• Health and Wellness

by doed

January 30, 2020

Medicare Part D | Prescription Drug Coverage 101

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Understanding Medicare

Medicare is the federal health care insurance program primarily for those of retirement age. The program was signed into law in 1965 and today covers over 60 million Americans. Medicare is divided into four parts—Part A, Part B (Part A and B are collectively known as Original Medicare), Part C, and Part D. 

What Is Medicare Part D?

Medicare Part D, also known as Medicare prescription drug coverage, is an optional program to help you cover the cost of prescription drugs. The Medicare prescription drug plan (PDP) was officially enacted in 2003 under the Medicare Modernization Act and went into effect on January 1, 2006. Under this act, Medicare Part D provided prescription drug coverage through private companies to Medicare beneficiaries.

What Does Medicare Part D Cover?

There are a variety of plans to choose from under Medicare D. Each plan offering has their own list of covered drugs. This list of drugs is called a formulary. A formulary includes both brand-name prescription drugs and generic drugs. All plans must cover at least two drugs per drug category. 

Using the drugs listed on the plan will save you money because the insurance coverage provider negotiated a lower price. If you choose a drug not listed on your plan you will have to pay full price for the drug instead of a copayment or coinsurance. Generally if your specific drug is not listed on the plan, there will be a comparable alternative available through your coverage. You can also apply for a formulary exception to have your drug approved through your insurance provider.

Each plan’s formulary will list drugs under different tiers. The higher the tier, the more expensive the drug will be to you. A breakdown of Medicare Part D’s cost structure is listed below under copay tiers.

What Are the Costs of Medicare Part D Plans?

Medicare will cover a portion of your prescription drug costs. The costs that you cover for prescription drugs is considered your out-of-pocket costs. Your out-of-pocket costs will depend on the following factors:

• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan’s network
• Whether the drugs you use are on your plan’s formulary  
• Whether you get Extra Help paying your Medicare Part D costs

Extra Help is an assistance program to help cover some of the Medicare costs. To qualify for Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

The following are the payments associated with Medicare Part D plans: 

Premium: Your monthly premium will depend on the area in which you live and the plan you choose. When reviewing your premium cost be sure to weigh it against the overall cost per year and the cost of the drugs you take. In other words, a lower monthly premium may or may not be the best choice for you if the other payments are much higher. Weigh all of the options before making a decision. 

Deductible: The deductible is the amount of money you must pay out of pocket before Medicare will cover costs. For example, a $300 deductible means that you will need to pay $300 before your insurance plan covers the remaining costs. A lower deductible may be a good option, however you should also compare the premium and other costs to ensure that it is the best financial fit for your situation.

Copay: A copay is a fixed dollar amount for your prescriptions. For example, you may have to pay $10 for a generic drug and Medicare will cost the remainder of the costs. 

Copay tiers: Each Medicare Part D plan places drugs in different tiers. These tiers determine how much your copay amount will be for each drug. The lower the tier, the lower the cost will be to you. Generic drugs are typically labeled as Tier 1 drugs.

Coinsurance: Coinsurance is the percentage of the prescription cost that you are responsible for covering. Typically plans require coinsurance for drugs in higher tiers.  

Coverage gaps: With Medicare, there is a threshold where the insurance coverage no longer covers the costs of drugs and you are required to pay out of pocket. The point where Medicare Part D stops paying is called the “donut hole.” The cost between the donut hole and catastrophic coverage is known as the coverage gap, and a percentage of it will need to be covered by you. This year, it is expected that you will not have to pay more than 25% for covered brand-name and generic drugs during the gap. In previous years, the percentage you had to cover was much higher. Now the insurance companies will be responsible for more of the cost.

Catastrophic coverage: In 2020, catastrophic coverage kicks in when your out-of-pocket costs for prescription drugs reaches $6,350. This is an increase from 2019 when the dollar amount was set at $5,100. At this dollar amount, Medicare will cover the majority of the remaining cost of the drugs. The amount you will be responsible for will be under 5%.

Late enrollment penalty: The late enrollment penalty is an amount added to your monthly premium. You may owe this amount if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of the following:

• A Medicare prescription drug plan (Part D)
• A Medicare Advantage plan (Part C) 
• Creditable prescription drug coverage

Is Medicare Part D Right for You?

