$100 Wal-Mart Gift Card Drawing

Would you like a chance to win a $100 Wal-Mart Gift Card? I am trying to get as many people as I can to "LIKE" my Facebook page, Medicare Answers from Connie. This will make it possible to reach more people who have questions about Medicare and those who are looking for Medicare Supplements and Part D Drug Plans. Everyone who “LIKE”s my page by February 28th will be entered in a drawing to win the $100 gift card, no strings! Details are on the page. All you have to do is go to Facebook, search for the Medicare Answers from Connie page and next to the name is the "LIKE" button-click it! I would appreciate your suggesting it to your friends too. Be sure to tell them about the drawing! Right under the profile picture it says "Suggest to Friends". Just click and choose your friends that you want to suggest it to (hopefully all of them). Thank you so much for helping me with this. There are so many people with questions about Medicare who don’t know where to turn and I am really trying to build this part of my business. I really do appreciate your help. – Connie Ulmer

Medicare Part D

Changes to Medicare Part D Prescription Drug plans for 2011

Question: Are there changes in the 2011 Medicare Prescription Drug Plans?

Answer: These are the changes in the 2011 Medicare Prescription Drug Plans

 Initial coverage phase has been increased from $2830 to $2840.
The initial coverage phase is the first phase of Part D Prescription Drug plans. In this phase, you pay your deductible, if you have one, and then pay copays until your total drug costs reach $2840 for 2011. Your total drug costs are made up of your deductible, the copays you pay and the amount your insurance company pays toward your drug costs. You can estimate when you will exit the initial phase by knowing the total retail cost of the drugs you take. Once you exit the initial coverage phase, you enter the Coverage Gap or Donut Hole.

 Help in the Gap.
Healthcare reform gave help in the form of a $250 rebate for people who entered the coverage gap in 2010. For 2011, people who enter The Gap will receive up to 50% off the retail cost of their medications. If you entered The Gap in the last quarter of 2010, you should receive your $250 in the first quarter of 2011.

 No increase in threshold for Catastrophic Coverage Phase.
Once your total out of pocket expense for your drugs reaches $4550, you enter the Catastrophic Phase. This is the same threshold as 2010. In this phase you have significantly lowered copays, $2.50, $6.30 or 5% of the retail cost of the drug, depending on the medication classification. You remain in the Catastrophic Phase through the end of the plan year which starts over every January.

 Reduction in plans offered and companies offering plans.
In an effort to simplify Part D Prescription Drug plans, it was mandated that companies offering these plans could offer no more than 2 choices of plans. As a result, many plans were discontinued for 2011 and many people are getting used to a new plan. Most insurance companies added deductibles to at least one of their plans. I have seen some confusion at the pharmacy with the deductibles in my clients’ situations so be alert the first few times you fill your prescriptions to make sure you are not over paying.

Medicare

TOPIC:  Medicare and the Health Care Reform Bill

QUESTION:  I’ve heard so many different things about how the new health care reform bill will affect my Medicare. Can you tell me what changes to expect?

ANSWER:  There are no drastic changes taking effect and all changes benefit you.

There are no changes to your Medicare Parts A and B benefits.

If you have a Medicare Part D prescription plan and enter the coverage gap or “Donut Hole” this year (2010) you will receive a $250 rebate. The rebate will increase over the next several years and eventually the coverage gap will be eliminated in 2020.

The Annual Enrollment Period for Medicare Part D Prescription Plans and Medicare Advantage plans has been changed and extended for 2011. The Annual Enrollment Period for 2011 will begin October 15^th and go through December 7^th. The Annual Enrollment Period for 2010 remains the same, November 15^th through December 31^st. There will be a reduction in the number of plans offered and companies offering plans that begin January, 2011.

New plan models for Medicare Supplement Plans C and F will be developed and implemented by 2015.

Safeguards have been put in to place to prevent overpayments from the government to Medicare Advantage Plans as well as assure Medicare Advantage Plan members are receiving adequate care under these plans.

If you would like more details on any of the provisions of the Health Care Reform Bill that affect your Medicare benefits you may ask a specific question or request a scheduled time to talk with me by clicking Ask A Question.

SOURCE:  http://www.medicare.gov/ , search for Publication 11467. If you are currently enrolled in Medicare, you should have received this publication in the mail.  

