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Alternatives to 1st Dollar Coverage Plans

by Jagger Esch
written by Jagger Esch

We’ve lived our lives planning for our future and the future is now. Unfortunately, gone are 1stdollar coverage plans. Instead of paying a monthly premium that allowed us to close our wallet after writing that check we can expect to do a little more searching to find just the right plan. It’s back to the licensed insurance agent to review your needs and benefits against costs and risk.

If you aren’t familiar with 1stdollar coverage, we are referring to Medicare Supplement Plans F and C. Medicare Supplement Plans are sometimes referred to as Medigap Plans. Plan F covered everything not covered by Original Medicare. Plan C covered everything not covered by Original Medicare, except excess charges.

What Now

Nonetheless, there are great coverage options available to you. The most comprehensive Medigap Plans available for the 2020 year will be Plans G and N. Previously, these two plans were overlooked by many in favor of paying a higher premium and nothing more. Medicare Supplement Plans G and N will now be the sought-after coverage options.

Plan G

In 2019, the Medicare Part B deductible will be $185. For beneficiaries enrolled in a Medicare Supplement Plan G, that $185 deductible will be all they pay for covered services. Between Original Medicare and Medicare Supplement Plan G, everything else is paid for you.

This plan is like Medicare Supplement Plan F in that you can minimize your out of pocket risk. But by assuming the $185 deductible, you will save much more than $185 on an annual basis. Currently, the Plan G is the most popular plan.

The reason is that in most cases a Medicare Beneficiary will save considerably more every year by paying their Medicare Part B deductible out of pocket. In many cases, a Beneficiary can save $300 or more over the cost of the year, and that is even after the deductible is met. To Savy seniors, this plan has been the choice for several years now.

Plan G does cover any excess changes that could be imposed by a hospital or physician’s office. So, you are not giving up any peace of mind to save several hundred dollars. The protection is in this plan. You can find Medicare Plan G reviews here.

Plan N

Medicare Beneficiaries that want cost-effective coverage and are willing to use facilities and physicians that accepts Medicare assignment should consider Medicare Supplement Plan N. Plan N does not offer does not cover the $185 (2019) deductible or excess charges.

In addition, Plan N has small co-pays when seeing the doctor or going to the emergency room. The co-pay for a doctor visit, primary or specialist, is up to $20. The emergency room co-pay is up to $50.

The Plan N caters to seniors that do not go to the doctor often. Many times, the cost savings from the Plan N to the Plan G are significant as well. The only real gap in the Plan N is that it does not cover excess charges.

Most doctors do not charge them, but you will frequently see a cancer specialist, and specialty hospitals charging those charges. A Cancer policy can always be purchased, roughly $1 per day for about $10,000 in coverage, to help cover these charges if you were to be diagnosed with cancer. You can find Medicare Plan N reviews here.

Why the Sudden Change

The end of first dollar coverage plans has been several years in the making. Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.

There are several reasons for the birth of MACRA. People agree the single most important reason is to keep doctors on the Medicare program. Medicare Beneficiaries need a large pool of doctors from which to select the one that best fits their needs and personality.

It is important to mention that someone who is already enrolled in one of the plans being retired can keep it. It is even permitted to change to another carrier’s Plan F or C, depending on which plan they have currently. Provided they can medically qualify, up until 2020.

The last plan that was retired was the Plan J. The difference is when Plan J was retired, Medicare Beneficiaries were allowed a special enrollment period to change to the Plan F with no medical underwriting. This is not the case this time around.

If you want to know more about the elimination of Plans F or C, click here.

History has shown that members that elect to stay on retired plans will be subject to larger than usual rate increases. It may not occur right away but as people that are healthy leave those plans to more cost-effective alternatives and people that cannot medically change pass on, there are less people in the pool of that plan. In order to keep up with the increased claims of sicker people, the prices must increase more dramatically to cover the claims.