You may wish to enroll in a Medicare Part D plan if:

• You use prescription drugs on a regular basis
• You think you may need prescription drugs in the future
• You do not have prescription drug coverage
• You are worried about increasing prescription drug costs
• You are having trouble paying for your prescription drugs

How to Enroll in Medicare Part D

In order to enroll, you must be eligible for Medicare. You are eligible for Medicare if you meet one of the following qualifications:

• You are age 65 or older
• You have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months
• You have been diagnosed with end-stage renal disease
• You are entitled to Medicare Part A and/or enrolled in Medicare Part B

The Initial Enrollment Period is a seven-month timeframe that begins three months before the month you turn 65 and ends three months afterward. During this period you can enroll into Medicare Part D. If you miss the initial enrollment period then you can sign up during the general enrollment period which runs every year from January 1 to March 31.

Once you are eligible, the first step to enrolling is to review the private plan offers available in your location. To learn about Medicare Advantage, Supplement, and Prescription Drug plans, request a free quote.

• Lifestyle

by doed

January 27, 2020

AARP Medicare Supplement Plans in 2020

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Find Your Medicare Supplement Plan in 2020

While Medicare Parts A and B, also known as Original Medicare, cover some health care costs, they don’t pay for everything. That’s where an AARP Medicare Supplement insurance plan may help. Medicare Supplement insurance plans, also known as Medigap, from private insurers help you pay for the costs not covered under your Original Medicare benefits. 

Medicare Supplement plans are set by the federal government which means that the basic benefit structure is the same from one insurance company to the next. However, some plans do offer additional benefits.

There are 10 standardized Medicare Supplement plans. Each plan has a letter assigned to it. The letters are specific to Medicare Supplement plans and have nothing to do with the parts of Original Medicare. For example, Medicare Supplement Plan B is not the same as Medicare Part B. 

Each Medicare Supplement plan offers the same basic benefits but some offer additional benefits. In Massachusetts, Minnesota and Wisconsin, Medigap policies are structured differently.

Insurance companies can choose which Medigap policies it wants to offer, as long as they comply with the state’s requirements. Insurance companies that sell Medigap policies:

• Don’t have to offer every Medigap plan
• Must offer Medigap Plan A if they offer any Medigap policy

In this article, you will learn about AARP Medicare Supplement plans.

AARP Medicare Supplement Plans

Through UnitedHealthcare, AARP offers eight Medicare Supplement plans. In 2019, they had over four million members enrolled within their supplement plans.

Although all of the plans are the same regardless of which insurance company you choose, each private insurer has the option to offer additional benefits.

One of the benefits of AARP’s Medicare Supplement plans is speedy service. AARP successfully processes 98% of claims within 10 days. In addition to timeliness, some additional benefits may include:

• The ability to see any specialist without a referral
• Limited claim forms to fill out
• Coverage during your travel 
• Medicare Part A hospitalization coverage — usually there is a coinsurance fee associated with Medicare Part A, some AARP Supplement plans will cover this cost plus coverage for 365 additional days after Medicare benefits end
• Medicare Part B medical expenses — usually there is a coinsurance or copayment fee associated with hospital outpatient services under Medicare Part B, some AARP Supplement plans will help cover these costs
• Blood — some plans will cover the first three pints of blood each year
• Medicare Part A hospice care — usually there is a coinsurance or copayment fee associated with hospice care, some AARP Supplement plans will help cover these costs 
• Skilled nursing facility care — usually there is a coinsurance fee associated with skilled nursing care, some AARP Supplement plans will help cover these costs
• Medicare Part A deductible — some AARP Supplement plans will cover your deductible
• Medicare Part B deductible — some AARP Supplement plans will cover your deductible
• Medicare Part B excess charges — some AARP Supplement plans will cover these additional fees sometimes related to extended care
• Foreign travel emergency care — some AARP Supplement plans will extend coverage to you during your travels outside of the United States
• Annual out-of-pocket maximum — some AARP Supplement plans will limit how your out-of-pocket costs and cover the remaining balance if your expenses exceed this amount

AARP Medicare Supplement Insurance Coverage

Overall, Medicare Supplement insurance plans give you more complete coverage by helping you pay for some of the out-of-pocket costs that Medicare does not cover. 

