Why Do I Need a Medicare Insurance Agent?

Medicare insurance agent. Who needs them? Medicare is simple. Pick the lowest rate. Why use and insurance agent? Cut out the broker. Go direct to the carrier. Save the commission.

You Don’t Need an Agent

Medicare expert? Truth is, you don’t need an agent to SELL you a Medicare plan. You can use Medicare.gov, go direct to a carrier or even use one of those online “FREE” quote services. But how will you know if you picked the right plan or paid too much?

Ask a Medicare expert.

Will you save money by eliminating the middleman?

No. This video explains.

Does an Insurance Agent Offer Real Value?

Experience.

About 70% of those who turn 65 and are enrolling in Medicare for the first time have never bought health insurance before. Most people will need to get it right the first time. For many there are no Mulligans. No do-overs. This may be your only chance to buy a Medicare supplement plan.

Medicare supplement rates change every year. Old carriers are retired. New carriers enter Georgia with low initial rates.

You can change Medigap plans anytime you want . . . as long as you are healthy. Medicare expert and insurance agent Bob Vineyard will help you find the right plan that fits your needs and budget.

Those Pesky Drug Plans

Medicare Part D drug plans are complicated. Deductibles, formularies, copay’s, preferred pharmacy’s change every year.

Too many people pay too much for their Medicare drug plan.

Could be they bought the same plan their friends have. Wrong.

Maybe they bought from the carrier that issued their Medigap plan. Wrong.

Sometimes seniors will shop on their own and pick the plan with the lowest premium. Not always correct. Not always wrong. But the criteria is definitely wrong.

Many times they buy a plan suggested by an insurance agent that really doesn’t understand Medicare Part D. This happens way too often.

Check out my YouTube Channel and review drug plan videos.

Learning the Language

Welcome to the world of Medicare where almost everything is a TLE and has an acronym. Here is a friendly introduction.

TLE = Three Letter Entity

CMS = Center for Medicare (and Medicaid) Services

MSN = Medicare Summary Notice

PDP = Prescription Drug Plan

ABN = Advance Beneficiary Notification

Having fun so far. You can’t tell the players without a scorecard.

Confused?

You have questions. We have answers. Call or email.

Do You Need a Medicare Expert?

Nope.

You can DIY. (Do It Yourself).

But if you mess up who can you blame?

You can spend hours online researching. Attend seminars. Invite strangers (insurance agents) into your home.

But they don’t leave until you buy something or call the cops.

You could also sort through the mountain of information that comes in the mail. Ask your hair stylist or members of your bridge club. Does anyone still have bridge clubs?

Buy direct from a name you trust. Here is a tip. Medicare carriers with familiar names often overcharge, sometimes by hundreds or thousands of dollars per year.

Why?

Because they can.

They know you are buying on name recognition and have not researched. You trust them to treat you right.

They will take advantage of that trust and profit from your lack of understanding.

Give Me 10 Minutes

That’s all I ask.

Look over my website. Watch my videos. Call or email.

Yes, I am an insurance agent. But also an expert with over 40 years experience.

And just like you, I am enrolled in Medicare.

If you don’t feel comfortable with my advice, move on. No hard feelings. I don’t chase. I don’t beg.

Either you want my help and advice or you don’t.

Not only will I save you a lot of time and keep you from chasing rabbits, but you will also learn how to maximize your Medicare dollars.

And isn’t that what this is all about? Finding real value in the advice offered by a Medicare insurance expert.

#GeorgiaMedicareExpert #GeorgiaMedicarePlans

Georgia Medicare Gives Thanks

Georgia Medicare Looks at 2018

As Dickens said, “This is the best of times and the worst of times.” Like all years, there are times when things are good and times when things are not so good. From a business perspective I would give this year a 9 on a scale of 10. Georgia Medicare expert reflects on 2018.

Georgia Medicare expert

The Good News

Georgia Medicare supplement clients continue to bless me with referrals. My business grows mostly by word of mouth. When my advice is useful clients remember and pass my name along to their friends.

Like that old shampoo commercial where Heather Locklear told two friends about Faberge, and they told two friends, and so on.

Good new spreads like wildfire, and it is appreciated. With more than 500 GA Medicare clients, new referrals come in almost every month.

Thank you for being generous and sharing my name with your friends.

Georgia Medicare YouTube Channel

After years of planning and hoping it would happen, I finally implemented my Georgia Medicare YouTube channel in early summer. With the help of Christy Sanchez this labor of love is now a reality.

The videos are not fancy or technically complicated. It’s just me talking to the camera the same way I speak to you on the phone. Feel free to like, share and comment on any of the videos.

Of course you can also ask questions.

