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Healthcare Coverage for Rheumatoid Arthritis

by Jagger Esch
written by Jagger Esch

Anyone with a chronic health condition knows it’s important to have healthcare coverage. For those with Rheumatoid Arthritis, healthcare coverage is vital.

Rheumatoid Arthritis (RA) is an autoimmune disease affecting approximately 1.5 million people in the United States. It happens to be the most common inflammatory joint disease, affecting 1-2% of the worldwide population.

The chronic inflammatory disease causes the immune system, which usually protects the body, to attack its own joints.

One of the biggest concerns for most suffering from a chronic illness is health insurance coverage. The second being out of pocket costs.

Medicare Coverage for Rheumatoid Arthritis

Looking for a health insurance plan can be a daunting experience, to say the least. Looking for a plan that includes major medical, hospitalization coverage and prescription drug benefits can be even more intimidating.

Finding a plan that’s affordable and one that meets your needs can be downright stressful! While researching Rheumatoid Arthritis coverage, you’ll want to look at the different types of insurances.

There are a variety of policies available, talking with a licensed insurance broker in your state will allow you to confidently choose which policy is most beneficial to your individual healthcare needs.

There are many different types of insurance, each offers coverage a little differently and it’s up to you to make the final decision on the best policy for you.

Coverage from a Medicare Advantage Plan

Medicare Advantage Plans will take over for Traditional Medicare benefits. They sometimes offer additional benefits like vision, dental and prescription drug coverage which isn’t normally covered with regular Medicare.

These plans contract with a group of healthcare facilities and pharmacies to provide services to beneficiaries. While premiums are generally lower, the policy limitations tend to outweigh any of the Advantage Plan benefits.

Health Maintenance Organizations aka HMO’s are the most common forms of managed care.

With most HMO policies come restrictions, such as:

  • Network of Doctors
  • Pharmacy Networks
  • Hospital Network
  • Referrals are Required
  • Limited coverage area

 

While this can limit who you see and what treatment you can obtain for your rheumatoid arthritis, HMO policy premiums are usually lower than other insurance types.

Another plus for HMO policyholders is there is little or sometimes no out of pocket cost for services in-network.

Medicare Advantage Private Fee-For-Service (PFFS)

This is traditional health insurance in which the policy either pays the medical provider directly or reimburses the beneficiary for services rendered.

With Private fee-for-service plans, you’re given the option to treat with the provider and facilities of your choice.

Medicare Advantage Preferred Provider Organization (PPO)

These policies are like HMO type policies; however, PPO’s offer more flexibility. There’s a list of providers you can choose, but you may also treat with, “out of network” providers.

You may have a higher out of pocket cost when treating out of network. Like HMO policies, PPO policies also require deductibles and copayments for the beneficiary.

Whether using an HMO, PPO, fee-for-service or Medicare, most plans allow treatment for autoimmune diseases.

Original Medicare Coverage for RA

Traditional Medicare offers coverage for your hospital (Medicare Part A) benefits and your outpatient care.

Whether using Part A or Part B benefits, Medicare covers treatment at 80%. The Medicare beneficiary is responsible for the remaining 20% once the policy deductible has been met.

There are additional ways in which Medicare beneficiaries can save on RA treatment.

Medicare Supplement Coverage for Rheumatoid Arthritis Treatment

A better option to consider is a Medicare Supplement Plan. These plans work in conjunction with the already excellent Medicare perks.

These policies help offset the leftover out-of-pocket costs associated with Medicare.

Deductibles, copayments, coinsurance and other out of pocket costs for any RA treatments may then be covered in full and cheaper for the beneficiary in the long run.

As rheumatoid arthritis is a chronic ailment, you’ll be looking at a lifetime of different treatment options to manage the condition.

You’ll want to make sure whichever policy you choose will benefit you for the foreseeable future.

Medicare Coverage for RA Treatment

Thanks to the Affordable Care Act passed in 2010, the comprehensive health care reform law has made health insurance more affordable to Americans.

Another added benefit is that you cannot be denied health insurance coverage for pre-existing rheumatoid arthritis. Additionally, your carrier cannot drop your coverage if you were to develop RA while already insured.

