Fifty-Fifth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

 Know About Medicare
 
before Age 65

During the Medicare Part D Initial Coverage Phase, you and the Insurance Company each contribute to the cost of your drugs. You pay the deductible, if any, and any copays for your medications. The insurance company pays the remainder of drug costs.

 

 

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Fifty-Fourth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

Some but not all Medicare Part D plans have a deductible that must be met in the initial coverage phase. The maximum deductible a Medicare Part D drug plan may have is $320 (2012).

 

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Fifty-Third of 65 Things Everyone Needs to Know About Medicare before Age 65

 

 

 

65 Things Everyone Needs to

Know About Medicare

before Age 65

All Medicare Part D Plans must be structured the same: Initial Coverage Phase, Coverage Gap, and Catastrophic Coverage Phase.

 

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Fifty-Second of 65 Things Everyone Needs to Know About Medicare before Age 65

 

 

 

65 Things Everyone Needs to

Know About Medicare

before Age 65

 

Insurance Companies who offer Medicare Part D prescription drug plans may set their own premiums, copays and deductibles (up to a set maximum) which are approved by the Federal Government according to Medicare Part D guidelines.

 

 

 

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Fifty-First of 65 Things Everyone Needs to Know About Medicare before Age 65

 

 

 

 

65 Things Everyone Needs to

Know About Medicare

before Age 65

 

Medicare Part D plans are regulated by the Federal Government but provided by private insurance companies.

 

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Fiftieth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

There is a penalty of 1% per month of the previous year’s average Medicare Part D premium assessed for every month you go without a Medicare Part D Prescription Drug Plan past your initial eligibility enrollment period.

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Forty-Ninth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

You may enroll in a Medicare Part D Prescription Drug Plan, 3 months prior to your 65^th birthday month and 3 months after.



For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Forty-Eighth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

Medicare Part D is the part of Medicare that covers prescription drugs.

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Medicare Personal Account Information Available Online

Medicare Personal Account Information Available Online 

Question:  Is it possible for me to go on line and look at my personal Medicare account? If so; how do I do it?

Answer:  Yes, you may go online and view your personal account information about claims, coverage, benefits, etc. Go to www.Medicare.gov . On the home page, right side, you will see a box with "MyMedicare.gov" - it's blue. You have the choice to "secure sign in"; "create an account"; and "learn more”. Ultimately you must create an account before you may use the site but I recommend you click "learn more" the first time before you set up your account. You will be directed to a page that will give you a tour of the site and explain the details. If that's what you're looking for then set up your account and get started! Hope this helps.

For answers to your Medicare Questions or to request quotes on a Medicare Supplement or Part D Drug plan visit www.MedicareAnswersfromConnie.com.

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2012 Medicare Premiums and Deductibles

2012 Medicare Premiums and Deductibles

Question:  What are my Medicare premiums and deductibles for 2012?

Answer:  Centers for Medicare and Medicaid Services (CMS) released the 2012 Medicare premiums and deductibles the end of October, 2011. These figures were not listed in the initial publication of CMS “Medicare and You 2012. Following is a summary of 2012 Medicare premiums and deductibles:

                                           

                                          2012                     2011

Part A Deductible        $1156/Event               $1132/Event

Hospital Days

61-90                    $289/Day                   $283/Day

Hospital Days         

91 & After            $578/Day                    $566/Day

Skilled Nursing

          Facility            $144.50/Day               $141.50/Day

Part B Deductible      $140/Year                    $162/Year

If you have a Medicare Supplement, the Supplement will automatically adjust coverage to reflect the 2012 amounts.

                                    2012                           2011 

Part B Premium       $99.90/month            $115.40/month

Most people who became eligible for Medicare in 2009 or before have been paying $96.40 per month for their Medicare Part B premium 2009 - 2011. Most that became eligible for Medicare in 2010 paid $110.50 per month in 2010 and 2011. Those who became eligible this year(2011)have paid $115.40 per month . All of these people will pay $99.90 per month in 2012, an increase for some, a decrease for others.

People with incomes above $85,000/year may pay a higher premium for their Medicare Part B as well as their Medicare Part D Prescription Drug Plan coverage. 

Most people pay no premium for Medicare Part A based on their or their spouse’s work credits. For those who must pay a premium for Part A, there has been an increase for the 2012 Part A premium as well.

For complete information about 2012 premiums and deductibles as well as premiums for those with higher incomes or those who must pay a Part A premium, follow this link: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4140

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

Medicare, What to Do, When to Do It?

What to Do About Medicare and When to Do It!

Question:  I turn 65 soon. I have no idea what I’m supposed to do about Medicare or when I’m supposed to do it!

