Your Medicare Questions Answered

Your Medicare questions answered by GA Medicare expert Bob Vineyard. Where do you go for answers? Why does no one want to help until you BUY something? Can anyone help?

How about the Georgia SHIP staffed by volunteers? Or calling Medicare direct? Who has all the answers when you want to know who has the best Medigap plan? Is there a Medicare for Dummies, or Medicare 101 site?

Medicare questions answered

Where is the best place to find answers to ALL my questions without getting a SALES PITCH?

Medicare Questions Answered

Why Search the Web When All Your Answers are Here?

Georgia Medicare expert Bob Vineyard spends hours every day searching so you don’t have to. Don’t you have something better to do with your time?

Even after working in health insurance for over 45 years Bob still is learning new things. He spends times reading information on Medicare, health and senior fitness so you don’t have to. Bob also participates in several consumer forums, answering the tough questions.

Bob is dedicated to helping YOU understand how Medicare works. He also makes sure you find the right plan that fits YOUR needs and budget.

Welcome to the NO SELLING ZONE!

Your Medicare Questions Answered by Volunteers

Why not talk to a SHIP counselor? They aren’t selling ANYTHING. It’s a non-profit organization. What could be wrong with that?

Counselors are volunteers with limited training. Kind of a Medicare 101 crash course for dummies. It would be rare to find someone who has had years of experience working with Medicare beneficiaries and insurance carriers.

The belief by some is, because they are volunteers working for a taxpayer funded, non-profit organization, their advice must be unbiased. Your Medicare questions answered by someone who truly wants to help . . . and that is true.

Motivation to help is good, but how accurate and useful is that advice? Will you have a counselor dedicated to help you . . . or will you be handed off to the first available person? Is personal service meaningful to you, or are you willing to accept advice from just anyone?

Going to the Source

Call 1-800-MEDICARE 24/7 except federal holidays. Operators are standing by . . . and most of them speak English.

When you ask questions about Medicare their computer “listens” to the conversation and an answer pops up on the rep’s screen. They will read the answer to you and assume you understand.

AI (Artificial Intelligence) is great but it is no substitute for the real thing. Remember HAL 9000 from Space Odyssey. “I’m sorry Dave. I’m afraid I can’t do that”.

While 800-MEDICARE is good, just like volunteer organizations, they don’t understand the insurance side of Medicare.

Medicare is easy.

Insurance is hard.

One Source for Answers to Your Medicare Questions.

Bob makes life simple. He explains how Medicare works using words that you understand.

For example. Many folks get confused about Medicare supplement and Medigap. What are they? How are they different.

Bob’s answer is this.

Medicare supplement and Medigap are interchangeable terms. Like Kleenex and tissue.

How easy is that?

Where can you get your Medicare questions answered?

Call or email. Give us 10 minutes. Ask any question. Never any pressure to buy. You decide if the information is helpful or not. No selling ever!

This is my offer you can’t refuse.

Will Medicare Pay For Shingles Vaccine?

Does Medicare cover shingles vaccine? Will my Medigap plan pay for Shingrix? Can I get the shot for free during my Medicare Annual Exam?

GA Medicare expert Bob Vineyard answers your immunization questions.

Does Medicare Pay for Shingles Vaccine
Will Medicare Pay for Shingles Vaccine?

What is Shingles?

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus. The same virus that causes chicken pox is also responsible for shingles.

After having chicken pox, the virus can lay dormant in your body for years. The virus lives in your nervous system near your spinal cord.

According to Mayo Clinic:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

  • Pain, burning, numbness or tingling
  • Sensitivity to touch
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching
Will Medicare Pay for Shingrix?

What is the Shingles Vaccine and How Does it Work?

Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.

Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.

Is Shingrix Better than Zostavax?

Currently there are only three approved shingles vaccines. Zostavax, Shingrix and Varivax.

Zostavax, approved in 2006, was the only vaccine for shingles for many years.