For those suffering from rheumatoid arthritis, this means insurance coverage will include:

  • Disease management
  • Emergency Room visits/ hospitalizations
  • Preventative care
  • Counseling for weight loss and nutrition
  • Mental health services

 

Those individuals with Medicare, Medicaid or who have insurance through a workplace, the same above benefits apply. This is good news for those with RA as most treatment options will be covered.

Things to Consider Before Buying Insurance

You can contact your individual healthcare provider or insurance carrier to see exactly what RA treatment options are covered. They should also be able to discuss any potential out of pocket costs to you.

Some key facts to consider when searching for insurance include:

  1. Make sure there is prescription drug coverage. RA medications, especially IV infusions and Biologics can be costly. Without proper prescription benefits, the out of pocket costs can be extortionate.
  2. Benefits that cover occupational and physical therapy. Therapy has been proven to help prevent joint pain and further damage caused by RA.
  3. Access to specialists. Once diagnosed with RA, it’s crucial to establish with a rheumatologist to start beneficial treatments. Proper care is essential to maintain your disease and to prevent further joint deformity

 

While having rheumatoid arthritis can be overwhelming, getting treatment shouldn’t be. With the ever-changing healthcare system and evolving treatment options, insurance coverage is more important than ever.

Care is available for RA and the sooner you start treatments, the better and more manageable the disease will be!

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Is Plan F a Viable Medicare Supplement Option?
Medicare Plans

Is Plan F a Viable Medicare Supplement Option?

by Garrett Ball
written by Garrett Ball

When you look over the Medigap coverage chart, which shows the standardized Medigap plans, you may notice an asterisk beside the Plan F. Most people never pay much attention to this or read the fine print below the chart to understand exactly what this signifies. Is Plan F a Viable Medicare Supplement Option?

Actually, this notation represents an entirely separate Medigap plan called the High Deductible Plan F (often referred to in shorthand as HDF).

High Deductible Plan F is a unique Medigap plan that has a large deductible of $2,200 (for 2017) that must be met before any plan benefits begin. After that deductible is satisfied, the HDF plan works like a “regular” Plan F, paying everything that Medicare does not cover at the doctor and hospital.

How Does High Deductible Plan F Work?

The HDF plan works like any standard Medigap plan in that you can go to any doctor or hospital. There are no networks on any Medigap plan, including HDF.
If you have this plan, Medicare is still your primary coverage. Medicare pays its portion of your medical bills, then you pay the remainder of the charges until you have paid out the $2,200 deductible amount. After that amount is satisfied, Medicare plus the HDF would cover your medical bills in their entirety.
Also, like with other Medigap plans, claims payments are handled automatically through the Medicare crossover system. You are not responsible for paying at the time of service. The doctor’s office or hospital would bill Medicare first and then bill you the remainder after Medicare has paid its portion.

Advantages of High Deductible Plan F

Obviously, High Deductible Plan F is best suited for someone who is in relatively good health with minimal known doctor visits or recurring or chronic medical conditions.
It does allow you to plan for your medical costs on a predictable basis because you can figure in the premium for HDF, plus the $2,200 deductible to come up with a maximum out of pocket cost that you would have in a calendar year.
The premiums for HDF are typically half the premiums of other common Medigap plans, such as Plan G or Plan N.

Downsides of High Deductible Plan F

While the premiums are lower on HDF, you are responsible for a significantly higher amount of out-of-pocket costs, so that is one downside of this plan. You are responsible for anything Medicare does not cover until you’ve met the annual deductible.
Also, you should keep in mind, if you are considering this plan, that you do have to qualify medically to change Medigap plans in most cases. So, although you may be in good health now, if that changes and you want to change plans, you may not be able to do so.
Lastly, the deductible amount, which is currently $2,200, does change annually. Whereas other Medigap plans expand to fill the Medicare “gaps” as they change, your out-of-pocket costs under the High Deductible Plan F do change over time as the deductible itself changes.
Overall, the HDF is a viable option if you are in good health and just looking to keep your premiums down. However, you should certainly take the time to understand the long-term implications of this plan or any other plan you are considering. Is Plan F a Viable Medicare Supplement Option?

Is Plan F a Viable Medicare Supplement Option?

Is Plan F a Viable Medicare Supplement Option? Is Plan F a Viable Medicare Supplement Option? Is Plan F a Viable Medicare Supplement Option? Is Plan F a Viable Medicare Supplement Option? Is Plan F a Viable Medicare Supplement Option? Is Plan F a Viable Medicare Supplement Option?