Answer: First, you automatically get Medicare Part A when you turn 65 so long as you or a spouse has earned enough work credits. Part A is the part of Medicare that pays for hospitalization. Next you have to decide if you need Medicare Part B. Medicare Part B pays for doctor visits and outpatient procedures. Basically it comes down to whether you have other qualifying insurance. For instance, if you have insurance from an employer you may not need Medicare Part B. In these situations you will not be penalized for failing to enroll in Medicare Part B when you reach age 65. Otherwise, you have 3 months before you turn 65 and 3 months after you turn 65 to enroll in Medicare Part B. You will receive a penalty for enrolling late once outside your initial enrollment. If you are receiving Social Security payments you will automatically be enrolled in Medicare Part B at age 65. If you have postponed receiving Social Security, you must contact the Social Security office (1-800-772-1213) to enroll in Medicare Part B or let them know you are delaying or declining enrollment.

Once you get Medicare Part A and B taken care of you have to decide how you will get your prescription coverage and if you need a supplement. You may have discovered that you get your prescription coverage through an employer group plan or through military service-related coverage. If not, you have the option of a stand-alone drug plan or some Medicare Advantage plans offer prescription coverage as part of their plan (you have the same 3 months before/3 months after your 65th birthday time frame to make this decision). Medicare and Medicare Advantage Plans do not cover 100% of all services. A Medicare Supplement picks up what original Medicare does not pay. You have several options when choosing prescription coverage and coverage for the GAPS left by Medicare A and B.

Here are two videos. One explains what Medicare is, the other explains details about Medicare Part D. Hope you find them helpful.

How to Leave a Medicare Advantage Plan

When and How You May Leave a Medicare Advantage Plan

Question:  I didn’t realize my choice of hospitals and doctors would be so limited when I enrolled in my Medicare Advantage plan. I don’t like this plan. How do I change plans?

Answer: There is a special enrollment period for people who have enrolled in a Medicare Advantage plan for the first time after becoming eligible (age 65 for most people). It is known as the 12 month “free look” and during the first 12 months of having enrolled in your first Medicare Advantage plan you may leave the plan and return to original Medicare at any time during those first 12 months. Leaving the Medicare Advantage plan under these circumstances also puts you in a guarantee issue period for Medicare Supplements and a special enrollment for a Part D prescription plan.

In general you may only make changes in your Medicare Advantage Plan at certain designated times throughout the calendar year. October 15 to December 7 is the annual open enrollment period for 2011. You also have a chance to leave a Medicare Advantage Plan and return to original Medicare between January 1 and February 14 each year. There are other special enrollment periods for certain situations. All of this is handled through Medicare directly. Medicare has created a tip sheet for understanding Medicare enrollment periods. Click “Ask a Question” and request “Medicare enrollment periods”- I will e-mail you the tip sheet.

Medicare with Private Health Insurance

Part D and Private Health Insurance

Question:  I will be 65 this fall. My husband is retired from a large company. What we have heard is if we get a Medicare Supplement policy they will cancel our insurance with them. As it is now my husband cannot even afford all of his medication. I am not real sure but this is what I have heard. Just this month I have had an eye scratch and have spent out of pocket 350.00. Do you know anything about this?

Answer: All retirement insurance is not the same. I can't give you an absolute yes or no about a supplement policy canceling your company sponsored insurance but it really would not make sense to get a supplement and also have the company insurance unless the company is paying 100% of your premium and even then it wouldn't really benefit you to have both. Getting a Part D prescription plan WILL cancel your company policy IF the company policy has prescription coverage.

Here is what I recommend: Evaluate what your insurance through your husband’s former employer costs and what it pays in benefits. Compare that to what Medicare and a supplement and drug plan will cost. If your combined income for 2010 was less than $170,000, then you are going to pay around $275-$300 /month (each, assuming you don't use tobacco) for your Part B premium, Supplement Plan F and Part D drug plan. That combination would pay 100% of your medical costs leaving you only the expense of copays for your drugs.

I realize it can be confusing. I help people in your situation all the time. Sometimes it makes better sense to keep the company provided retirement insurance, sometimes not. I can help you figure out what's best for your situation.

Medicare Part D

Part D Coverage Evidence

Question:  How do I know if I have prescription coverage?

Answer:  I am assuming you do not have employer sponsored health insurance and are Medicare eligible. In most cases you must enroll in either a Stand Alone Prescription Drug Plan (also known as a PDP) or you may receive prescription coverage if you are enrolled in an Advantage Plan that includes prescription coverage. If you qualify for extra help and failed to enroll in a plan when you were first eligible, Medicare will enroll you in one of their choosing. At the very least you will have an ID card for your coverage, either the PDP or the Advantage plan. If you have not been issued an ID card, it's likely you don't have prescription coverage.

