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Have You Checked Your Plan Recently?

Published by SSO

We have recently discussed a number of different proposals that could alter seniors’ access to the medicines through the Medicare programs we rely on to stay healthy. It is critical that we, as seniors, are our own best advocates and that includes making sure we are up-to-speed on the provisions of our personal Medicare plans.

Health insurance can be complicated, which is why we are here to provide guidance for seniors so we can make the best decisions for our personalized needs. As we have discussed, Medicare Parts A and B, the parts that cover hospital and medical insurance, are included in your Medicare coverage as soon as you turn 65 years old. However, Medicare Part D, which is an optional add-on service, covers many of the prescription medications that we rely on every day.

Although Medicare Part D is optional, an overwhelming majority of seniors choose to add this important part of health coverage to their plans. In fact, out of the 60 million American Medicare beneficiaries, 43 million were also enrolled in Part D coverage as of May 2018—showing just how important this part of the program is to seniors’ overall quality of life.

It is critical that we keep on top of our Medicare plans to make sure they are working for us and our needs. The fall open enrollment season may seem far away now, but it is right around the corner! Make sure you are checking your coverage options, and stay informed, empowered, and independent!

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Happy Birthday Medicare!

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On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965, officially creating what we now call Medicare. Now celebrating its 53rd birthday, Medicare has helped seniors across the nation to better afford the care and medications they need.

In honor of Medicare’s birthday, Seniors Speak Out wanted to provide a brief overview of Medicare’s four parts for those who may be unfamiliar with the program or may be preparing to sign up for Medicare for the first time this year. Below you’ll find a brief explanation of each part, as well as a handy graphic that you can keep on hand for reference. You can also learn more by clicking the links to Medicare.gov’s web pages on each of the four parts.

Medicare Part A: Part A was created as part of the original Medicare law and helps provide a variety of services, including hospital stays, hospice care, and nursing home care.

Medicare Part B: Part B was also created as part of the original Medicare law and covers outpatient services like doctor visits, ambulance services, and mental health services as well as preventative services like vaccines.

Medicare Part C: Also called “Medicare Advantage Plans,” Part C is coverage offered by Medicare-approved private companies. Advantage Plans cover all your original Medicare services, but can also extend to prescriptions, dental, vision, and other types of coverage.

Medicare Part D: Part D is the newest part of Medicare and covers prescription drug medications. To receive Part D coverage, you must opt in for a plan when you turn 65 by using one of these two options.

With each part covering such important aspects of care, it’s clear that Medicare is instrumental in helping seniors acquire the medical services they need without being overburdened by costs. As we celebrate another year of this important program, we’d love to hear how Medicare has helped you! Feel free to reach out to us over Facebook and Twitter to share your Medicare story!

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Call on Congress to Fix the Medicare Part D Cliff!

Published by SSO

Attention seniors! In 2020, you may be faced with a significant spike in out-of-pocket spending under the Medicare Part D prescription drug benefit.

A measure included in the Affordable Care Act that slowed the growth rate of the “catastrophic threshold” is set to expire. This will cause the catastrophic threshold, or the amount of out-of-pocket spending needed to reach catastrophic coverage, to increase by an estimated $1,250 from 2019 to 2020.

Such a drastic increase could have terrible consequences for seniors on Part D. As you may know, once beneficiaries reach the catastrophic coverage phase, we are responsible for about 5 percent of our prescription drug costs. Unfortunately, this change will force many Medicare beneficiaries to spend substantially more out-of-pocket before reaching that phase, threatening our ability to afford the medications we need. The dramatic out-of-pocket cost increase many will experience could have especially disturbing consequences for patients with chronic conditions and mental illness, who might be forced off their medication entirely.

We need to let our Members of Congress know just how important Part D is to our health and wellbeing. Join us in calling for Congress to protect our access to medication NOW!

You can tell your members to stand up for a fix to this coverage cliff by signing on to the letter here: https://www.votervoice.net/SSO/campaigns/59358/respond 

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Seniors Speak Out About What Part D Means to Them

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There are about 42 million Americans with Medicare Part D insurance for their medicines. We have different health conditions, take different medicines, live in different states and are covered by hundreds of plans. There is something we do share, however: our understanding of the importance and value of Part D coverage to our health and well-being.