With AARP Medicare Supplement plans: 

• You’re able to keep your own doctor who accepts Medicare patients
• See any specialist without a referral
• There are no claim forms to fill out
• Coverage goes with you anywhere in the U.S. when you travel

The cost of each plan is dependent upon your area or region and specific coverage needs.

Are You Eligible for AARP Medicare Supplement Plans?

To be eligible for Medicare Supplemental coverage, you must already be on Medicare or turning 65. You can enroll for Medicare coverage up to three months before your 65th birthday and up to three months after your birthday. This is known as the Open Enrollment Period. If you already receive Social Security benefits, you will be automatically enrolled in Medicare. 

The Open Enrollment Period for buying Medicare Supplemental coverage is six months after you turn 65. During this period, the insurer cannot take into consideration any pre-existing medical conditions if you enroll during this “open enrollment” period. Even though the carrier cannot prevent you from buying supplemental insurance, they can make you wait another six months until the coverage goes into effect for pre-existing conditions. 

If you are worried about the expense of copays, coinsurance, and deductibles not covered by Medicare, an AARP Medicare Supplement plan may be a good fit for your insurance needs. 

To enroll in AARP Medicare Supplement plans, you must first become an AARP member. You can complete the AARP membership application online. If you have more questions about AARP’s Medicare Supplement plan, you can contact AARP for more information, or request a free quote. Call toll-free at 888-OUR-AARP (888-687-2277) or email member@aarp.org. 

• Health and Wellness

by doed

January 24, 2020

AARP Medicare Plans: What You Need to Know

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Understanding Medicare and AARP Medicare Plans

Medicare is a federal insurance program with four parts—Part A, Part B, Part C and Part D. Part A and B are known as Original Medicare. AARP Medicare Supplement plans help pay for some of the costs not covered by Original Medicare.

Part C, also known as Medicare Advantage, offers insurance coverage through private companies such as AARP. In order to sign up for AARP Medicare plans you must be enrolled in Original Medicare.

Part D provides prescription drug coverage. Prescription drug coverage is available to AARP members through the prescription drug plans (PDPs). AARP offers Medicare plans insured by UnitedHealthcare Company. UHC is a private insurance company that contracts through Medicare to provide coverage to beneficiaries. Below are the Medicare health insurance plan offerings through AARP.

Medicare Advantage Plans Offered through AARP

AARP Medicare Advantage plans, insured through UnitedHealthcare, include Medicare Part A (hospital stays), Medicare Part B (doctor visits) and, in most cases, Medicare Part D (prescription drug coverage). 

Every plan has its own unique benefits. Additional plan benefits may include:

• Preventive services—some plans offer a $0 copay when you visit your in-network primary care provider to receive preventive services. Below is a list of the preventive services offered through AARP Medicare Advantage: 

• Disease management programs — these programs are designed to help members who have chronic conditions, such as diabetes or certain types of heart disease. 
• Health management programs — these mail-based programs focus on self-care and are designed to provide members with guidelines on how to stay healthy and avoid disease. 
• Alternative care services — some plans offer alternative therapies in preventing and treating disease, healing illness, and promoting health. Covered therapies include acupuncture and/or chiropractic care in some areas under some plans.
• Dental — dental coverage is now available with most Medicare Advantage plans. All plans that include a dental benefit cover exams, annual X-rays, cleanings, and fluoride for a $0 copay with in-network dentists. Many plans may also include dental coverage for fillings, crowns, bridges, dentures, and certain types of root canals.
• Vision — nearly all Medicare Advantage plans offer $0 copay annual eye exams. Many plans also offer an eyewear allowance on contacts or frames. Lenses may be covered in full, including designer-quality prescription glasses such as Warby Parker. 
• OTC (over-the-counter) — this benefit will help you save 40% or more on OTC medications and products. 
• Hearing — many Medicare Advantage plans offer $0 annual hearing exams and low copays on name brand and private-label hearing aids. Through UnitedHealthcare Company, AARP has a nationwide network of over 5,000 hearing provider locations and online ordering with home delivery.
• Virtual medical visits — this benefit gives you the ability to live chat with a licensed virtual provider from the comfort of home or any location. You have unlimited access to these visits for a $0 copay. Many plans also offer virtual behavioral health visits for a low or no copay.