Medicare Part D Prescription Drug Plan

Medicare Part D

This video was created in 2011. Dollar amounts cited have changed for 2012. Changes are:
Initial coverage stage increased to $2930
Coverage Gap increased to $4700
Maximum deductible increased to $320

Medicare Part D with TRICARE

Medicare Part D with TRICARE

Question: If you had TRICARE for Life would you even get a Part D plan of any kind?

Answer: Probably not. With TRICARE for Life your prescription coverage is considered creditable which means it is as good as or better than what you could get with a Medicare Part D plan. There is no reason to get other coverage unless you are unhappy with how TRICARE is covering your prescriptions (which I doubt you will be). In that case, you may enroll in a Part D plan without losing your TRICARE. Medicare Part D would pay first, TRICARE would pay second. I assume you are aware you need to enroll in Medicare Part B at or past age 65 once you are no longer active duty. For more specific questions about TRICARE prescription benefits call the TRICARE Pharmacy Program 1-877-363-1303.

Part D Excluded Medications

Part D and ED Medications

Question: I will be 65 in Oct. Are ED meds such as Viagra and testosterone injections covered by Medicare?

Answer: No. ED medications are not covered by Medicare unless they are prescribed for a medical condition other than sexual or erectile dysfunction. This is known as prescribing "off-label". Viagra is sometimes prescribed for treatment of pulmonary hypertension so if you are taking it for that and your doctor certifies nothing else will work for you then Medicare might cover it, but that’s a long shot because there are so many other drugs available. A few years back a glitch in the CMS system allowed ED drugs to be covered but that has been corrected.

For answers to your Medicare Questions or to request quotes on a Medicare Supplement or Part D Drug plan visit www.MedicareAnswersfromConnie.com.

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What is Medicare

Medicare with VA Benefits

Medicare with VA Benefits

Question: I am 61, on VA disability, and get free health care except dental. When I turn 65 and get Medicare, will I still be able to go to the VA for medical care?


Answer: Qualified veterans may have and use Medicare and VA benefits at the same time.

You're several years away from 65, so bear in mind this answer is for current guidelines and those could change by the time you reach 65.

In most cases you will have your VA benefits and Medicare once you reach age 65. With VA, there are several levels of eligibility so it is important to contact VA as the time nears to find out exactly what your coverage will be.

Typically, to automatically receive Medicare Part A you must have a minimum number of credits earned from employment or receive them under a spouse's coverage. You can find out how your disability effects this requirement by calling Social Security (1-800-772-1213). You likely will need to enroll in Medicare Part B. There is a premium for Part B. Your disability and financial circumstances will effect what you are required to pay. Also, there is a penalty for enrolling outside your initial enrollment period if you are not covered under a qualified plan. VA can advise you on how your VA coverage fits these guidelines.

 Right now VA prescription coverage is considered "creditable coverage" to Medicare Part D -the drug plan for Medicare. This means you are not penalized for failing to enroll in a Medicare drug plan (Part D). You may have both Medicare Part D and VA but may only fill a prescription with one or the other, not both.

 You don't say how long you have been on VA disability. I have talked to some disabled veterans who are under 65 and because they qualify for Social Security Disability they begin receiving Medicare benefits in their 25th month of disability. VA benefits, in general, and disability benefits even more so, are complicated so be sure to check with VA for specifics to your situation.

Medicare Part D waiver

Requesting a Drug Waiver on a Medicare Part D Plan

Question: Why is it that insurance companies have the last say of all meds that we take even if the doctor’s order means that I cannot take a certain med because it causes real severe allergies that can make it more severe for my COPD? My doctor has made a great effort to help me and the insurance company won't listen. Is it because we are old and they don’t care of our quality of what little life we have left?

Answer: Insurance companies participating in Medicare Part D are required to cover drugs in all categories but not every drug available in a category. Generics are used where available. There is always an exception and there is a process for requesting an exception waiver. I have had several clients whose doctors have documented that my clients are unable to take a particular drug and must take a certain other drug, and of course the reason why. Their waiver has been granted. Perhaps your doctor is not providing the documentation required. Has your agent contacted the plan on your behalf? If your case is a documented need and not just a preference you should be able in most cases to get the drug your doctor is ordering. If you've tried all these things, you might want to consider switching plans when annual enrollment comes around (Oct 15-Dec 7, 2011). Some plans are more tightly managed and some are just easier to work with than others.