Medicare Part D |How Does it Work?

How does Medicare Part D work? Almost no one understands it. The few that do know can’t explain it. 800-MEDICARE can’t help, neither can your friends. Most agents have no clue and neither do volunteer counselors.

Medicare Part D is confusing

GA Medicare plan expert Bob Vineyard looks at the most confusing part of Medicare.

How Does Medicare Part D Work?

Who Can Explain Medicare Part D?

The folks in Congress who designed the PDP program don’t understand it and they will never use the plan. Most carrier service reps who answer the phone MIGHT be able to explain their plan but they won’t have a clue about their competitors.

Why is Part D so difficult?

Consider this . . .

The program was designed by folks in Congress who know nothing about health insurance and they turned it over to insurance carriers to manage. What could possibly go wrong?

If you believe they know what they are doing just witness how they messed up Obamacare. And don’t overlook the misnomer for the law . . . the AFFORDABLE Care Act.

WHO thinks Obamacare is AFFORDABLE? How many got to keep their plan no matter how much they liked it? Which of you were able to keep their doctor?

So why do you think they got Medicare Part D right?

Almost no one Understands Part D.

Medicare prescription drug insurance plans have moving parts. Some have a deductible, others do not. All have copay’s. Some copay’s are a flat dollar amount, others are a percent of the retail price. All plans have the donut hole. All plans have preferred pharmacy’s and drug formulary’s.

Some drug plans have a mail order option, others do not. Some mail order refills will save you money, others will not and some will even cost you MORE than filling at a pharmacy. The preferred pharmacy you use this year may not be favored next year.

Am I Required to Use my Drug Plan?

Will you pay less for your medications if you pay cash or use a discount like GoodRx vs running everything through your drug plan? Are you better off running ALL your drugs through the Medicare Drug Plan Finder or only checking prices on some of your med’s? Why will I pay a higher copay by using my drug plan vs a discount card?

Why should I buy a drug insurance plan if I don’t need it? What is the penalty for not having a drug plan? Is it the same every month? How long will I have to pay the penalty? Can I pay the penalty from my HSA?

Can I save money by ordering from Canada? Why is it less expensive to pay cash, use a discount card or order from Canada?

Can I enroll in Medicare Part D at any time? Can I switch drug plans whenever I want? Do I need to review my prescription plan every year or can I just let it renew?

Who Will Help me Find a Medicare Drug Plan?

Why do some agents help with Medicare Part D and others don’t? How much are agents paid to help with Part D? Are agents required to show me ALL the drug plans in my area? Why do agents only sell one or two plans? How many drug plans are offered in Georgia?

What is wrong with picking the plan with the lowest premium? Aren’t all drug plans the same? Why do I have to buy my drug plan from an insurance carrier? Many of the policies are from carriers I have never heard of. Why shouldn’t I just buy from the same company that sold me the Medicare supplement plan? Don’t I get a discount for buying Medicare Part D and Medigap from the same carrier? Is there a reason why I shouldn’t enroll in the same drug plan as my spouse?

My best friend says her plan is the best. What is wrong with buying the same plan she has? Can I use my PDP with any drug store? Can I continue to fill my prescriptions at the same pharmacy I have always used?

Where Can I Get Help With Medigap Coverage?

Shameless plug follows . . .

Georgia Medigap rates. Best GA Medicare supplement prices. GA Medigap rates. GA Medicare 2020. Medigap 2020 plans. 2020 Medicare premiums. Plan G. Georgia Medicare agent. Medicare 101. Georgia Medicare Minute. Medicare explained. Medicare Part D. Silver Sneakers. How does Medicare work?

Bob Vineyard has over 40 years experience in the health insurance field. All your questions will be answered. People love to buy but they hate to be sold.

All I ask is for you to give me 10 minutes by phone. Time to answer YOUR questions. You will NEVER be pressured to buy anything. This is your opportunity to ask ANY Medicare related question, then decide if you want to work with me or not. It’s that simple.

I call it “An offer you can’t refuse

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 look for drug plans that have a deductible.

#HowDoesMedicarePartDWork #GAMedicarePlans

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 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.

Medicare Drug Plan Finder
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.

Am I Required to Buy a Medicare Drug Plan?

Am I required to buy a Medicare drug plan? What if I don’t take drugs? Can I wait until I need a plan? GA Medicare expert Bob Vineyard explains.

Is Medicare Part D required by law? What is the best 2019 drug plan? Is there a penalty if I DON’T buy a prescription plan? Is Part D optional?

required to buy medicare drug plan
Required to Buy a Medicare Drug Plan?

Medicare Part D

I don’t take any prescription drugs. Why must I buy something I don’t need or want?

You are not REQUIRED to buy a prescription Medicare drug plan. But if you don’t enroll in a plan when first eligible you will pay a penalty.

And the penalty is payable for life. It also increases every year.

So . . .

Am I Required to Buy a Medicare Drug Plan?

Where Can I Find the BEST Plan?

Finding the best Medicare drug plan isn’t easy. Part D is the most confusing part of Medicare. How do I find the RIGHT plan for me?

You could get lucky this time, but what about next year?

Is there a GUIDE to Medicare Prescription Drug Coverage? Yes, and it is only 88 pages . . .

The best drug plan is the one that is right for you. Do the following before enrolling.

  • Use the Medicare Drug Plan Finder
  • Enter all your current medications
  • Choose a pharmacy. Look for the one with the lowest copay’s.
  • Make sure all your drugs are on the formulary
  • Consider buying generics with cash or a discount card
  • Look for plans with a deductible
  • Enroll in a plan with the lowest total out of pocket cost

You can do all this by yourself.

Or you can ask a Medicare expert to help. I am always willing to help my Medigap clients. If you are not a client, please don’t ask. It’s not personal, it’s just business.

Why is Medicare 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 look for a Medicare drug plan with a deductible. https://youtu.be/LaA9NnFeBXI

You have questions? I have answers. Call or email.

#MedicareDrugPlan #MedicarePartD #GAMedicareExpert