Say Hello to New Medigap Carriers

I currently count almost 60 insurance carriers offering Medicare supplement plans in Georgia. Many are brand new to the Medigap business. Others are new to Georgia.

At least 6 carriers are new to the Georgia Medicare market. Each one has cut rates to the bone in an attempt to gain market share.

It’s a race to see who can offer the lowest Medigap rate.

For at least a year.

New carriers include Lumico, Western United (late 2017), Everest (late 2016), American Continental, Prosperity (gotta love that name), Mass Mutual, Unified and Pan American. I might have missed a few but that’s a mouthful.

I generally don’t recommend a carrier until they have been here at least 3 years. In the past carriers (like AFLAC) have either disappeared from the market or blew up their rates on renewal in the first 3 years.

I don’t need that kind of drama in my life and neither do you.

Say Hello to a New Name for an Old Friend

One shining star is Anthem Blue Cross. BCBSGA has been co-branded with parent Anthem for a few years now. As of July 2018 the Anthem name is on all new Medicare plans in Georgia.

Of course you can call them direct or use an agent like myself. When you go direct you are a “house account”. You will never know who will answer the phone or anything about them. 

Last week they could have been asking if you wanted fries with your meal.

When you call me you will never hear “Press 1 for English”. You get me or voice mail. Leave a message and I will call you back.

No extra charge for my 40+ years experience.

You can enroll in an Anthem Medigap plan using my link . . . if you have an hour or so to kill. 

https://brokerportal.anthem.com/ac/BobVineyardAnthemGA

Or call me direct. I can take your information in about 10 minutes.

You choose.

The Bad News

A few carriers like Equitable, Manhattan and Aetna Health and Life stopped writing new Medigap business in Georgia. If you have a plan with them you can keep it as long as you pay your premiums.

I hope to move as many as possible away from these carriers in hopes of seeing fewer and smaller rate increases at renewal.

Thank You!

Thank you for all your support, for passing my name along and especially the kind words for my Georgia Medicare YouTube Channel.

I look foward to helping as many people as possible to navigate the Georgia  Medicare maze.

Medicare Open Enrollment 2019

Medicare Open Enrollment 2019. Shop Medicare supplement plans and Part D. New, lower Medigap premiums. Are higher drug costs coming in 2019?

Who is invited? Who should stay home?

Can anyone help navigate the Medicare maze?

 

Medicare Open Enrollment 2019

So much information. So much confusion. Medicare Open Enrollment is not for everyone, and certainly not for the faint of heat.

If you think you already have all the answers, don’t read this post. If you believe Medicare open enrollment is for everyone you will probably learn something.

Medicare AEP is not a casual stroll. For most people, this is the only time you can change your Part D drug plan or Medicare Advantage plan.

Make a mistake and you will have to live with that decision for a year.

 

Be Prepared

Before you enter the annual election period, do this.

  • Make a list of all doctors including name, address, phone.
  • List all area hospitals, especially the ones you have used.
  • Make a list of all medications including dosage, refills, prescribing doctor and pharmacy.

Be aware of the donut hole and look for ways to avoid that trap. Make use of generics and off plan purchases.

Look for FDA approved generics and ask your doctor before making a change.

 

Part D Jungle

If renewing, get your drug list ID and password date from your last drug plan finder.

If renewing, study your ANOC for changes.

Use Medicare.gov for reviewing Advantage and drug plan options.

Avoid using Medicare.gov for PDP comparisons prior to October 25.

 

Review Medicare Supplement Options

Medicare.gov and the GA DOI site is essentially useless when comparing Medicare supplement options.

Most Medigap quote engines only list a handful of options and rarely have plans with the best value

Many quoting sites will sell your information to numerous agents; some don’t provide instant quotes

Never put anything on auto-renew unless you like unpleasant surprises.

 

Understand the Differences

Both Medigap and Advantage plans cover the same types of medical treatment, but what you pay out of pocket for your care, and where you receive your care, is very different.

Advantage plans are managed care plans. Some are PPO, some are HMO. In 2018 about half the plans are HMO with the balance being PPO.

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Your max OOP may also be higher. Some plans do not cap out of network charges.

Non-emergency out of network care charges may be denied if you have an HMO.

 

Medicare Advantage Considerations and Cancer

In 2018 most Advantage plans issued in Georgia limit your out of pocket for approved in network health care expenses to $6700.

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

Some cancer centers, such as Mayo Clinic and MD Anderson do not participate in Medicare Advantage plans.

Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.

Chemotherapy drugs administered in a doctor’s office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.

This is why most of us chose a Medicare supplement plan in 2018. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.

We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.

