Medicare Part D Archives | Georgia Medicare Plans

What Are Part B Drugs? – Why is the List Limited?

Bob Vineyard · February 9, 2022 · Leave a Comment

Most prescription drugs are covered by Medicare Part D, but SOME are Part B drugs. What’s the difference? Where is the list of Part B drugs? GA Medicare Plans. Do Advantage Plans include Part B coverage for insulin?

Medicare Part B Drugs

When you have original Medicare and a supplement plan (Medigap) your drugs are covered under a separate Part D plan. Even if you have an Advantage plan (MAPD) drugs are also Part D baked into your plan.

What is a Part B?

Medicare Part B is normally limited to outpatient HEALTH CARE. Part B will cover doctor visits, labs, X-rays, MRI, CAT scan, ER (Emergency Room), Ambulance (when it is a medical necessity), physical and occupational therapy and so forth.

Part B also covers certain medications and durable medical equipment like diabetic test strips, nebulizers, and wheelchairs.

Part D pays for drugs you take regularly for chronic conditions such as: heart disease, high cholesterol, or asthma. It also covers medications you take for a short period of time, such as antibiotics.

But why are SOME Drugs Covered by Medicare Part B, yet Others are not?

For certain medical conditions some of your medications are covered by Part B. For example, Medicare covers flu vaccination once every fall-winter season under its Part B benefit. Also, insulin may be covered if you have a CGM pump, but it falls under Part D if you self inject.

Medication for a nebulizer is another example of a drug that may be covered by Part B.

Most pharmacies cannot bill Part B Medicare prescriptions referred to as Part B drugs) or medical equipment.

If you need Part B drugs or medical equipment, ask if your pharmacy is able to bill your medical plan directly.

Specialty DME (durable medical equipment) providers that may be approved by Medicare include:

Wheel chairs and walkers

Hospital beds and transfer devices

Infusion pumps

Oxygen

Compound and specialty pharmacy

Mail order pharmacy

Does Part B Cover Vaccines?

There are two vaccines for pneumonia that protect against different types of the infection.

Medicare B (Medical Insurance) covers 2 different pneumococcal shots. Part B covers the first shot at any time and a different, second shot if it’s given at least one year after the first shot.

PCV13 helps protect people from 13 of the most severe types of bacteria that cause pneumonia.
PPSV23 protects against an additional 23 types of pneumonia bacteria. Neither can prevent every type of pneumonia, but they work against more than 30 common, severe types.
People who need a pneumonia vaccine should get both shots: first, the PCV13 shot and then the PPSV23 shot a year or more later.

For most people, one of each shot should be enough to protect them for their entire lives.

Does Medicare Pay for Shingles Vaccine?

Shingles vaccine, including the new Shingrix formula, is included in your Medicare Part D benefit.

Will Medicare Pay For Shingles Vaccine?

Shingles, or herpes zoster, is a skin rash that is caused by the same virus that causes chickenpox. Symptoms include blisters, burning, itching, fever, and pain. It usually takes about two to three weeks to clear up.

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

How Do Most Vaccines 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 Insulin Covered by Medicare B or Part D?

If you have an insulin pump your insulin and other diabetic supplies may also qualify for Part B coverage.

Many retail pharmacies cannot bill a medical plan for Medicare medical prescriptions (commonly referred to as Part B drugs) or medical equipment.

WALGREENS has a specialty pharmacy that can help with your intravenous medications (including insulin) and other specialty medications

https://www.walgreens.com/topic/pharmacy/specialty-pharmacy.jsp

Many Part B Drugs are Administered in a Clinical Setting

Part B drugs are often administered by a health care provider (i.e. vaccines, injections, infusions, nebulizers, etc.), or through medical equipment at home.

Some pharmacy’s administer vaccines without a prescription. Shingrix and flu vaccines do not require a doctor’s order and may be free at your local pharmacy.

What are examples of drugs covered under Part B?