Medicare Prescription Drug Plans

Most AARP Medicare Advantage plans (Part C) include Part D coverage. Medicare Part D, also known as a Medicare prescription plan, helps cover the cost of your medication. 

All plans include brand and generic drugs, but vary in terms of which specific drugs it covers. The list of drugs a plan covers is known as its formulary. Within the formulary, there are tiers of drugs. The higher the tier, the more expensive the drug.  

Medicare Supplement Plans through AARP

Medicare Supplement insurance plans, also known as Medigap, help pay for some of the healthcare costs not covered by Medicare Part A and Part B. These costs include coinsurance, copays, and deductibles. 

In addition to covering healthcare costs, some of AARP’s supplement plans include the following benefits:

• Renew Active—through some Medicare Advantage plans, you will receive access to various gyms and fitness locations at no additional cost. And rewards for remaining physically active.
• AARP Staying Sharp– this online program includes a brain health assessment, brain exercises, recipes and activities designed to nurture a healthy brain.
• Hearing Care Program by HearUSA—through this program you receive a discount on hearing aids and access to screenings by certified HearUSA hearing care providers.
• AARP Vision Discounts provided by EyeMed—with this benefit you save on eyewear purchases and routine exam exams
• NurseLine Plan—with this benefit you receive 24/7 phone access to a registered nurse. The nurse can help answer medical questions and/or guide you to outside help if necessary. In addition to registered nurses, NurseLine also has a health information library with recorded messages on more than 1,700 health topics. This service is intended for non-emergency needs.
• Wellness coaching—with this benefit you receive access to trained coaches to reach their health and fitness goals.
• Foreign travel—some plans cover emergency care services during a portion of your trip(s) outside of the United States 

To be eligible to apply for a Medicare Supplement plan, you must be an AARP member or spouse of a member, enrolled in both Part A and Part B of Medicare, and not covered under any other Medicare Supplement plans. 

If you are not yet age 65, you are only eligible to apply if you do not have end-stage renal disease and then you may only apply for A, B, C, F or K, unless you are in your birthday Open Enrollment Period and replacing a Medicare Supplement plan. 

You must apply within six months after enrolling in Medicare Part B or receiving notification of your retroactive eligibility for Medicare Part B, unless you are entitled to Guaranteed Issue. 

What Are the Costs of AARP Medicare?

All AARP Medicare Advantage plans include the following payments:

1. A monthly premium
2. A deductible
3. A copay
4. Coinsurance

The amount of each payment varies based upon the plan you choose and your state or region. The payments associated with PDP plans depend upon the tier of the drugs as described above in the Medicare prescription drugs section.

When Can You Enroll AARP Medicare?

In order to enroll into AARP Medicare, you must:

1. Be an AARP member
2. Be enrolled into Original Medicare (Medicare Part A and Part B) and 

To apply to be an AARP member, visit AARP.org/membership. On their site you will also find the monthly payment information and a full list of the benefits provided to members. In addition to healthcare insurance, AARP also offers car, vehicle, and property insurance, as well as a plethora of other benefits offered to members.

The second step is to be enrolled into Original Medicare. You will be automatically enrolled in Medicare Part A once you qualify for federal retirement benefits. If you are not automatically enrolled, you will need to enroll during your Initial Enrollment Period. The initial enrollment period begins three months before your 65th birthday and ends three months after your birthday. If you miss this period, you can enroll during the general enrollment which runs from January 1 to March 1.

You can enroll into Medicare Part B during the same time periods. This can be the Initial Enrollment Period or the General Enrollment Period if you happen to miss the initial. In the event of a life change such as your employer or spouse health insurance ends, you will have access to a special enrollment period. 