According to the Mayo clinic, “new cancer treatments are routinely priced at over $100,000 per year of treatment.”

5 Medicare Open Enrollment Tips You Must Know

Understand how Medicare works. Open enrollment only comes around once a year. Take advantage of this time to review all your options.
#GeorgiaMedicarePlans #GAMedigapQuotes #Turning65
How does Medicare work? Open enrollment 2018

 

Rich Man, Poor Man – a Tale of Two Scanners

It was the best of times. It was the worst of times.

Does where you receive medical treatment make a difference? If two different facilities use the same CT scanner shouldn’t the pricing be about the same?

Ben Hayden had a pain in his abdomen . . . so he went to see his doctor. To rule out anything serious, Ben’s doctor sent him to a free standing imaging center for a CT scan.

The radiologist didn’t see anything wrong on the images, and Ardesia didn’t recommend any treatment.

A few weeks later, Hynden, who has a high-deductible health insurance policy with Cigna, got a bill for $268. He paid it and moved on. – KHN

Then 3 months later the pain returned. Ben’s regular doctor was not available so he saw a nurse practitioner. Thinking Ben might have appendicitis, he was told to go to the hospital ER for a scan. Tale of Two Scanners

The results of the scan ruled out appendicitis but this time he had a different problem.

 

Two Scanners – Two Prices

A word of advice.

If you have a choice between going to the hospital ER for a CT scan, and a free-standing imaging center, choose the center.

“It was the exact same machine. It was the exact same test,” Hayden said.

The results were also the same as the October scan: Hayden was sent home without a definitive diagnosis.

And then the bill came.

Patient: Benjamin Hayden, 29, a adviser in Fort Myers, Fla.

Total Bill: $10,174.75, including $8,897 for a CT scan of the abdomen

Service Provider: Gulf Coast Medical Center, owned by Lee Health, the dominant health care system in southwest Florida

Quite a shock.

This time instead of owing $368 Ben’s share was $3,656, roughly 10x his share for the same scan 3 months earlier.

Click here for the rest of the story . . .

 

High Deductibles, Networks and More

Ben was only 29 years old and not on Medicare. But the outcome could have been the same under a managed care Medicare plan.

Over half the Advantage plans offered in Georgia are HMO’s. As long as you use a network provider your claims should be paid. But step outside the network and you could owe the entire bill. What happens if the provider who does your scan is not in network?

An exception could be made in the case of a life-threatening emergency.

But who decides if your case is a true emergency?

If the carrier decides against you, the claim is denied. Do you really want to take that chance?

 

 

 

 

Original Medicare and a Supplement Plan

Original Medicare does not have networks. You can use any doctor, any hospital, anywhere in the country. Never any penalties for using the wrong provider.

Even better, your out of pocket for a scan is limited to 20% of the Medicare approved amount. With a Medicare supplement plan (Medigap) your out of pocket cost could be less than $200.

Which makes more sense to you?

It was the age of wisdom. It was the age of foolishness.

Answers to Common Medicare Questions

I have answers to your most common Medicare questions. Here are just a few examples of questions asked by people just like you who are turning 65.

  • How do I know which Medicare plan is right for me?
  • When should I enroll in Medicare?
  • Should I have the same plan as my spouse?
  • How much does Medicare cost?
  • Does Medicare cover (fill in the blank)?

Many of your questions can be answered by copying this into your Google search bar – site:http://www.georgia-medicareplans.com

Answers to Common Medicare Questions

 

Answers to Common Medicare Questions

Below are links that correspond to the questions shown above.

  • https://www.georgia-medicareplans.com/ufaqs/find-right-medicare-plan/
  • https://www.georgia-medicareplans.com/enroll-in-medicare-at-age-65/
  • https://www.georgia-medicareplans.com/medicare-traps-and-mistakes/
  • https://www.georgia-medicareplans.com/ufaqs/how-much-do-medicare-premiums-cost/
  • https://www.georgia-medicareplans.com/does-medicare-cover-my-cancer-treatment/

You have Medicare Questions.

I have answers.

Give Bob Vineyard a call. I would love to help. (404) 252-5859

 

Medicare Supplement – What If You Just Bought?

Let’s say you turned 65, enrolled in Medicare and just bought a Medicare supplement plan. Did you make the right decision? What are some of the traps and mistakes?

Please take 3 minutes to read this then decide if you need to reconsider your decision. It might just save you a lot of time, money and grief.

You are turning 65 and about to go on Medicare. Here are some things you need to know about your journey.

Medicare Supplement - Turning 65

 

About That Medicare Supplement Plan You Just Bought

You are not alone.

Roughly 80% of retirees about to turn 65 have never bought health insurance before.