Let me be the first to share my story about how and why Part D helps me personally. Before I reached 65, the insurance coverage I had available to me had very limited benefits for medicines, and one of my medicines wasn’t even covered at all. It was stressful and very costly. Now, I have a plan that works perfectly for me, and all my medicines are covered. When I moved three years ago, I was even able to choose a plan that worked with pharmacies in my new neighborhood and still get the same value I had been receiving before.

Here are some other stories from your friends and neighbors around the country:

Doug from Minnesota first made the change to Part D during open enrollment in the fall of 2016, and noticed that the change saved him $26 a month, on top of not having a co-pay for visits to the clinic. In his own words, for him “drug costs are minimal.” Even better, he is able to fill his prescriptions from his local pharmacy and support their business. As he says, “Being from a small town of 800 people it is critical to support the local pharmacy rather than the mail order system.”

Then there is Claudia from Alabama. Claudia has seen just how helpful Part D can be at a couple of different points in her life. The first came during her mother’s illness. Part D was instated while her mother was sick and she was able to see first-hand the “huge difference” that Part D made in her mother’s care. Now that she has it herself, she is happy to have access to it, as it “can really save you money.”

Robert from New Hampshire is a lung transplant recipient, which he noted “has drastically changed my views about Medicare Part D.” He and his wife used to get insurance through work, but a sudden change in employment meant they had to find a new plan. Everything they found meant increased drug prices and shorter prescriptions for the medication Robert needed, but his insurance agent eventually recommended Part D, which provided every medication he needed, and on 90-day prescriptions instead of the 30-day ones offered by other plans. By Robert’s own estimates, he now saves between $2,500 and $3,000 every year, in addition to fewer trips to the pharmacy due to the increased prescription length.

These are just a sampling of the outpouring of responses we received when we asked people to speak out about how Part D has helped them. These and other stories demonstrate how Part D remains an essential piece to our good health and quality of life.

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Keeping Part D Strong: The Value of Choice

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Consumer choice is one of the most powerful tools in any marketplace. Don’t like the service at Restaurant A? No problem, there are many others waiting to serve you. Department Store X is having a great sale and Store Y isn’t…I know where I’m going to shop.

As consumers and smart shoppers, we vote with our pocketbook every time we make a purchase, and by doing so, we affect the market that wants our business. While we embrace the importance of competition in many other types of commerce, we often overlook its importance in health care.

For Medicare Part D, choice is a critical part of the program design. In fact, there was initial concern there would not be enough plans offered. However, as you know, the opposite happened. Many companies entered the Medicare Part D marketplace and continue to provide seniors like you with a wide variety of plan options so you can find one that best meets your individual needs.

Choice — and the resulting competition among plans — has made you the real winners by keeping premiums steady, program satisfaction high and making Medicare Part D a successful public-private initiative.

Some want to change this successful program – to limit choices or undermine the elements of consumer empowerment that have made it so successful. Attempts to weaken and disrupt Part D’s competitive structure do not serve the best interests of the seniors like you who benefit from the program. As Part D beneficiaries, we need to stand firm to protect this program which is fundamental to our health and well-being.

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Protect and Preserve the Medicare Part D LIS Program

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Sometimes there is a double meaning to the term “Medicare reform.” “Reform” can mean improve and strengthen or it can mean change and weaken.  One example is a proposed reform of the Medicare Part D Low-Income Subsidy (LIS) Program, also known as Extra Help. This program saves low-income beneficiaries close to $4000 per year in prescription drug costs according to the Centers for Medicare and Medicaid Services (CMS).

The proposed reform would change and weaken the program by requiring low-income Medicare beneficiaries to pay higher copays for brand name drugs while lowering copays for generic drugs. The reform, first proposed by the Medicare Payment Advisory Commission (MedPAC), aims to drive more seniors and individuals with disabilities to use generic drugs, which in theory could lower costs to Medicare.