Shingrix gained approval as a vaccine in 2017 and is considered to be 97% effective in adults age 50 to 69. Whereas Zostavax has a 50% effectiveness rate.

Varivax was approved in 2018. It is similar in price and effectiveness to Shingrix.

All three named shingles vaccines are approved by Medicare and should be included in all Medicare Part D plans.

How Much Does the Vaccine Cost?

Cash prices for Shingrix are currently $150 per dose. You need two doses for maximum effectiveness. Your second does should be given at least 2 months but no more than 6 months following your first dose.

Zostavax is a single dose immunization with a cash price of $225.

The cash price for Varivax is $150 per dose. The manufacturer recommends two doses a month apart.

How Long Before I Need to be Vaccinated Again?

Shingles vaccinations should remain effective for several years before you need another vaccination.

You can get Shingrix at age 50, when your chance of having shingles rises. Studies have shown that its protection remains strong for at least 4 years, but researchers hope it will last much longer because the immune response is stronger. – WebMD

Is the Shingles Vaccine Covered by Medicare?

Medicare covers the shingles vaccine as one of its preventive benefits. But, unlike some other vaccines that are paid through Part B, the shingles vaccine is covered by Part D.

Have You Had Shingles?

If you have chicken pox as a child? If you did you have a one in three chance of getting shingles as an adult.

Two years ago during my annual Medicare wellness visit my doctor asked if I wanted to get the shingles vaccination. We discussed the pro’s and con’s. She wrote a prescription for Shingrix.

I had every intention of getting the shot but all the local pharmacy’s were out of stock. They had no idea when they would have it in stock.

Two months later I woke up with intense itching and moderate pain. It started near my kidney and radiated around my left side.

My wife looked at it and said I had the Shingles.

Welcome to old age.

This was a weekend and my regular doctor was not available. On Sunday I went to a nearby urgent care facility. The doctor confirmed I had shingles.

I was given a prescription for the generic form of Valtrex.

Valacyclovir (Valtrex) is an antiviral medicine. It is used to treat or prevent infections caused by certain kinds of viruses. Examples of these infections include herpes and shingles.This medicine will not cure herpes. It is more popular than comparable drugs. It is available in generic and brand versions. Generic valacyclovir is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. –GoodRx

Using Part D the prescription would have cost nearly $50. Using the coupon and paying cash my cost was $9.

Pay Cash or Use Your Drug Plan?

If you use your Medicare Part D plan for generic drugs you will almost always pay more. Buying generics and paying cash will normally save money.

The approved Shingles vaccines are all brand names. There are no generics. But you may still save money using coupons or drug assistance programs. Check the Medicare site for Patient Assistance Programs.

Do you have Medicare questions? Call or email.

#ShinglesVaccine #Shingrix #GAMedicareExpert

Medicare Cancer Drugs Are Costly

Medicare cancer drugs are about to become more costly because of proposed changes in the way they are covered. CMS wants to “save money” by moving Part B drugs to Part D. GA Medicare expert Bob Vineyard breaks it down for you.

Medicare cancer drugs
Medicare Cancer Drugs Becoming More Expensive

Not only cancer drugs, but medications for rheumatoid arthritis, macular degeneration and osteoporosis. DME drugs such as insulin may become ineligible for Medicare Part B reimbursement.

Medicare Cancer Drugs Becoming More Expensive

Saving Medicare – Sort of . . .

Medicare Advantage plans are now able to make changes in the way expensive, injectable drugs are covered. Drugs administered in a clinical setting will be subject to scrutiny.

Medicare Advantage plans will be REQUIRED to try cheaper drugs which may not be as effective as cancer drugs administered in a clinical setting.

These Advantage plans will be encouraged to employ step therapy to “reduce costs and improve outcome”.

Reducing costs means saving money spent by Medicare and the insurance carrier.

Not saving YOU money.

Note, this is only a test. Using Medicare Advantage patients as guinea pigs to see if lower cost drugs result in similar outcomes as more expensive protocols. Do you really want to be a test model?