Examples include:

Injections for osteoporosis
Some transplant medications
Immunosuppressants
End-stage renal disease (ESRD) medications
Flu, pneumonia, and Hepatitis B shots
Medicare Part D may cover medications that aren’t covered under Part B, and vice versa.

Who is Georgia Medicare Plans and What Do They Do?

Medicare information. Our videos help you understand all about Medicare. You have questions, I have answers.

What is Medicare and how does it work? What is Medicare Part A, Part B, Part C and Part D? What is a Medicare Advantage plan and why is it free? What is the difference in Medicare Supplement and Medicare Advantage? Which is better? Why do I have to pay a premium for Part B Medicare? Why is Part A free but Part B is not? How can I pay my Medicare premiums? Can I use a credit card? Can the premiums be deducted from Social Security?

GA Medicare expert Bob Vineyard takes the time to LISTEN then offers ANSWERS in plain English Medicare supplement plans, Medicare Advantage vs Medicare supplement. Medicare Part A, Medicare Part B. Which Medicare plan is BEST? How to change Medicare plans? Medicare supplements plan G information and rates. Which Medicare options are best? What is original Medicare? What are Medicare basics? Turning 65 Medicare? Medicare explained.

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#DoesMedicarePartBCoverPrescriptionDrugs #WhenCanIusePartBforDrugs #IsInsulinCoveredByMedicarePartB

Georgia Medicare Plans. An offer you can’t refuse.

Why Is Medicare Part D Confusing?

Bob Vineyard · March 29, 2021 · Leave a Comment

Can I opt out of Medicare Part D? Do I need a Medicare drug plan if I don’t take prescription drugs? Can I change Medicare Part D at any time?

Most people sign up for Medicare Part D prescription-drug coverage when they are first eligible for Medicare at age 65.Your initial enrollment period starts three months before your 65th birthday, the month you turn 65, and the three months after your 65th birthday.

If you miss your eligibility period you will pay a late enrollment penalty in addition to your regular premium. The penalty is payable for life.

How Does Medicare Part D Work?

Medicare Part D is confusing. Almost no one understands how it works. 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.

GA Medicare plan expert Bob Vineyard looks at the most confusing part, Medicare drug plans.

And the folks in Congress who designed the Medicare Part D 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.

Am I Required to Buy a Medicare Drug Plan?

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. If you believe they DO 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 drug plans right?

Trust me when I say almost no one understands Part D.

Will I get a lower prescription price if I pay cash?

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.

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 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?

Can I use a discount drug card like GoodRx?

Why should I buy a drug 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 a drug plan 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?

How do I find the BEST Medicare drug plan?

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 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?

Should Diabetics Take Cholesterol Medication?

Bob Vineyard · May 21, 2020 · Leave a Comment

Are you a diabetic with high cholesterol? Should you take a statin drug? Are you at risk for heart disease? How much should you expect to pay for your diabetic medications?

Georgia Medicare Plans feels that retirees on Medicare need good information to maintain their physical and financial health. Free Medicare Part D review, free instant Medicare supplement rates and access to our most popular report “Medicare and Social Security” are just a few of the valuable services we provide.

This report has been viewed and shared over 1,000 times in the last few months.

Diabetic and High Cholesterol

Many diabetics also battle high cholesterol, but are statins the treatment of choice?

New guidelines from the American Diabetes Association (ADA) call for giving the cholesterol-lowering drugs known as statins to all people with diabetes to help prevent heart disease.

Health Day

But are diabetics at any higher risk for heart disease than anyone else with high cholesterol?

According to Dr. Richard Grant, not necessarily.

“We agree that the decision to start a statin should be based on a patient’s risk,” said Dr. Richard Grant, a research scientist at Kaiser Permanente Division of Research and chairman of the ADA’s professional practice committee.
“It turns out that patients with diabetes have the same risk as people with heart disease, so all of our patients need to be on statins,” he said.

But are statins the only way, or even the best way to treat cholesterol?