However, this proposed reform is flawed for a number of reasons. It fails to take into account that many patients, including those at or below the poverty level, require access to brand name drugs because their doctor has determined these medications will produce more positive health outcomes than generic medications would provide. In these instances, patients must have affordable access to brand name drugs or their health and well-being could suffer as a result.

Unfortunately, the proposal would increase cost sharing for these patients.  According to analysis by the Leadership Council on Aging Organizations (LCAO), this would deter access to needed medicines which could in turn lead to much higher Medicare costs on other types of health care services.

Further, even if this change provided some exclusion for certain therapeutic classes of drugs, the exclusion may not be broad enough to address the treatment of chronic diseases for which there are often no generic substitutes.

The LIS program must be protected and preserved. This program works to keep cost sharing low for the most vulnerable beneficiaries to ensure patients can access the treatments they need. Adding to those costs could make health care unaffordable for them. The most inappropriate way to celebrate Medicare’s 50th anniversary in 2015 would be to adopt an LIS reform proposal that increases costs for low-income people instead of maintaining its commitment to improve their quality of life.

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Stand Alone or Take Advantage?

Published by SSO

A very important question you should ask regarding Medicare prescription drug coverage is what type of plan you want.  There are two very different choices.

The first is to enroll in Medicare Part D. This is a stand-alone plan that covers just your medications. You use this coverage in conjunction with the medical coverage you receive with Medicare Parts A and B (hospitalization, provider visits, testing, etc.).

The other option is to opt for a Medicare Advantage Plan that provides all of the health care services under Part A and B as well as coverage for your medicines in one plan. Examples of Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Medicare Medical Savings Account Plans, and Special Needs Plans.

Both types of plans have advantages, the right choice for you depends on many factors including where you live and your preferences regarding provider choice. Also, be sure to examine more than just the bottom line on premium costs when evaluating any program.

Some beneficiaries choose to enroll in traditional Medicare health coverage as wells as a stand-alone drug plan (Part D) because it gives them freedom to choose providers without having to coordinate within a network or get referrals. The Part D plans cover your medicines but do not include extra services or provide care. (Note: Some beneficiaries who have regular Medicare and Part D plans also purchase Medicare Supplemental Insurance to assist in copayments and deductibles for medical services.) Part D plans are available throughout the United States, so you have this option no matter where you live.

On the other hand, Medicare Advantage Plans provide health coverage through specific provider networks and facilities. Once you enroll, you are required to seek care within your network. In some cases, these plans also offer additional services not available to beneficiaries who aren’t in their program. Medicare Advantage Plans contract with Medicare to provide Medicare Parts A and B services as well as coverage for your medicines. If you choose to enroll in a Medicare Advantage Plan you do not need to purchase Medicare Supplemental Insurance. These plans are not available everywhere, so it’s important to check what is available in the region or area in which you live. You can check online using the plan finder at www.medicare.gov or use our tools to find a local office to assist you in your search.

Here are a few questions to consider when determining what is right for you:

  • Does my current doctor or other care provider participate in the Medicare Advantage Plan?
  • If not, am I willing to change doctors/providers?
  • Are the care providers and other facilities in Medicare Advantage Plans convenient to me?
  • Are my medicines covered?

One last thing: Medicare provides a rating of 1 to 5 stars for Medicare prescription stand-alone plans and Medicare Advantage Plans. These ratings are based on both Medicare quality standards and beneficiary experience. For a full explanation of the star rating system, go to www.medicare.gov and don’t forget to look for and consider the rating as you select a plan.

Remember that a Medicare is open 24/7 at 1-800-633-4227.

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Thanksgiving Plans???

Published by SSO

Thanksgiving weekend has been a traditional time for discussion and consideration of Medicare Part D plans. This year, as families gather, both Medicare beneficiaries and younger family members may be considering their various healthcare coverage options. It’s a great thing to do because plans and coverage needs can and do change from year to year!

The tools Medicare has provided on its website, www.medicare.gov, have become even more streamlined and user friendly over the years, and surveys consistently show that those of us who use them appreciate that convenience as well as the coverage we receive.

Happy Thanksgiving!