Medicare Part B Physician Services Fees

Physician Services Fees

QUESTION:  I have received bills from the doctors who treated me from a recent hospitalization. I thought my Medicare covered all but my deductible for hospital stays.

ANSWER:  Medicare Part A covers room, board, general nursing and miscellaneous services and supplies after you pay a deductible of $1,100(for 2010) per hospitalization. Your doctors’ fees or “physician services” are covered under Medicare Part B. Medicare Part B pays 80% of Medicare approved amounts after you pay a deductible of $155 (this $155 deductible is in addition to your Medicare Part A deductible). You are responsible for 20% of those charges. Each charge may not exceed the Medicare Part A deductible but this can add up pretty quick if you have had a serious illness or injury and been treated by several doctors.

Some Medicare Supplements would pay those approved charges that Medicare Parts A and B do not pay.

SOURCE:  www.Medicare.gov, Medicare and You 2010 Handbook; page 20

Medicare Part B Enrollment

Declining to Enroll in Medicare Part B

QUESTION: I am covered for health insurance on a group health plan. Do I have to enroll in Medicare Part B ?

ANSWER: No, but there could be some consequences to not enrolling, so do your homework!

Be sure you understand the benefits offered on your group plan. Make sure there are no gaps in your coverage.

The most critical concern comes should you ever leave or loose that group coverage. In most cases, once group coverage ends you will enter a special enrollment period that runs for eight months from the time your group coverage ends. Failing to enroll in Medicare Part B during the initial enrollment period or your special enrollment period may result in a penalty being added to your Medicare Part B monthly premium once you enroll.

SOURCE: http://www.socialsecurity.gov/ ; search for publication 10043.

Medicare and Other Health Insurance

Choosing Medicare or Group Health Coverage

QUESTION: I am retiring in a few months. I am covered on my wife’s group health plan through her job. Should I stay on my wife’s insurance or go on Medicare?

ANSWER: There are a couple important things to consider in making your decision.

First, determine if Medicare is primary or secondary to your insurance.

The number of people employed usually determines if Medicare is the primary insurance or the secondary insurance. Medicare is usually (but not always) secondary to insurance provided by businesses that employ a large number of people. Medicare is primary to insurance provided by small employers (less than 20 employees). If Medicare is secondary to your insurance, there is a good possibility you will be better off staying on your current plan. If Medicare is primary its probably not going to be the best value cost wise. Your employer’s HR department can tell you if Medicare is primary or secondary to your insurance.

Your premium cost is another consideration. Compare the cost of both options and the benefits provided. Medicare will cost, on average for a 65 year old, around $250 per month for Medicare Part B premiums, a Medicare supplement and a Part D Prescription Plan.

SOURCE: Medicare and Other Health Benefits: Your Guide to Who Pays First, A booklet available from The Centers for Medicare & Medicaid Services. I will be happy to e-mail you a copy of the booklet. Click the “Ask A Question” button and request “Who Pays First” Booklet.

Medicare Part D Enrollment Periods

Enrolling in a Medicare Part D Prescription Plan

QUESTION:  My drug costs are going up. I would like to get a Medicare Part D Prescription Plan.

ANSWER:  Unless you meet one of the following conditions for an exception, you will have to wait for annual enrollment to enroll in a Medicare Part D Prescription Plan.

Those exceptions are:
- You are new to Medicare
- You recently moved outside your current plan’s service area
- You recently moved in or out of a nursing home
- Certain situations where you receive financial assistance in paying for your premiums
- You have lost or are losing employer coverage

Annual enrollment has been set by the healthcare reform bill to begin October 15, 2010 and run through December 7, 2010. THIS IS A CHANGE FROM PREVIOUS YEARS. Once enrolled, your plan will begin January 01, 2011.

Should you choose to enroll in a Medicare Part D Prescription Plan during annual enrollment and you don’t meet one of the above exceptions, you may be subject to a penalty added to your plan premium. This penalty is 1% of the monthly cost of the average premium in you geographic area, multiplied by the number of months you have gone without enrolling in a plan. For example, if the average premium is $36 per month, 1% of $36.00 is 36 cents. If you have gone without enrolling in a plan for 12 months, $4.32 ( .36 x 12 months ) may be added to your new plan premium each month.

SOURCE:  http://www.medicare.gov/, Medicare and You 2010 Handbook; pages 63-67.