According to Dr. Grant, some diabetics may not need statins. Younger, healthier patients and older patients with other medical conditions may not benefit from statins.

Heart disease is the No. 1 killer of people with diabetes, Grant said. People with diabetes are two to four times more likely to have a heart attack or stroke than people without diabetes, he said.
The increased risk of heart disease in people with diabetes is what was behind the rationale for this year’s recommendations on statins, blood pressure and exercise, according to Grant.

Many people can control their blood pressure and cholesterol with diet and exercise alone. But some people, such as my wife, have high cholesterol as part of their genetic make up. No matter how much she exercises or how closely she watches her diet, she cannot get her cholesterol below 240.

She does take Red Yeast Rice (a natural statin) and fish oil at the suggestion of her doctor. This seems to help but she can’t overcome the genetics.

Diabetic medications

Treating chronic illnesses can be very costly for retirees. Georgia Medicare Plans works closely with their clients to help them find ways to save money while treating their diabetic condition.

Many type II diabetics can fill their metformin prescription at no charge at select pharmacy’s. Some diabetic supplies (including insulin) are covered under Medicare Part B. A good Medigap plan combined with original Medicare can save you several hundred dollars per year in out of pocket costs.

Medigap carriers will issue coverage to most type II diabetics (as long as you do not have complications associated with the disease) and some type I diabetics. You may even qualify for standard rates.

Switching from brand name drugs can save you anywhere from a few hundred dollars a year to several thousand dollars.

One such example is Glucophage (brand) vs metformin (generic). Most drug plans will not cover a brand name drug if a generic alternative exists.

Glucophage was once available as a brand name drug only. Your cost was over $1,000 per year at retail. Now that is is generic a 30 day supply is $4 or less.

Actos is another popular diabetic medication. If you are taking Actos and pick a low cost ($15) drug plan your drug cost for a 30 day supply is over $300! Switching to the generic version ( Pioglitazone ) will drop your drug costs to $12 for a 30 day supply.

While these savings are significant, changing from Actos (brand) to pioglitazone (generic) will not only allow you to pick a lower premium drug plan ($15) but more importantly lowers your annual drug costs to a more respectable $150 per year.

Most agents are willing to help you find ways to save money on your Medicare supplement coverage but few are willing to explore savings on drug plans. We find that most of our clients who bought drug plans without any help are paying more than they need to both in premiums and out of pocket drug costs.

We save our clients $550 per year or more on their Medigap premiums but the savings exceeds $1000 per year on drug costs.

Recently we reviewed drug coverage for one of our clients. They were paying $115 per month for a drug plan and spending $13,000 per year for their medications. A 30 minute review showed them how to cut their premium in half and drop their drug costs to $6,000 per year.

You don’t have to be a diabetic to realize these kind of savings. Your path to saving money begins with a free Georgia Medicare Plan rate quote.

#diabetic #Medicare #cholesterol #MedicarePartD

Do I Need an Insurance Agent?

Bob Vineyard · March 10, 2020 ·

Do I need an insurance agent to buy a Medicare supplement plan? How much extra will I pay to buy through a broker? Do insurance agents offer the same plans that I can get direct from a carrier? Don’t most insurance agents push the plans that pay them the highest commission?

It doesn’t matter if you are turning 65 and going on Medicare for the first time or you have been in the Medicare system for a few years. Most people still don’t really understand how Medicare works and how it applies to them.

You have questions. We have answers.

Shopping for Medicare coverage? With more than 230 different Medicare supplement plans in Georgia, how do you find the one that is right for you? Click and compare rates and plans from GA Medigap rates

Have you ever seen a Medigap rate report like this?

Everyone I talk to will get a report that is customized to reflect the plan or plans where they have an interest.

If the agent that is trying to SELL you on buying from him or her isn’t offering information like this, what else are they keeping from you?

Should I use an insurance agent when buying a Medicare supplement plan?

This question comes up from time to time but I suspect it is often considered but rarely asked. When it happens to me it usually comes in the form of “How much do you charge for your advice?”.