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MedicareMedicare Plans

Does Medicare Cover Power Mobility Scooters?

by Guest Blogger
written by Guest Blogger

Power scooters increase mobility to make everyday tasks possible again for many individuals. They are a great choice for this, but they are quite expensive.

Medicare will provide coverage for mobility scooters if you are able to meet certain requirements. Scooters and wheelchairs are considered durable medical equipment, which is covered under Medicare Part B.

If you follow the steps we’ve listed below, you can increase your chance of getting Medicare to pay for your scooter.

DME Guidelines from Medicare

Medicare Part B covers 80% of outpatient medical expenses whenever they are deemed medically necessary. Whenever a piece of equipment is expensive, proving medical necessity starts with your Medicare doctor writing an order for this equipment.

Medicare requires that you meet with your doctor in person. He must assess that you have a chronic or permanent health condition that makes a mobility scooter necessary for you to get in and around your own home. Medicare Part B will not cover your power scooter if you are living in an assisted living or nursing home facility.

Your doctor needs to also provide documentation showing that other less expensive devices like canes or walkers will not sufficiently meet your mobility needs.

Assistance with Activities of Daily Living

There are a number of activities of daily living that are related to mobility. This includes being able to prepare and eat meals, take a bath, use the toilet or move around your home from one room to another.

Your power scooter will be considered reasonable and necessary if you are unable to perform these activities of daily living safely and in a timely manner without it.

Medicare Defaults for DME

There are several types of DME that can help with mobility. Medicare will want to first provide the least expensive equipment that meets your needs. Obviously, mobility scooters are some of the most expensive types of DME, so Medicare will only cover it if all other DME won’t do the job.

For example, if your upper body strength is sufficient to operate a manual wheelchair, Medicare will provide you with that instead of a mobility scooter.

There are also requirements that you use an approved DME supplier that has a staff member who specializes in wheeled mobility equipment. This professional will be quite familiar with the various rules and requirements for power scooters and will also have the knowledge and experience to select a mobility device that you can not only qualify for but can also safely operate in your own home.

Medicare will want you to see a physical therapist or occupational rehabilitation therapist to be thoroughly evaluated for use of a scooter. This is helpful to you as well because your therapist can gather the necessary information and document the reasons why you should qualify for a scooter.

You must also be properly evaluated to qualify for a scooter through Medicare. Usually, you will need to make an appointment with either an Occupational or Physical Therapist to complete this step. They will gather the information and documentation Medicare requires to qualify someone you a mobility scooter.

What Medicare Pays for a Mobility Scooter

Part B has an annual deductible which you must first satisfy before Medicare begins paying outpatient benefits. Once the deductible is met, Medicare will pay 80% of your covered expenses ad you will pay the rest. This is called your coinsurance.

Many Medicare beneficiaries enroll in Medicare supplement insurance to help them pay for these gaps. Medicare supplements pay after Medicare first pays its share. This coverage can be used at any provider nationwide that accepts Medicare. Depending on the standardized plan that you choose, you may have nothing to pay afterward or you may have a small amount of cost-sharing.

These plans have no networks which make it easy to use them anywhere. They do not include drug coverage, but a standalone Part D drug plan can be purchased alongside them.

Some beneficiaries choose to get their benefits through a Medicare Advantage plan instead of through Medicare itself. These plans have networks and contract their own DME vendors. If you have this kind of coverage, the insurance company that provides your plan will have its own requirements and guidelines that it uses to determine if the scooter is truly medically necessary for you. You can consult the plan’s Summary of Benefits to determine your cost-sharing under the plan. Under many Advantage plans, you could pay as much as 20% of the cost of your scooter, but not more than the plan’s out-of-pocket maximum.

While this type of coverage may not pay for as much as a comprehensive Medicare supplement Plan F or G, Medicare Advantage plans do typically have lower premiums than Medicare supplements.

It’s up to you to choose the type of supplemental coverage that best fits your needs and budget for the long term.

Summary

Ensuring that your power mobility scooter will be covered by Medicare requires a number of steps along the way. Nonetheless, if you meet the requirements for medical necessity, Medicare can and does offer coverage so that you can easily get around your own home.

Danielle K Roberts is a member of the Forbes Finance Council and is the co-founder of Boomer Benefits, a licensed insurance agency that helps baby boomers navigate their Medicare benefits.