My 40 years in the health insurance business was not enough to prepare me for understanding the Medicare system. It took me about a month of research and talking to Medicare specialists before the light bulb turned on.

If it was that difficult for me I can imagine how confusing it is for you and everyone else.

Medicare supplement or Medicare Advantage?

 

Your Friends May Offer the Worst Advice

Your friends that are on Medicare are probably still confused about what they have and how it works. I know this because I talk to people every day that were told something about Medicare that is 100% wrong and will prove very costly down the road.

They are probably very good at many things, but Medicare experts they are not.

Ask your friends who THEY talked to in making their decision. If they were pleased, ask for a recommendation. Then you talk with that person and decide if they are giving solid advice or simply pushing a product.

Sadly, most agents talk too much and never listen to your needs.

If they bought a $0 premium Advantage plan (along with a bunch of junk to fill the gaps), or Medigap plan F they will learn to regret that choice later down the road.

 

Things You Probably Don’t Know

When you turn 65 you have ONLY ONE Initial Enrollment Period (IEP). During that time you can purchase ANY PLAN from ANY CARRIER without answering health questions. Your initial enrollment for Medigap begins the month when you turn 65 AND go on Medicare Part B. It ends 6 months later.

During your IEP you can freely change Medigap plans within the same carrier or move from one carrier to another without penalty. Most people we talk to will end up paying a lot more for their coverage than was necessary. It is not too late to change. Don’t let pride stop you from making a better financial decision. (More on this later)

You have 60 days from the time you turned 65 and enrolled in Medicare Part B to pick a Part D drug plan or Medicare Advantage plan. If you wait, your next opportunity will be during the Annual Enrollment Period (AEP) and you will pay a LIFETIME late enrollment penalty.

If you bought an Advantage plan and then learned that was the wrong decision you can still purchase a suitable Medigap during your IEP. This happens with some frequency so no need to feel embarrassed.

Many of the newer Advantage plans are “front end loaded” so you pay most of the costs of your care without the benefit of a copay. The networks are also more restrictive than you may have been accustomed to with traditional health insurance.

Get instant GA Medigap quotes, then request our FREE Medicare Supplement rate report that shows ALL the Medicare supplement rates.

 

Discovering What You Bought

Medigap “gotcha’s”

Medigap is simple, but not as simple as some might think. Sure, the plans are standardized. All plans with the same letter (plan F for example) are identical in every way except the price you pay.

But the simplicity stops there.

Financial ratings don’t matter. “A” rated carriers like AFLAC and Omaha have sucker punched retirees in the past. Offer a low going in rate then substantial increases in later years. Sometimes they stop writing new business with that carrier name.

Then what happens?

Look for LONG TERM STABILITY in the Medicare supplement market. If a carrier doesn’t have at least 5 years in the Medigap market operating under the SAME NAME, you probably want to cross them off your list.

The carrier names are interchangeable and every 3 – 4 years an old carrier will be swapped for a newer one that has rates 20 – 30% below the “old” carrier. The new, lower rates are only for NEW APPLICANTS.

Some carriers have “hot” rates in Georgia right now. But none of them have more than 2 years in the Medigap business an at least one has already had a 9% rate increase.

 

Which Carrier Did I Pick for My Own Coverage?

My choice

You don’t have to do what I do but consider this. I have more experience in the health insurance business than anyone you have talked to so far. There are some paths I won’t take because I know the pitfalls. Maybe you should do the same.

I enrolled in Medicare in September 2015. How many agents have you talked to so far that are also on Medicare?

My guess is none.

I didn’t buy a plan from any carrier with less than 5 years in the Medigap business.

I didn’t buy Medicare supplement plan F.

I didn’t buy a Medicare Advantage plan. Even if I did, I certainly would NOT buy a hospital indemnity plan, a cancer plan, a heart attack plan, etc to fill the gaps. An agent that pushes those policies is all about making as much money as possible off you.

 

It’s Your Plan and Your Money

Choose wisely.

Ultimately, whatever choice you make should fit your needs and budget. I don’t expect everyone to make the same decisions I make, nor would I pressure anyone to buy something just because I am doing it. But I do believe my clients deserve to know the choices I will make and why I am making them.

There are more than 250 different Medigap plans and rates in Georgia. You probably looked at half a dozen or less. What did you miss by not seeing ALL the rates?

There are only TWO or THREE Medicare supplement carriers with competitive rates that have 5 or more years in the Medigap business. If you didn’t buy from them you probably are, or will eventually be, paying too much.

When you pay more you don’t get more. You simply paid too much.

Let me know how I can help. Call (404) 252-5859 to speak with Bob Vineyard. 

