enrollment Period, Medicare beneficiaries can change their coverage. This is a very important time of the year for beneficiaries enrolled in Medicare Advantage plans. We’ll discuss what Medicare Advantage plans cover, when you can make changes.

Medicare Advantage refresher

Medicare Advantage (Medicare Part C) plans are an alternative way to receive your Original Medicare benefits from a private insurance company. These plans must cover everything under Original Medicare and have a maximum out-of-pocket, but they have their own schedule of benefits and the items and services they cover.

Many of these MA plans include prescription drug coverage and benefits that Medicare doesn’t, such as coverage for routine dental, vision, and hearing. In addition, they can include plan extras such as transportation, flex cards, and gym memberships at no additional costs.

Types of Medicare Advantage plans

These plans have a few different structures to choose from. Since private health insurance companies administer Medicare Advantage plans, they have additional rules for using them. Most of these plans are network-based HMO or PPO plans. In an HMO plan, you must use in-network providers except for in emergency situations, PPOs allow you to see out-of-network providers, but you’ll pay a higher cost.

Health Maintenance Organization (HMO)

HMO plans are the most restrictive regarding networks and authorizations. Most HMOs don’t only require you to use in-network providers, except for emergencies. In addition, you must see your primary care physician to get a referral to see specialists and for tests. These plans typically have lower costs, and maximum out-of-pocket limits compared to other MA options.

Preferred Provider Organization (PPO)

When you enroll in a PPO, you can choose your providers, but if you have services out of the plan’s network, you’ll be subject to higher copays, and out-of-pocket costs for these out-of-network services. In addition, in most cases, you won’t need a referral to see a healthcare specialist.

Private-Fee-For-Service (PFFS)

PFFS plans work slightly differently. These plans can either include a network or have no network. When enrolling in a PFFS plan, you should show the plan information to the healthcare provider before services; You can use any Medicare contracted healthcare provider. However, the doctor must accept the terms and conditions of the plan before service.

Refresher on Medicare Advantage plans for Medicare beneficiaries with special needs

Medicare Advantage plans are designed specifically for beneficiaries with certain circumstances. Most of these plans are HMOs; however, some are PPO-style depending on where you live. There are three types of special needs plans, chronic, dual, and institutionalized.

Chronic Special Needs Plans (C-SNP)

C-SNP plans are designed to help Medicare beneficiaries with specific chronic health conditions. The most common are COPD, diabetes, and heart conditions. These plans typically have lower copays for specific services, and medications catered towards treating the health condition.

Dual Special Needs Plans (D-SNP)

For beneficiaries that are low-income and qualify for Medicare, there are D-SNP plans. These plans work together with Medicaid to help cover the costs of healthcare services for these lower-income beneficiaries. These plans typically have the most transportation, healthy food cards, and otc benefits to assist Medicare beneficiaries that qualify for these D-SNP plans

Institutional Special Needs Plans (I-SNP)

These I-SNP plans are for beneficiaries that are living in an institutionalized setting. These special needs plans have benefits catered towards beneficiaries living in an institution.

AEP timeline and importance

The Annual Enrollment Period starts on October 15th and ends on December 7th. During this time, Medicare beneficiaries can review the changes in their current plan, and consider the other plans available there. Next, we’ll cover things you should remember when considering your Medicare Advantage options during AEP.

Refresher how to review Medicare Advantage options

One of the most important things to consider when reviewing Medicare Advantage plans is your healthcare needs. No two people have the same situation, so choosing a plan that fits your needs is important, not one that a family member or neighbor likes. Some plans do a better job than others for certain items. Here are a few examples of what you may need to consider when reviewing these Part C plans.

Do you need transportation to get to healthcare visits?
Are your prescriptions covered and affordable on the plan?
Do your healthcare providers accept the plans?
Do you need additional coverage such as dental, vision, or hearing?

These four items are the most important for considering your healthcare needs. There are a few other things that beneficiaries may want to consider, such as:

Compare costs
- Copayment
- Coinsurance
- Maximum out-of-pocket
Plan Extras
- Fitness programs
- Over-the-counter allowance
- Healthy food cards
- Flex cards
- Routine vision, dental, and hearing

FAQs

How many times can you switch Medicare Advantage plans during Annual Enrollment Period?

You can make as many changes as you want during the AEP. The last plan submitted before the end of the election period will go active on January 1st of the following year.

Does a Medicare Advantage plan automatically renew?

Each year, Medicare Advantage plans will renew automatically, except in cases where Medicare terminates the plan’s contract, or the insurance company discontinues it. You might be eligible for a Special Enrollment Period if the plan doesn’t renew.

Can you change Medicare Advantage plans during the year?

You can only change your Medicare Advantage plan during AEP or MAOEP. To make plan changes, you’d need to qualify for a Special Enrollment period outside these two periods.

Get help reviewing Medicare Advantage plans for AEP

It’s wise to enlist the help of a licensed insurance agent that specializes in Medicare. These agents have access to tools to make comparing options quick and seamless. Fill out our online rate form to view Medicare options available in your area.

from Medigap.com https://www.medigap.com/research/refresher-for-navigating-medicare-advantage-during-aep/
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