Power Scooters Offered by Senior.com

 

 

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Medicare Plans

What is the Medicare Special Enrollment Period?

by My Senior Health Plan
written by My Senior Health Plan

Right now, we’re in Medicare’s Open Enrollment Period (OEP). But what happens if a major disaster strikes and you’re not able to take advantage of OEP? Don’t worry, you’ll still be able to change your plan if you need to. The Medicare Special Enrollment Period (SEP) extends the Medicare enrollment period during extenuating circumstances.

For example, you might find yourself in the midst of a life-altering weather event that prevents you from selecting coverage during OEP. Or you might need to move to a new state and discover that your previously selected coverage is not offered in your new state of residence. You can’t go without coverage, so a SEP allows you to choose a new plan.

Life changes, and sometimes your coverage has to change as well. SEPs can be difficult to understand, but we’re here to help you understand what you need to know about Medicare SEPs and how you can take advantage of this important enrollment period.

Am I eligible?

There are several circumstances for qualifying beneficiaries for SEPs. The most common are FEMA-designated natural disasters and changes in residence.

Extreme weather event or natural disaster

In order to initiate a SEP, the Federal Emergency Management Agency (FEMA) must officially declare an area affected by an emergency or a major disaster. This includes but isn’t limited to, extreme rain and flooding events, hurricanes, tornadoes, wildfires, man-made environmental catastrophe and more.

If you were planning to initiate or alter coverage during a predesignated enrollment period, like OEP, but weren’t able to because of the FEMA-designated disaster, you may take advantage of the SEP.

One extra benefit is that it doesn’t have to be you that lives in the disaster area to qualify. The SEP takes into consideration that many seniors rely on a family member to assist with their Medicare coverage selections. If the family member or caregiver charged with this duty lives in a FEMA-designated area, the same principle applies.

Change of residence

You may not have realized that moving can impact your Medicare coverage. For example, if you live in Arizona and selected a plan during last year’s OEP, but you now need to move to California to be closer to family, you will also need to also change your coverage. Different Medicare plans service different areas, and if you move into a state not serviced by your current plan, you’ll need to take advantage of this SEP.

You’ll want to take advantage of the SEP to find better coverage options in your new state that wasn’t available in your previous area of residence.

How long are SEPs?

The length of SEPs varies based on the circumstances. If you have a qualifying change of residence, you have two months to alter coverage. In the case of extreme weather or natural disasters, the SEP begins the day the disaster strikes and runs for four full calendar months thereafter.

This is almost always the case, but there have been a few cases when FEMA-designated SEPs were extended beyond four months. Hurricane Katrina, for example, made U.S. landfall on August 25, 2005 before pummeling the Gulf Coast for several days thereafter. The SEP for this natural disaster was extended through December 31, 2006—more than 16 months.

What can I change during SEP?

During SEP, you can enroll in, disenroll from, or switch Medicare health or prescription drug plan. Essentially, you can add, update, change, or drop both medical and prescription drug coverage during the SEP period.

Usually, if you need to take advantage of a SEP, you’re experiencing some significant life change. During these times, the last thing you want to worry about is your Medicare coverage.

If you need help or have questions about SEP, visit our website or call (877) 255-6273. You’ll be able to talk to a knowledgeable member of our team who will help you navigate SEP and find your best coverage options.

You may also seek assistance from Medicare by calling (800) MEDICARE (1-800-633-4227).

 

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Medicare Plans

How to Enroll in Medicare if You’re Working Past 65

by My Senior Health Plan
written by My Senior Health Plan

For decades, the gold standard for retirement age was 65. But in the last several years, we’ve seen the retirement age inch up with many folks working past 65. Now, 20 percent of Americans age 65 and older are participating in the workforce—the highest rate in nearly six decades.

Some of this is due to the U.S. government formally changing the Social Security retirement age. Since 1983, the retirement age, previously set at 65 has slowly inched toward 67, with the current age set at 66 and eight months.

But there’s more going on here. Not only are we living longer, but also the cost of living is exponentially higher than 10 or 20 years ago. Unfortunately, many of us weren’t able to adequately plan for retirement.

What is fortunate is that no matter your employment status, you can still enroll in your Medicare benefit at age 65. Here’s how.