Free and Low Cost Prescription Drugs

Medicare resource for free and low cost prescription drugs. Are you 65 or older and can’t afford your medications? Paying too much for generics? Medicare’s annual election period, commonly referred to as open enrollment, is the only time of year when anyone can change their Medicare Part D plan.How to find free and low cost prescription drugs

Many seniors mistakenly believe Medicare open enrollment allows them to change their Medicare supplement plan without answering health questions. The truth is, you can drop your existing Medigap plan and purchase a new one any time of year, as long as you can pass medical underwriting.

The cost of prescription medications has steadily risen since 2006 when Medicare Part D was created. Some generic drugs that were once considered affordable are now out of reach. Many of these medications now reach $200 or more.

Help is on the way.

 

How to Find Low Cost or Free Prescription Drugs

Finding low cost or free medications can be challenging if you don’t know where to look.

For many, an even bigger challenge is finding a Medicare prescription drug plan that is right for you. Fortunately there are many articles and sites on the internet providing a treasure trove of information, if you only knew where to look.

One such site is VeryWell, a health and information site owned by the folks at About.com. Earlier this year they published an article titled Stores that Offer Free and Low Cost Prescription Drugs.

We found the page while searching for one of our Medicare clients that was having trouble paying for her medications. She has Part D, but that was not enough. VeryWell’s article listed national and regional chain stores where you can save a lot of money on prescription drugs. Here is a partial list.

  • Costco
  • Kroger
  • Publix
  • Walmart
  • Sam’s

Warehouse clubs like Costco and Sam’s allow anyone to purchase prescription drugs even if they are not members. The hope is visitors will see other things where they can save money and will purchase a membership.

Costco also has a branded Visa card with an annual cash back reward for purchases at Costco including gasoline. The card can be used anywhere so your annual “dividend” can multiply with almost every purchase.

 

Rising Medicare Supplement Rates

Many retirees on a fixed income are also finding their Medigap premiums rising to the point where budgets are squeezed. Georgia Medicare plans offers a free, no obligation way to shop and compare Georgia Medigap rates in the comfort of your home.

Using our search engine you can compare about 30 popular plans, compare benefits and rates side by side.

We also offer a more comprehensive research report showing over 200 Georgia Medicare supplement plans and rates.

Your information is never sold. There is never any charge for the report. We do hope to earn your business and believe many will appreciate our no pressure approach.

 

Even More Ways to Find Low Cost Drugs

For over 20 years we have shown our clients how to save money on prescription drugs. Many drug discount plans are worthless and often you will pay a higher price than you normally would by just paying cash.

GoodRx is an exception to the rule.

Last year I needed to refill a prescription for Clobetasol to tame the itch of eczema. A tube normally lasts about 18 months and it normally is less than $20.

However I was shocked to learn the price with my Part D drug plan was going to be $92.

I left the store without taking my prescription with me. By using the GoodRx drug finder I was able to purchase the cream at a competing pharmacy for only $27!

Another resource is Blue Sky Drugs, a reputable Canadian pharmacy. Current pricing for Clobetasol is even lower than GoodRx.

 

How to Find Inexpensive Prescription Medications

Many people who live in rural areas may only have a few places where they can fill their presciptions. The folks at NeedyMeds offer a wealth of information when searching for free and low cost prescription drugs. They also have PAP’s (patient assistant programs) for many of the newer, high priced brand names.

The NeedyMeds $4 Prescription Drug Finder lists savings plans in alphabetical order by pharmacy name.

Some places, such as Publix grocery stores, offer FREE prescription medications.

Below is a partial list of free and low cost prescription drug resources. Grocery chains

  • Publix
  • Kroger
  • Winn Dixie

Many national drug stores have their own promotional plans for saving money on generic drugs.

  • CVS / Target
  • Rite Aid
  • Walgreens

Another resource for locating low cost prescription drugs in the US and Canada is Pharmacy Checker. Enter the name of your medication in the box and start the search.

If you need or want to save money on your medications (who doesn’t?) there are plenty of ways to lower your costs.

Our FREE annual review during Medicare open enrollment saves our clients hundreds or even thousands of dollars vs. their current drug plan. Two of our Medicare supplement clients will save over $4,000 next year by switching Part D plans and pharmacy’s.

We can’t guarantee you will save that much but many times the drug plan savings alone is enough to cover the cost of your Medicare supplement premium.

Need to save money on prescription drugs? Ask us. We can help.

 

#FreeLowCostPrescriptionDrugs #MedicareSupplementRates  #MedicarePartD  #MedicareOpenEnrollment

 

 

 

Medicare Open Enrollment 2019

Medicare 2019 Open Enrollment starts on October 15th and ends on December the 7th. Who is affected? How do you decide what to keep and what to change? Where can you get answers to your questions?Medicare Open Enrollment 2018

Don’t get distracted by the hype.