 

 

 

 

 

 

 

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What to do with the elimination of Medigap Plans C & F
Medigap

What to do with the elimination of Medigap Plans C & F

by Jagger Esch
written by Jagger Esch

For decades Medicare Supplement Plan F has been a top seller; it covers all the gaps in Medicare and leave beneficiaries with a $0 bill. With predictable healthcare costs, financial planning is easier. What to do with the elimination of Medigap Plans C & F
Plan C, like Plan F, is a very comprehensive plan. The only thing it doesn’t cover is the Part B Excess Charges. Plan C is not the same as Part C. Plan C is a Medicare Supplement plan and does not cover prescription drugs.

Why Plan C & F are Being Eliminated

Congress, wanting to cut spending, decided that by no longer allowing companies to cover the part B deductible, medical overuse could be prevented. Plan C & F are the only plans that cover the part B deductible. For 2018, the annual part B deductible is $183.
Cutting spending is not the only reason these plans are being phased out. The big issue Congress has been trying to avoid was, how to get doctors better paid for their Medicare services in the next few years. If the deductible is paid by the beneficiaries instead of the insurance companies, the doctors can be better paid.
Doctors that are not adequately paid are not going to want to work in the Medicare program, as you can imagine. Many health care providers made threats to quit the Medicare program if they were paid any less.
Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.
This bipartisan legislation created the Quality Payment Program which does several things:

  • Repeals the Sustainable Growth Rate
  • Changes how Medicare rewards clinicians for value instead of volume.
  • Arranges quality programs under the Merit Based Incentive Payments System.
  • Gives bonus’ for use of eligible alternative payment models.
  • MACRA is also requiring CMS to remove Social Security Numbers from all Medicare cards by April 2019.
  • Medicare Premiums for higher income individuals will also be increasing.

If you are going to be impacted by these changes, you have plenty of time to plan now to minimize any financial impact ahead.
This new legislation enacted by Congress should get doctors the fair payment they want for their Medicare services. The only difference is Plan F and C will be phased out and new enrollees will be responsible for the Part B deductible on Plan D or G.
Plan G is one of the top plans available to Medicare Beneficiaries. The savings usually makes it the most affordable plan for enrollees, depending on the state and enrollment type. The annual part B deductible is only $183, and sometimes a Plan F premium will be $200 more than a Plan G. Making plan G the more sensible plan anyways.
I don’t know if this is really going to cut the annual expenditure of Medicare, arguments on both sides of the spectrum have been given. nce 2020 comes we can all discover the real outcome.
If the beneficiaries are not experiencing higher than usual costs and doctors are paid fair compensation, then Congress found a great quid pro quo solution. If it doesn’t work in raising the pay for doctors, hopefully we will see more creative solutions.

MACRA and How It Impacts Providers

MACRA implements values-based initiatives aimed at improving care and access for Medicare and CHIP beneficiaries. The Quality Payment Program aims to transition the healthcare industry from fee-for-service to value-based care.
This means Medicare physicians, physician assistants, and nurses must participate in either a Merit-based Incentive Payment System (MIPs) or in Alternative Payment Models (APMs). The clinicians’ performance score will determine payment adjustment in later years. CMS will determine a positive, neutral or negative payment threshold.

Current Medicare Beneficiaries

If you are already enrolled in a Medicare Plan F or Plan C you should be “grandfathered” in to your plan and can keep your plan if you would like.
Some people are worried that the rates for Plan F and C will increase substantially, like in 2010 when plans H, I, and J were discontinued. The discontinuation of Plan F will be different in each state, some beneficiaries will still be able to change to other Plan F carriers in the future.
The states that follow the birthday rule or similar rule which lets them change Medicare Supplement companies during certain times of the year without going through any underwriting. This is the regulation in California, Connecticut, Missouri, New York and Oregon.
Only one Idaho has enacted legislation to be sure premium increases won’t affect Plan F beneficiaries specifically. The Idaho Department of insurance received misleading information from agents, telling people to switch plans now to avoid potential rate increases. Idaho Rule 18.01.54 protects Plan F policy holders from seeing a higher premium increase than other letter plan policy holders.