What if you have employer-provided health benefits?

When you turn 65, even if you’re working, you gain access to what’s called the Initial Enrollment Period (IEP). If you have employer-provided healthcare, you can still apply for Medicare Part A.

You may be wondering why this is necessary. If you require medical care not covered by your employer-provided plan, your Medicare Part A plan will pick up where your primary coverage leaves off. Part A Medicare benefit is premium-free, so you stand nothing to lose financially by enrolling.

If you have a spouse who isn’t working, is over 65 and covered by your private insurance, the same principles apply.

But do stay on top of enrolling, because Medicare won’t remind you to sign up unless you currently get Social Security or Railroad Retirement Board benefits. Also, in order to take advantage of Medicare, you or your spouse must have worked and paid Medicare taxes for at least 10 years of your lives.

What if you’re working past 65 and losing your employer-provided health benefits?

When you decide to retire, you’ll need to make changes to your (and your spouse’s, if applicable) Medicare coverage. You probably already have Part A at this point, but you need to get supplemental coverage to make up for what used to be covered by your employer-provided health insurance.

If you’re beyond your IEP and are losing your employer-provided insurance outside of another enrollment period, like OEP or AEP, you’ll be eligible for a Special Enrollment Period (SEP). SEPs enable beneficiaries with extenuating circumstances to enroll in Medicare programs outside the typical enrollment periods.

The SEP for Parts A and B will last for eight months beginning the month after you lose your private health insurance benefits. The SEP for Parts C and D will last for two months beginning the month after you lose your private health insurance benefits. So, if you retire in March 2020, you’ll have between the months of April and November 2020 to enroll in Medicare Parts A and B and April and May to enroll in Medicare Parts C and D, if needed. Confused? Don’t worry, MySeniorHealthPlan.com is here to help.

What about Medicare Part B and D?

You may be aware of penalties for late enrollment in Medicare Part B and/or D. Since you’re covered by employer-provided health insurance during your IEP, you may be eligible for a Special Enrollment Period (SEP) to delay enrolling in Parts B and D.

You’ll have to consult with your employer to confirm eligibility.

With any health insurance decision, particularly those related to Medicare, we recommend you work with your employer’s plan administrator to understand what coverage you have, what coverage you need and how those options will change upon retirement.

If you need help or have questions about Medicare when working past 65, visit our website or call (877) 255-6273. You’ll talk to a knowledgeable member of our team who will help you navigate the Medicare system and find your best coverage options.

You may also seek assistance from Medicare by calling (800) MEDICARE (1-800-633-4227).

 

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Medicare Plans

Understanding the 2020 Policy Changes to Medicare

by Jagger Esch
written by Jagger Esch

The beginning of a new decade is upon us, and significant changes are happening. Understanding the 2020 Medicare Advantage Open Enrollment Period could bring you great benefit.

The enrollment period provides an extra opportunity for you to get the best coverage. Medicare is full of many parts, and it may be challenging to keep up with all the new rules.

Different enrollment periods have varying guidelines. Regulations include specific dates.

Beneficiaries can forget about the old Medicare Advantage Disenrollment Period. The new and improved Medicare Open Enrollment Period is the replacement.

The last time to enroll, according to federal law, allows you a final chance to switch Advantage plans. Yet, you must be a Medicare Advantage enrollee to use this option.

Understanding the 2020 Medicare Advantage Open Enrollment Period

The new chance to switch Medicare Advantage plans is happening right now in 2020. It starts January 1 and runs until March 31.

Beneficiaries with an Advantage plan may now use this time to switch. Another option is to drop a current Advantage policy and go back to Medicare and buy Part D.

In 2010, the ACA law put an end to the Medicare OEP. Replacing the OEP was the Medicare Advantage Disenrollment Period. The dis-enrollment period began on January 1 and only ran until February 14.

So, what makes this period different? Well, this period only allowed beneficiaries to return to Medicare. The Medicare Advantage Open Enrollment Period allows a one-time switch between Advantage plans.

What is the Medicare Advantage Open Enrollment Period

The Open Enrollment Period allows you to switch from one Advantage plan to another. Although, you may not use this period to switch from one Part D drug plan to another.

Think of this as your chance to make any last-minute policy shifts.

Life happens at the most inconvenient times, Medicare understands. As of 2019, Advantage plan enrollees may make policy changes until the end of March.