During this open enrollment many will want to offer advice but how do you know their opinions are useful? Can you really get solid, unbiased advice or are you at the mercy of scoundrels?

Let’s set the record straight and give you some guidelines about what you need to know and how to sort out good advice from bad.

Five Medicare Open Enrollment Tips You MUST Know

Medicare Open Enrollment 2019 – A Journey with a Purpose

Let’s start with the basics of Medicare 2019 open enrollment. One area that creates more confusion than anything else is changing Medicare supplement plans.

You can change your Medigap plan any time of the year. The annual enrollment period does not include Medicare supplement plans. Only Medicare Advantage and Part D drug plans are included in open enrollment.

There is generally only one time when you can buy a Medigap plan without answering health questions. For most folks that is when they turn 65 and enroll in Medicare for the first time. Once you have been enrolled in Medicare Part B for 6 months you can change plans as long as you pass through underwriting.

If you have questions about your ability to change plans, give us a call. In less than 5 minutes you can learn if you are healthy enough to be approved or not. We will also be glad to quote Medicare supplement rates over the phone and email you a Medigap rate report like this one.

If you can change your supplement plan at any time of the year, what do I need to know about Medicare Open Enrollment 2018?

Medicare open enrollment allows you to change your Part D prescription drug plan, or your Medicare Advantage plan. Neither require medical underwriting with one exception. If you are currently in renal failure you cannot change Advantage plans.

At Georgia Medicare Plans our focus is strictly on finding the best Medigap coverage that fits your needs and budget. We also offer detailed advice on Part D and will guide you through the enrollment process.

We do not offer Medicare Advantage plans but we will refer you to an associate if you are convinced Advantage plans are right for you.

 

Medicare Drug Plans are Confusing

The most difficult part of my work is helping clients find the right drug plan that delivers the best value. Let’s look at how I handled a review for a new client.

Bill currently takes two different medications to control his cholesterol, Ezetimibe and Xarelto. While was covered under a group health insurance plan his Xarelto copay was $0. That goes away once he is covered by Part D.

Bill likes to take charge of things and his own review of drug plans led him to believe his best option was a plan with a monthly premium of $55.

I felt he could do better.

Both of these drugs are expensive. Ezetimibe has a retail price of $300 for a 30 day supply; Xarelto is $400.

2019 update – Ezetimibe is currently $12 with a GoodRx discount. 

 

Avoiding the Donut Hole

My analisys indicates he will enter the donut hole by the 4th month and his out of pocket drug costs will exceed $350 per month.

My suggestion was to drop Ezetimibe from his drug plan evaluation and purchase outside of Part D using GoodRx. His copay would be about the same as his drug plan but by removing the drug from the formulary calculation he is able to delay entering the donut hole to month 7 vs. the 4th month.

Can he avoid the donut hole completely?

As it turns out he can.

He can buy Ezetimibe through Blue Sky and lower his costs even more than using GoodRx. Before he enters the donut hole his Xarelto copay is $46. Once in the donut hole his copay more than triples. Copay’s for all drugs, not just the expensive ones, increases while in the donut hole. He can avoid the donut hole completely by purchasing his meds (except Ezetimibe) through the drug plan and then buying Xarelto from Blue Sky right before entering the donut hole.

Combining these suggestions he can choose a drug plan with a $22 monthly premium vs the $55 plan he would have picked on his own. Bill saves over $500 in prescription drug costs.

 

Medicare Drug Plans – Who is Advising You?

Where can you go for help and advice for drug plans during Medicare open enrollment 2018? Let’s run down the list.

  • You can do it on your own
  • You can call 1-800-MEDICARE
  • Ask a friend what they have
  • Choose the same plan you spouse has
  • Talk to a volunteer at Georgia Cares
  • Search online
  • Ask an insurance agent
  • Talk with your hair stylist

Obviously there are many choices but whatever route you take during Medicare open enrollment 2018 make sure you consider all of the following.

  • Start with the Medicare plan finder even if you are going to ask for advice
  • Next, record your Drug List ID number and Password Date for future reference
  • Be sure to consider lower cost generics where possible
  • Make sure you are including the lowest cost participating pharmacy’s*
  • Check generic pricing using GoodRx
  • Also check pricing at a Canadian pharmacy such as Blue Sky
  • Include star ratings in your evaluation
  • Don’t just assume the plan that worked well this year is your best choice for 2018
  • If you use an agent, make sure they are looking at ALL available plans, not just the one that compensates them
  • If you use 1-800-MEDICARE ask if they have suggestions on ways to save by purchasing drugs outside of Part D
  • Sometimes free advice is worth what you paid for it

*In 2017 Walgreen’s often has the lowest prices for medications. If your evaluations for this year did not include Walgeen’s as an option you probably never saw the lowest priced drug plans. Low price pharmacy’s change every year. Make sure you don’t make the same mistake for 2018.