So, if you haven’t already done so, take a break from that post-turkey-dinner nap, non-stop football, or Black Friday shopping and go over your Part D coverage!   Don’t forget to also check out all of the resources that are available at www.SeniorsSpeakOut.org!  They will get you prepared for the tasks at hand.

Remember, www.medicare.gov is ready and waiting all the time, and though Medicare’s call center is closed of Thanksgiving Day, you call them bright and early Friday morning or any other time including the weekend at 1-800-633-4227.

Have a safe and wonderful Thanksgiving!

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Shopping for Plans In-Person or Via the Phone

Published by SSO

Earlier this week on the blog, we laid out the simple steps you can take to compare plans and shop for coverage using the online tools, such as the Plan Finder, available at www.medicare.gov. Of course, there are people of all ages who are not comfortable putting all their information into a computer – or at least trying to do it without help. Fortunately, Medicare understands this. If you would rather have an in-person discussion or talk to a specialist on the phone, those resources are available as well.

The initial steps to shopping for coverage are the same whether with a representative or online. Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. You’ll also need your Medicare card available which will have key information like your Medicare number and the date you became enrolled in Medicare.

If you don’t use a computer or have one available, you can call your local Area Agency on Aging and make an appointment to meet with the SHIIP Counselor who can help you compare available plans. You can find information on local agencies using our online mapping tool. When you go, remember to bring your medication information and your Medicare card with you when you go.

Additionally, you can speak to a Medicare counselor over the phone any day of the week by calling 1-800-MEDICARE or 1-800-633-4227. A live person will walk you through any questions or concerns you have along the way. They are available 7 days a week excluding federal holidays.

How long will this process take? Probably about an hour or so.  Not long, but enough time to maybe save you money or at least confirm that you are getting the best coverage you can for the medicines you take.

Finally, you can always get information directly from the plan you are interested in. To do this, go to the Plan Finder on the Medicare website, follow the directions, and you will get a list of plans in your area. Click on the name of the plan in order to obtain the contact information. You can also call a local SHIIP Counselor to get plan contact information.

Have you gone through the paper enrollment process? Any guidance you would share with fellow seniors? We’d love for you to sound off in the comment section or through our Facebook page to let us know about your personal experience.

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Online Tools to Shop for Part D Coverage

Published by SSO

It is interesting to hear younger people talk about how hard it is to choose health insurance plans. They’re right. Evaluating all the intricacies of multiple plans can at times be a significant challenge. That’s why Medicare beneficiaries are incredibly fortunate. We have easy-to-use tools and real people to help us compare choices and select the Part D plan that’s right for us.

A quick visit to the Medicare Plan Finder website is all you need to get started using the tools that are available to compare plans. So, if you are thinking about reviewing your Medicare Part D plan options now that it is open season – and you really should be thinking about it – here are some easy steps to follow.

Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. With that information, a laptop or tablet computer, a phone, and your Medicare card, you are ready to go.

Once on the Medicare Plan Finder website, you will be asked if you want to look broadly at all of the plans available in your area or do a more personalized search which requires providing your name, Zip Code, Medicare Number, date of birth, and the year your Medicare coverage became effective. All of that information can be found on your Medicare card. If you or someone searching for you has never put in your information before, you should use the General Search option.

Continuing with the General Search, you next have to provide some information about yourself and your income and Medicare status as well as the list medicines you take and their dosage. All of this is necessary to help narrow down the list to plans that are right for you.

If you have searched for coverage before, it’s even easier. Simply choose the Personalized Search option and it will automatically reflect the information you provided the last time you compared plans. It will also give you the chance to update the information with any changes or additions.

From that point on, just follow the directions on the screen until you have a number of choices that you are comfortable working with, or in some cases, a single choice that best meets your needs. You can always go back and change the search data to get more or fewer choices.

But the best news is that if you need help or have questions, — day or night, weekday or weekends — you can call 1-800-MEDICARE or 1-800-633-4227 and speak to a live person. They’re available anytime except federal holidays.

Watch the blog for more information this week about the resources available to you if you’d rather not search for a plan online. In the meantime, let me know what your experience has been like with the online tools – both good and bad.