New policies or any adjustments begin the 1st of the following month. Let’s say Katherine has a Medicare Advantage policy. She realizes her benefits don’t cover the care she needs in the upcoming months.

It’s February 1, so Katherine decides to find a more accommodating plan. She must wait until March 1 for her plan to start.

When to use the Medicare Advantage Open Enrollment Period

One big question is why beneficiaries would make another change? The reasons vary, but a common issue is that most people don’t understand how Advantage plans work.

Often Medicare enrollees attempt to make changes on their own without the help of an agent. There are many factors to consider when choosing an Advantage plan or a drug plan.

When deciding what option is best for you, it’s easy to overlook essential elements. That’s why working with an expert is beneficial; they make sure you don’t miss anything.

Unfortunately, beneficiaries forget to check the plan’s provider network before switching. Using an out-of-network doctor means paying out-of-pocket for services.

Recipients see the low premium cost and miss all the other costs associated with the plan. Yet, most programs have copayments and other expenses.

Medicare Enrollment Periods – The Breakdown

Learning the ins and outs of Medicare can be confusing, to say the least. One thing that seems to confuse many is the different Medicare enrollment periods.

The various election periods happen during certain times of the year. Election periods allow beneficiaries to make changes to their current coverage. Understanding each election period is essential for all.

The Annual Election Period

From October 15 through December 7 each year is the Medicare Annual Election Period. The AEP is the most common time for beneficiaries to change their Medicare Advantage or Part D plans.

Changes made during this time take effect on January 1. The Annual Election Period is for making changes to Medicare Advantage or Part D plans.

Each year, beneficiaries receive a Notice of Change letter in September. After reviewing this letter, you may decide you don’t like the upcoming changes. Use the AEP to switch to more comprehensive coverage.

The Special Election Period

Trying a Medicare Advantage plan for the first time can be nerve-wracking. You have twelve months to change back to Medicare if you try an Advantage plan for the first time.

During your first 12 months on the plan, you can switch without underwriting using the SEP. Advantage plans aren’t for everyone. The coverage may not meet your expectations or healthcare needs.

In such cases, the Special Election Period exists as a chance to go back to Medicare coverage. Beneficiaries may only use the Special Enrollment Period once in their lifetime.

Many circumstances qualify a person for a SEP. Moving out of state is a good reason, which means finding coverage in a new area. Beneficiaries may use a Special Enrollment Period to find a plan in the new service area.

Any major change can open the door for a SEP. If you get married, divorced, or are planning to move, expect eligibility for a plan change.

The Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is different than the fall AEP. Often the Annual Election Period is mistaken for the Open Enrollment Period.

The Advantage OEP is from January 1 – March 31 for Medicare Advantage or Part D enrollees. During this time, you have options for policy changes.

Although, this period doesn’t guarantee a pass into a Supplement. Choosing to enroll in a Supplement to go with your Medicare may save on costs of care.

First, you must apply and answer any health questions. Following your request, Medigap companies underwrite your application to determine your health risk.

Companies may deny coverage based on your health. When this happens, you may have Medicare coverage without Supplement insurance.

Changes in plan benefits or coverage take effect on the 1st day of the month following the request. So, if you have any changes to make, be sure to get the ball rolling.

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Medicare Plans

Medicare OEP 2020: How to Make Changes to Your Medicare Advantage Plan

by My Senior Health Plan
written by My Senior Health Plan

Medicare Open Enrollment Period (OEP) 2020 will begin on January 1st. If you are enrolled in a Medicare Advantage Plan (maybe you signed up for a new plan during AEP 2020?) and wish to adjust your coverage, you may qualify to make a one-time change to your existing policy.

Medicare OEP 2020. What is it?

OEP is the Medicare election period that runs from January 1st to March 31st each year. It allows Medicare beneficiaries enrolled in Medicare Advantage Plans to:

  • Switch from one Medicare Advantage plan to another Medicare Advantage plan
  • Disenroll from a Medicare Advantage plan and return to Original Medicare, with or without a Part D drug plan

 

Note: According to Medicare.gov, the following are changes that you cannot make during OEP.

You will not be able to:

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan if you’re in Original Medicare.
  • Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare.