 

Look for Medicare Supplement Premium Savings

At Georgia Medicare Plans we do things other agents fail to do. If an agent fails to offer you a free Medigap rate report are they showing you the best options for you or only the plans that pay them the most money?

Every prospective client receives this report for the plan(s) they are considering. Just ask. It’s that simple. We email your report  for review. Take time to study the report and form your questions. We are happy to help.

You have entered the “No Selling Zone”. Most of all, there is no pressure to buy but we do hope to earn your business. Call or email with questions, when you turn 65 or during the Medicare Open Enrollment 2019 dates.

 

#MedicareOpenEnrollment #MedicarePartD #GeorgiaMedicareSupplementRates #Turning65

Does Medicare Pay For Glucose Monitors?

Continuous Glucose Monitors (CGM’s) are life savers for many insulin dependent diabetics. Medicare does cover diabetic supplies and medications but it is the way those items are covered that can be confusing. Not all diabetics need a pump. Not all diabetics that need a pump need a CGM. Some are able to manage their disease with either oral medication or by injection.

CGM Continuous Glucose Monitor CGM

If your doctor certifies to Medicare that you meet their criteria for an insulin pump then maybe Medicare will cover the device.

Or maybe they won’t.

And Medicare might pay for some glucose monitor’s but not for others.

Confused?

Read on.

 

CGM’s and Medicare

A CGM can be an insulin pump but not all insulin pumps are CGM’s.

In insulin pump is an implantable device used to administer insulin rather than using a syringe and needle. Pumps can be programmed to release small doses of insulin in much the same way as your pancreas does. By delivering “mini” doses of medicine the need for long acting insulin is eliminated.

A Continuous Glucose Monitor continuously measures your glucose levels but not your blood glucose levels.

Medicare covers therapeutic CGM’s but not adjunctive CGM’s.

 

Medicare Part B and Part D

Insulin is covered under Medicare Part D (drug plans) unless it is covered by Part B.

Screening for diabetes is covered by Medicare Part B . . . unless you need more than two screenings per year.

Medicare Part B pays for glucose monitors, lancet’s, test strips and most other Durable Medical Equipment (DME) but they do limit the quantity and how often you can get these supplies.

If you use insulin Medicare covers up to 300 test strips and lancets every 3 months. But if you do not use insulin Medicare covers up to 100 test strips and lancets every 3 months.

Apparently Medicare believes you do not need to test your blood sugar as often if you are not insulin dependent.

Medicare Part D covers insulin unless it is covered by Part B.

Medicare may pay for Continuous Glucose Monitor sensor’s but only if your monitor is a specific brand. Sensors are devices planted under the skin to monitor and relay information about your glucose levels.

Medicare has approved the Dexcom G5 CGM but only if you use the receiver that comes with your device but not if you use a smart phone app.

Do you really think Medicare will track everyone who has a Dexcom G5 to see if they are checking their glucose on their smart phone? And why should Medicare care if you use your smart phone or not?

Medicare Advantage or Medicare Supplement

If you have a Medicare Advantage plan in many cases your plan will pay 80% of the cost of your pump or CGM and you will pay the remaining 20%. Monitors run anywhere from $1000 to $1400 plus another $300 or so each month for sensors. And you will need a battery that is changed about once a year or so. They run around $500.

With an Advantage plan your out of pocket costs can get expensive over the course of a year.

Medicare Advantage plans are purposely designed to maximize your out of pocket expense while minimizing the carriers out of pocket.

For those with original Medicare and a supplement plan your out of pocket cost for a pump and approved continuous glucose monitor can be $0 if you have Medigap plan F.

And let’s not forget insulin.

Many Advantage plans run your insulin through the drug plan portion of your coverage.

Unless your Advantage plan does not cover prescription drugs. Then your insulin may still be allocated to Part D. Insulin under Part D can run $300 – $500 monthly depending on the type of insulin and dosage. It also varies by where you are in regard to the donut hole.

 

Medigap and Your Diabetes

Under original Medicare, if you have a pump, with or without a CGM, your insulin is covered by Part B. That means your out of pocket cost could be $0 for the year if you have a Medigap plan.

The BEST time to purchase a Medicare supplement plan is when your Part B goes into effect and you are turning 65 or older.