When enrolling in Medicare, you can consult an insurance agent or utilize free resources. In order to enroll, you can choose one of the three following options: 

1. You can apply by visiting your local Social Security office or
2. Calling Medicare at 1-800-772-1213 or 
3. By filling out a simple application at the Social Security Administration website. Note if you have Medicare Part A and wish to add Medicare Part B, you will not be able to fill out an online form to do this. You will have to call the above number or visit your local Social Security office. 

Once you are enrolled into Original Medicare, review the plans offered by AARP to determine which one(s) are the best fit for your situation. A licensed Medicare insurance agent can help you understand your options and provide you with a free personalized quote. 

• Lifestyle

by doed

January 21, 2020

Is Humana Medicare Right for Me?

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Enrolling in Humana Medicare

Medicare is a federal insurance program with four parts—Part A, Part B, Part C, and Part D. Humana is a private insurance company that contracts through Medicare to provide coverage to Medicare beneficiaries. In 2019, Humana Medicare had 8.4 million members.

Part A and B are known as Original Medicare. As a private insurer, Humana offers Medicare Supplement plans to help pay for some of the costs not covered by Original Medicare.

Part C, also known as Medicare Advantage, coverage offers beneficiaries insurance coverage through private companies such as Humana. In order to sign up for Humana, you must be enrolled in Medicare Part C.

Part D provides prescription drug coverage. Humana Medicare also offers prescription drug coverage to its members. Below are the plan offerings through Humana.

Humana Advantage Plans

Humana’s Advantage plans provide all of the benefits of Original Medicare along with additional benefits. There are four plans under Humana Advantage including:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee For Service (PFFS)
• Special Needs (SNPs) 

Each plan offers a unique set of benefits. Below are some of the benefits provided under these plans. These benefits are solely and only provided to Humana beneficiaries.

1. Choice of a primary care physician from within the plan’s provider network
2. $0 monthly premium on some plans in some areas
3. Prescription drug coverage for some plans
4. Emergency coverage anywhere in the world
5. Coverage for most annual preventive screenings at no additional cost to you
6. Hospitalization coverage
7. Membership in the SilverSneakers fitness program on most plans
8. In-network home healthcare
9. Free coverage for most annual preventive screenings
10. Optional fitness programs for an additional premium
11. Prescription drug, vision plan and dental insurance coverage for additional premiums

Prescription Drug Plans (PDPs) through Humana Medicare

Humana’s prescription drug plans (PDPs) offers prescription drug coverage through Medicare Part D. There are three plan options including the Humana Basic Rx plan, Humana Premier Rx plan and Humana Walmart Value Rx plan.  

Each plan offers its own unique benefits. Some of the benefits a plan may offer include:

1. Preferred pharmacies that extend additional savings to Humana members
2. Mail-delivery service for a fee
3. $0 or $1 copays after deductible for generic drugs 

What Are the Costs of Humana Medicare Plans?

All Humana Medicare plans include the following payments:

1. A monthly premium
2. A deductible
3. A copay, although some plans offer a $0 copay
4. Coinsurance

Each plan’s premium varies depending upon the state or region. With PDPs plans, the premium is also determined by the tier of the drug. 

Below is a breakdown of the drug tiers. The higher the tier, the more expensive the drug.

To help cover some of your Medicare costs, Humana also offers supplement plans.

Medicare Supplement Plans through Humana Medicare

Medicare Supplement plans, also known as Medigap, help pay for some of the health benefit costs not covered by Medicare Part A and Part B (Original Medicare). These costs include coinsurance, copays and deductibles. 

To qualify, you must be enrolled in Medicare Part A and Part B and reside in the state where the policy is offered.

In most states, Medicare Supplement plans are standardized into plans labeled A through N. Medicare Supplement insurance plans A through G provide benefits at higher premiums with limited out-of-pocket costs. Plans K through N are cost-sharing plans offering similar benefits at lower premiums with greater out-of-pocket costs. 

When Can You Enroll in a Humana Medicare Plan?

To be eligible for Medicare you must be over the age of 65, or have a disability or End stage renal disease. Once you are eligible and signed up for Medicare, you will receive a Medicare ID number. You will need this number to enroll into a Humana plan. You can enroll online or call a licensed Humana sales agent at 1-855-578-6813.