If the test works cancer drugs will be shifted away from Part B coverage to Part D. This means you, the patient, will pay MORE for your medication.

Treating Cancer is Expensive

Years ago most treatment involved extensive surgery, radiation and chemo. Most of the treatment was as a hospital inpatient.

Now cancer, like most other medical conditions, is treated on an outpatient basis.

If you have original Medicare and a supplement plan your out of pocket costs are minimal. Often less than $500 per year for health care.

Drugs are a different story . . . unless you are receiving treatment under Medicare Part B.

Also, outpatient self administered drugs are subject to copay’s or coinsurance. It doesn’t matter if you have an Advantage plan or stand alone PDP. Your cost is the same.

Cancer forces 42% of patients to exhaust life savings in 2 years. The average patient saw a loss of $92,098. Bankruptcy occurred in 38.2 percent after four or more years. – Becker Hospital Review

Finding and Choosing the Right Plan

Turning 65 many get confused about the various health insurance options. Some ask friends or relatives. Others attend seminars. And there is all the mail that arrives every day before you are Medicare eligible.

Part D is the most confusing component of Medicare.

If you or a family member have experienced cancer you know about the cost of prescription drugs.

You need help, but not from just anyone. Consider talking with an expert. A GA Medicare expert . . .

Give me 10 minutes by phone to answer your questions. Ask me anything about Medicare. Anything at all.

Either you like what you hear or you don’t. If you don’t feel I can help you then we part as friends. No hard feelings. It’s not personal, just business.

But if you want and need my help I am ready to guide you through the Medicare maze. We move forward at your pace, not mine.

All I ask is an opportunity to EARN your business.

When you allow me to be your agent you have unfettered access any time. Call or email.

And there is never any charge.

This is my offer you can’t refuse.

Medicare Part D is Confusing

Medicare Part D is confusing to me. Why is that? What makes it so hard to understand? What is the donut hole? I thought it was going away. What’s wrong with picking the plan with the lowest premium . . . as long as it doesn’t have a deductible? And why do some plans have a deductible? How does it work? Do I pay the deductible BEFORE I have copay’s?

Medicare Part D is Confusing

Can anyone explain how Medicare drug plans work?

GA Medicare expert Bob Vineyard can help.

Why is Part D so Confusing?

Why is Medicare Part D so confusing. The Medicare drug coverage is designed by folks in Congress who will never use the plan. Part D is administered by insurance carriers.

What could possibly go wrong?

When you search for the phrase “Medicare Part D confusing” there are 107 million results. Congratulations! You are not the only one who is confused by Medicare drug plans.

Medicare Part D is Confusing

What if I Can’t Afford My Drugs?

Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. If you have limited resources and income you may be able to get Extra Help. Monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

To qualify for Extra Help you must meet the resources and income requirement. You must also live in the United States.

In some cases you might qualify for a PAP (Patient Assistance Program).

Yes, Medicare Part D is confusing but there is plenty of help. You just need to know who to ask. Consider the folks at Georgia Cares as an example.

Medicare Late Enrollment Penalties

Did you know you can be penalized for failure to enroll in a Medicare drug plan on a timely basis?

The late enrollment penalty is an amount added to your Medicare Part D monthly premium.

You may owe a late enrollment penalty if you lack creditable coverage for 63 days or more after your Initial Enrollment Period is over, you go without:

  • Creditable drug coverage
  • Medicare Part D plan
  • Medicare Advantage plan that includes drug coverage
  • Other coverage such as employer group health plan

Also the LEP depends on how long you went without creditable coverage.

Your penalty is determined by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The penalty you will pay is based on a formula so it could increase from year to year. It is also payable for life.

Medicare Part D is confusing. GA Medicare expert Bob Vineyard can help.

Part D Deductible

The majority of Medicare drug plans include a deductible. In most cases the deductible applies to tier 3 or higher drugs. The deductible can also be avoided by using mail order or filling your med’s at a preferred pharmacy.