Georgia Medicare Plans specializes in helping seniors find Medicare supplement plans with the lowest premiums in their area. Our exclusive report shows you every Medigap plan in your area based on your age and gender. No need to waste time searching for the best rates. We shop, you compare. Call or email.

You can also run your own Medigap quotes from the comfort of your home.

CGM Monitors - Georgia Medicare Supplement Rates

You have questions. We have answers. Never any selling.

 

#CGM #ContinuousGlucoseMonitor #DexcomG5#InsulinPump #MedicareDiabetes #MedicareDiabeticCoverage #GeorgiaMedicareSupplementRates

 

Does Medicare Pay For a CPAP

Does Medicare Pay for CPAP

Many people over  65  on Medicare have some form of chronic sleep apnea and need a CPAP machine. Most go undiagnosed so only a small percentage use a CPAP. According to the UCLA Sleep Center “It is very common for people over the age of 65 to have problems with their sleep. Insomnia is their most common complaint. Many drugs used to treat medical problems can also disrupt your sleep. Some people are able to sleep better by using sleeping pills from time to time. But many older people rely too much upon drugs to help them sleep. Studies show that some common drugs may not even work well in older people. In fact, they may even make sleep problems worse.”.

A Continuous Positive Airway Pressure device known as a CPAP machine can remedy many of the problems associated with Obstructive Sleep Apnea (OSA).  Not everyone can use the machine and with prices anywhere from $500 to over $3,000 coming up with the money to pay for the machine may be difficult.

Medicare Coverage for CPAP

With so many people over 65 having OAS you would think Medicare would pay for your machine. Actually, Medicare has some of the strictest guidelines for coverage of any health insurance plan. Perhaps that has something to do with also having the most generous coverage with Medicare picking up 80% of the cost of your machine under Part B.

Under the Obama administration the OIG (Office of Inspector General) was directed to find ways to eliminate waste, fraud and abuse in the Department of HHS (Health and Human Services). That report, released in June of 2013, found that “beneficiaries receiving CPAP treatment may have received more supplies than were medically necessary”.

Even though the report showed that the number of supplies did not exceed the recommended replacement schedule it also stated that if someone DID receive more supplies than necessary that would be wasteful spending.

Let that sink in for a moment.

Here are Medicare guidelines with regard to CPAP machines.

Medicare covers a 3-month trial of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea.

Medicare may cover it longer if you meet in person with your doctor, and your doctor documents in your medical record that the CPAP therapy is helping you.

If you had a CPAP machine before you got Medicare, Medicare may cover rental or a replacement CPAP machine and/or CPAP accessories if you meet certain requirements.

If you had a CPAP before going on Medicare and your doctor states that the machine is helping you, Medicare MAY pay for the rental or replacement of the machine.

Your doctor and the AASM (American Academy of Sleep Medicine) may say you have sleep apnea but Medicare may say you don’t.

In other words, until Medicare says you have OSA you don’t have a medical problem that requires a CPAP. You can get the machine if you want, but Medicare won’t pay for it.

 

Competitive DME Bidding

The folks at Medicare want to make sure they get the best price on Durable Medical Equipment so they make supplies bid on contracts for their business. But the game doesn’t stop there.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.

In an attempt to save money, Medicare imposes a competitive bidding process where DME (Durable Medical Equipment) supplies must compete if they want to be a sanctioned Medicare supplier.

What could possibly go wrong there?

Competitive bidding means fewer suppliers participating in the DME process. Fewer suppliers means delays in getting your equipment. Without a CPAP any related medical conditions can get worse.

But hey, at least Medicare is saving money, right?

 

Getting Medicare to Pay for a CPAP

The good news is, you can get Medicare to pay for your nightly breathing assistance machine. All you have to do is follow their guidelines.

If you are able to convince Medicare you do in fact have apnea, and that your condition will IMPROVE by using a CPAP, they will cover 80% of the cost under Medicare Part B. If you also have a Medigap plan your out of pocket cost could be $0 or limited to your annual Part B deductible.

Advantage plans do cover a CPAP in most cases but your out of pocket cost for the machine and supplies under most plans is 20%. That could amount to several hundred dollars per year. Even more if you fail to use a network approved DME supplier.

Georgia Medicare Plans specializes in helping seniors find Medicare supplement plans with the lowest premiums in their area. Our exclusive report shows you every Medigap plan in your area based on your age and gender. No need to waste time searching for the best rates. We shop, you compare. Call or email.

You can also run your own Medigap quotes from the comfort of your home.

Georgia Medicare Supplement Rates

You have questions. We have answers. Never any selling.

 

#CPAP #OSA #SleepApnea #Medicare #MedicareSupplementPlan #MedicareApvantage