 

Also, if you’re within the first three months of your Initial Enrollment Period, you have the option to

  1. Change to another Medicare Advantage Plan (with or without drug coverage) OR
  2. Go back to Original Medicare (again, with or without a drug plan)

Let’s look at an example.

During AEP, Sylvia enrolled in a Medicare Advantage Plan. The plan will activate January 1st. However, early in February, she decides she could benefit from Medicare Advantage Plan D.

Being in the OEP window and having had her existing plan since January, Sylvia can make the one-time change. Her new policy will go into effect on March 1st.

However, that’s not where Sylvia’s story ends. Her plan activates March 1st, but after a couple of weeks (and still within the OEP), she finds that the new plan isn’t a good fit for her needs.

Unfortunately, Sylvia will have to wait until October 15th when AEP begins again—unless, of course, she qualifies for Special Election Period (SEP).

What is SEP?

SEP allows seniors to make changes to their Medicare Advantage and Medicare prescription drug coverage under particular circumstances.

Examples of when you may qualify for SEP include the following.

You’re moving to a new address that affects your coverage (e.g., moving back to the States after living overseas or moving to a new address that isn’t in your existing plan’s service area).

You’re living in an area where a weather event has occurred—one that FEMA has determined as an emergency or major disaster. Due to the weather situation happening during another valid election period (e.g., AEP), you may qualify for SEP.

Additionally, the weather-related SEP is available to beneficiaries who depend on friends or family members living in the affected areas to manage their healthcare needs.

You will lose your other insurance coverage. For example, if you are no longer eligible for Medicaid, you may qualify for SEP and the opportunity to sign up for a Medicare Advantage Plan. Also, if you no longer have coverage from your employer (or union), SEP will allow you to apply for Medicare Advantage coverage.

Tapping into your Medicare resources

Medicare election periods from OEP to SEP can get complicated. However, you have access to resources—from your insurance specialist to online information (such as the Medicare.gov website). The key is to keep an eye on election period dates that apply to you, take action early and, if necessary, ask for help.

Need to adjust your Medicare Advantage coverage during OEP? The MySeniorHealthPlan.com team can answer all your questions and guide you through the process.

Call today toll free: 877.255.6273

 

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Why Compare Part D Plans Annually?
MedicareMedicare Plans

Why Compare Part D Plans Annually?

by Garrett Ball
written by Garrett Ball

What is Medicare Prescription Drug Coverage (Part D)?

Prescription drug coverage is available to everyone who is enrolled in Part A and Part B of Medicare. You have two options for getting your Part D coverage: Why Compare Part D Plans Annually?

  • Buy a stand-alone prescription drug plan (PDP)
  • You can enroll in a Medicare Advantage Plan that already includes prescription drug coverage.

If you do not sign up for a PDP when you are first eligible, you will have to pay a penalty every year for the duration of Part D. It is also important that you be a resident in the service area of the drug plan you are planning to enroll in, as plan vary by geographic location. Why Compare Part D Plans Annually?

What is the cost for Part D coverage?

Cost is one of the most important factors in signing up for Part D. Finding the right plan can save you big bucks! Your actual costs may vary depending on:

  1. which prescription drugs you take and if they are found on your plan’s list of covered drugs (formulary);
  2. which “tier” your prescription drug is in. Prescription drugs are categorized into tiers, the lower the tier, the less expensive the drug;
  3. which plan you enroll in;
  4. how you get your drugs, i.e. in-network, out-of-network, mail order, retail pharmacy;
  5. whether you get “extra help” or not. This is a Medicare program that assists those persons with limited income and resources pay for their prescription drug costs.

Please note that plan costs may change each year, which is why it is crucial to compare your Part D plans annually.

How Do You Compare Part D Plans?

The simplest way to compare your prescription drug plan to other plans is to call Medicare
(1-800-633-4227), TTY users,1-877-486-2048. However, during busy times you may be on hold for quite a while. Another alternative is to compare the plans yourself by viewing the Medicare Plan Finder at Medicare.gov/find-a-plan TTY users, 1-877-486-2048. Here is a step-by-step guide to comparing Part D plans. And, below, there are quick and easy steps to run a comparison report:

  • Click on the Find Health and Drug Plans found halfway down the page;
  • Enter your zip code and click on Find Plans – more than one county may come up and in that case, select your county;
  • Choose one of the choices under the two questions that appear on the following page, then click Continue to Plan Results;
  • Enter your medications into the box and click on Find My Drug. A list of several drugs might appear with the various dosages. Choose the one that pertains to you;
  • When you are finished entering your medications, click on My Drug List is Complete;
  • Various pharmacies may appear – choose your preferred one. You may extend the zip code to search a greater distance;
  • Click “Continue to Plan Results”.
  • Check the box for “Prescription Drug Plans”, then click “Continue to Plan Results”.
  • On the next screen, you will see “Original Medicare” listed first. You can skip that.
  • Under “Prescription Drug Plans”, you will find a list of the plans that are available to you. They range in order from the lowest estimated annual cost, which comprises premiums, deductibles and co-pays based on the medications on your drug list at the pharmacy you selected.
  • You can select up to three plans and click “Compare Plans”. You can also just click on the plan you want more information on without comparing it to any others.
  • Once you view a comparison of the plans you have selected, you can print these plans by clicking on Print Comparison Report found under the drug coverage section halfway down the page.

 

By following the steps above and running your Part D comparison, you may be able to find a cost-effective plan that will result in substantial savings in your pocket. You will be able to see the difference between utilizing generic drugs instead of brand name drugs, as well as choosing your preferred way of buying your medications, i.e. retail pharmacy or mail order company. Why Compare Part D Plans Annually?

Why Compare Part D Plans Annually?

Why Compare Part D Plans Annually?

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Deadline for Medicare Open Enrollment Nears
Medicare Plans

Deadline for Medicare Open Enrollment Nears

by Kimberly Johnson
written by Kimberly Johnson

WITH DECEMBER 7TH DEADLINE FAST APPROACHING, easyMedicare.com OFFERS FOUR QUICK TIPS TO HELP FIND OUT IF YOUR CURRENT MEDICARE PLAN IS RIGHT FOR YOU Deadline for Medicare Open Enrollment Nears

With the deadline of December 7, 2017 just a few weeks away, there is still time for those who are eligible for Medicare to make an important decision about their healthcare during the annual open enrollment period. Deadline for Medicare Open Enrollment Nears

With more Medicare health plan options than ever, it is important for people to understand their options. Medicare consumers want to feel confident that the plan they choose will fit their needs and budget. So, what is the best way to determine whether your current Medicare plan is right for you?
Drawing on many years of Medicare enrollment experience, Anthony P. Solazzo, CEO of e-TeleQuote, explains how asking the right questions is of the utmost importance in determining which plan may be the best fit for you. Here are the four questions he says are important to ask:

  1. Has your health changed since last year? Are you taking different medications since last year? Some plans change their coverage, so it’s best to know which medications are covered for 2018.
  2. Do you have a chronic illness, such as hypertension, diabetes or heart disease? There are special health plans that offer specific benefits for these conditions that may improve your quality of care and reduce out-of-pocket costs.
  3. Are you concerned about out-of-pocket expenses or extra benefits? Some Medicare Advantage plans may cover much of your overall healthcare costs and also offer prescription drug coverage.
  4. Are your doctors and hospital part of the network? Some Medicare health plans may change provider networks, which can affect which doctors (especially specialist physicians) you may see under your benefits.

“Education based on your specific healthcare needs is the key to selecting a good Medicare health plan,” said Solazzo. “It is important to ask the right questions and to remember that each year your needs may change.”
For more information, and to download the complimentary easyMedicare.com guide, Making Sense of Medicare: The Medicare Basics, visit www.easyMedicare.com (https://www.easyMedicare.com).

About e-TeleQuote and easyMedicare

e-TeleQuote Insurance, Inc. is an independent digital insurance agency providing consumers the ability to purchase Medicare insurance from the comfort of their homes. The company diligently researches available plan options from multiple insurance carriers to help consumers choose a plan that best suits their needs. e-TeleQuote provides consumers personal consultation through experienced licensed insurance agents, who suggest plan coverage options based on a customer’s particular needs. The company proudly serves tens of thousands of consumers annually across the United States.

e-TeleQuote Insurance, Inc., earned the 446th spot on the 2017 Inc. Magazine 5000 Ranking. The company also ranked #6 in growth among all insurance sector companies nationwide. For more information about e-TeleQuote, visit https://www.etelequote.com.

Deadline for Medicare Open Enrollment Nears

Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears Deadline for Medicare Open Enrollment Nears

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