Most people do not understand how the deductible works so they focus on plans without a deductible.

Many agents also do the same. Rather than explaining how a Part D deductible works they only sell plans without a deductible.

In most cases no deductible plans have higher premiums AND higher copay’s.

If you want to learn more about Medicare Part D plan deductibles, this video will help.

Using the Medicare Drug Plan Finder

Why is Medicare Part D confusing? If it was easy you wouldn’t need me.

Pick a Drug Plan

Pick a drug plan, Medicare 101. Finding the RIGHT Part D plan is the most challenging part of Medicare. Experienced agents often get it wrong.

Medicare 101 - Picking a drug plan

Medicare Part D has a lot of moving parts. Formulary’s. Deductibles. Copay’s. Coinsurance. Preferred pharmacy’s. Brand name drugs. Generics. Which drugs are less expensive if you pay CASH.

It usually takes me anywhere from 5 to 20 minutes to run a drug report. Add another 10 to 30 minutes to explain to my Medigap client how to properly use the plan.

Very few people, including agents, understand drug plan deductibles.

Choosing Part D Isn’t Easy

Many think choosing a Part D plan is simple. Look for the plan that does not have a deductible and pick the one with the lowest premium.

That is the WRONG way to pick a drug plan . . . unless you enjoy OVERPAYING for your drug coverage.

Whether you pick a drug plan or you allow someone to help , at least make sure you get it right.

Do you want to DIY? Here is where you start.

Let me know how this works for you.

I have been running Medicare drug plan reports since 2010. The first few years I had no idea what I was doing. I made mistakes but fortunately they weren’t costly.

Showing clients how their copay changed once the plan deductible was satisfied was impossible. A few years ago Medicare reworked their software so now they can see month to month how their OOP changes.

When you use these new reports it is very obvious why a deductible plan produces lower OOP costs.

Why is Medicare Part D so Confusing?

Seniors often buy the wrong drug plan and spend too much on their prescription plan. Seniors on Medicare spend an average of $263 per month on prescription medications.

Lower your medication bill by only using your drug card when necessary. The right drug plan will save a lot on brand names but you will almost always pay MORE for generics.

Consider paying cash or using GoodRx instead for maximum savings. Also pick a drug plan that has a deductible.

This report compares a $17 plan with a deductible vs a $79 plan with no deductible. Not only is the premium for the no deductible plan considerably higher but so are the copay’s.

This is not an aberration. No deductible drug plans are more difficult to find. Also the premiums AND copay’s are noticeably higher than plans with a deductible.

Why not let my Pharmacist Help me Pick a Plan?

Your druggist probably has no idea how to run a Medicare drug plan report. Even if they do know how, they will not have the time. He or she will simply recommend a plan they see most often.

That means you may not know how much you could have saved compared to the other 2019 Medicare Part D plans.

Have you bought something recommended by a friend then later discovered you PAID TOO MUCH?

Sometimes you can return the item for a refund.

Medicare drug plans don’t work that way.

Your copay can range dramatically from one plan to the next. Copay’s are even further impacted by using the wrong pharmacy.

Last year I ran a report for a client. Had he kept his existing plan and pharmacy his total annual out of pocket (premiums + copay’s) would have been $13,000. By switching plans AND pharmacy’s he cut his OOP to $6,000.

You Can Pick Your Own Drug Plan

Some folks don’t want help with Part D. They have done it for their parents or other relatives. The plan they found worked so no need to make a change.

As one who runs hundreds of Medicare Part D reports every year I can tell you this. Picking a drug plan is not easy.

Sometimes I will run the report several times to find the lowest possible combination of premiums and copay’s.

Most folks who take the DIY approach only run the report once.

I tell my clients to run their own report, then let me generate a report. Almost without exception my total out of pocket is less.

This is all about saving money by picking the best drug plan. And that is the way it should be.