New to Medicare Enrollees

Congress believes that by implementing a mandatory deductible should make people think twice about visiting a doctor for a minor issue. Ideally this will mean fewer doctor visits, and lower Medicare spending.
Critics argue that by eliminating Plan F some people may choose to forego care altogether, resulting in even higher expenses later. If health conditions are not diagnosed early enough, Medicare could end up paying the price later.
The good news for Medicare beneficiaries is that the Part B deductible is not one of the biggest health care costs under Medicare. The Part B deductible for 2018 is only $183 for the year.
The Part A deductible is more than seven times the amount of the Part B deductible. In 2018 the Part A deductible costs $1,340 for each benefit period. Almost all standardized Medicare Supplement plans available in many of the states still cover at least 50% of the Medicare Part A deductible. Medicare Supplement Plan A is the exception, it does not cover the Part A deductible
For those new to Medicare, there are plans that are comprehensive and affordable; Plan G is one of them. You will be able to enroll in a plan G when you first become eligible for Medicare Part A and Part B.
Plan G covers everything Plan F covers, except for the Part B deductible. The doctor flexibility and $0 copayments give beneficiaries on this plan excellent coverage.
Plan N is another good option that is not getting discontinued. It is recommended that Medicare beneficiaries talk with an insurance agent about the plan that will be best suited for your individual healthcare and financial needs.

Things to Consider

The opponents of the legislation pointed out one brilliant thing; If someone has the money to purchase high-dollar coverage, they should be able to have that coverage. In theory, requiring beneficiaries to pay the Part B deductible should deter people from going to the doctor for minor problems.
Congress makes changes to the regulations on Medicare plans every so often. In 1990 they first made insurance companies standardized plan options for Medicare beneficiaries.
Then, in 2010 they removed some of the plan options like E, H I and J. The plans H, I and J were including prescription drug coverage; by eliminating that coverage option, congress was able to cut Medicare spending.
Congress can’t solve the Medicare-financing problem by borrowing funds. Debt in the Government is just a promise to raise taxes in the future. Younger workers will face massive tax increases if Congress does not cut Medicare spending.
With millions of people being affected by this change, at least Congress has given Medicare beneficiaries plenty of time to prepare. Legislation will always be changing and 2020 is still a few years away. What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F

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Guide to Choosing a Part D Prescription Drug Plan
Prescription Programs

Prescription Drug Coverage

by Jeff Dailey
written by Jeff Dailey

When you join Medicare you may want to add coverage for your prescription medications. Medicare Prescription Drug Coverage (MPDC, or Part D) will cover both brand-name drugs and generic at participating pharmacies. Part D helps to protect you from unexpected drug expenses and help you better predict your medical spending.
If you want to enroll in Medicare Part D, make sure to do so when first eligible. If you do so at a later date, you will have to pay penalty fees that will last as long as you have the drug plan. When you do choose to join Medicare Part D, your premium cost will increase by a minimum of 1% per month for every month that you waited to join.
Prescription Drug CoverageYou can receive prescription drug coverage either by enrolling in a Medicare Advantage Plan (or any health plan that includes drug coverage) or by joining the new Medicare Prescription Drug Plan. Before you choose a plan, check that the pharmacies in the plan are convenient for you; or if not see if it offers mail order prescriptions. You should also review the formulary list of all the drugs the Medicare drug plan covers.
Coverage:

  • Formulary: a list of all drugs that a Medicare drug plan covers. Includes generic and brand name drugs.
  • Prior Authorization: Some drugs cost more than others, even though the less pricey drug is just as effective. Other drugs may have more side effects, or restrictions on how long they can be taken. To help ensure drugs are being taken properly, and when truly needed, some plans may require “prior authorization”. Prior authorization is when your doctor provides the plan with proof that there is a medically necessary reason you must use a particular drug.

Coverage Gap:

  • If you have high drug costs, you may consider which plans offer additional coverage until you spend $4.350 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This “gap” in coverage is generally above $2,700 in total drug costs until you spend $4,350 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage.

Convenience:

  • Drug plans have to contract with certain pharmacies in your area. Check your plan to see which pharmacies are included. Some plans will also offer mail order prescriptions.

How does Medicare Prescription Drug Coverage work with Employer or Union coverage?

  • If your drug coverage from your employer/union is on average at least as good as MPDC, you can keep it as long as its offered.
  • If your employer/union coverage stops, you will have a special enrollment period to sign up for MPDC (with no penalty fee).
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