Perhaps I should consider it an affront, but I don’t. I do wonder if they ask their home and auto insurance agent same question. Similarly, when people go online do they ask them how much more they have to pay for buying a plan from an 800 number agent?

My response is always the same.

Medicare supplement plans you buy through me are the exact same plan at the same rate as those you would buy direct from the carrier. The only difference is, when you buy from me you get the advantage of my 40 years of experience at no additional charge. When you have a question you can call or email.

When you call you get me or my voice mail. You will never hear “Press 1 for English”. You won’t be routed through a bunch of prompts. I return calls within 2 business days and often the same day. If I can’t answer your question I will tell you so and will get back to you within 24 hours with the answer you need.

Call a carrier and you talk to whoever answers the phone that day, if you get a live person. More often than not you get voice mail. You have no idea who will call you back or when. You don’t know if they have worked for the carrier for years or just started last week.

Did I mention you pay the same premium for the same plan when you buy from an insurance agent?

Where can I see all the Medigap plans?

You can’t.

Some of is because most agents don’t have a quote engine on their site where you can see Medicare rates instantly. Something like this.

Even if you find a quote engine you will probably only see a few plans. That’s the way it is on my site. The people who designed and maintain the quote engine only have permission from a few carriers to illustrate their rates.

If you found a site with 230+ Medigap plans and up to 50 different carriers it would probably overwhelm you.

Insurance agents act as filters, showing you the good and bad and providing insight into not only current rates but carrier history.

Bill and Brenda went Medicare shopping

Last year Brenda visited my site a few times, reviewed available plans and rates, but was not available when I called. I left a message but never heard back.

I only call once. If I get voice mail, I leave a message. That’s it. I don’t bug people to death. I don’t chase them down.

Meanwhile Bill and Brenda received several automated emails from me. Each one had information about Medicare in general as well as specific information on Medigap, Medicare Advantage and Part D.

After a few weeks had gone by Bill emailed me. They were both turning 65 and going on Medicare in a few months and they wanted me to come to their home one evening to discuss options.

Only one problem.

I don’t make house calls and I rarely conduct business after normal office hours, but I did agree to call them at a designated time and day.

How Much Can You Really Save?

We talked for perhaps 40 minutes or so. I walked them through the Medicare process and answered all their questions. I agreed to send them information by email so they could study their options in their time frame.

Brenda had already discussed Medicare with her friends and was convinced they needed to buy plan F from AARP/United Healthcare. If they needed plan F they could save $500 per year with a different carrier but the real savings would come by switching to plan G and save over $1000 per year.

The savings didn’t stop there.

Brenda was taking a “prescription” dose of Niacin as part of her cholesterol medication regiment. When I ran their drug report it turns out she was prescribed an OTC version. Her pharmacist was pulling the medication off the shelf, slapping a label on it and charging over $100 per fill for a 30 day supply. She was paying over $1200 per year on her high deductible plan.

I looked on Amazon for the same strength, slow release Niacin.

$17 for 175 tablets.

She could get a years supply for around $35 vs. $1200 from her druggist.

I suggested she ask her doc about the OTC version from Amazon. She did and he blessed the change.

She changed drug stores shortly after that. Probably should have changed docs too but that was up to her.

The point of this is, a few phone calls and emails with an insurance agent (that would be me) resulted in a savings of over $2,000 per year by using an agent. Had she followed the advice of her friends that decision would have cost her a lot of money over the next few years.

Do you need an insurance agent?

Not really.

Anyone can do this but very few insurance agents take the time to educate their clients the way I do.

In September of this year I will be going on Medicare and I am pretty sure I will take my own advice. The same advice I give others.

You need adequate coverage to protect you against the cost of health CARE.

You don’t need to spend all your money on insurance.

You don’t need as much coverage as you think you do and can certainly do better than buying what your friends have. Unless they bought it through Georgia Medicare Plans.

Shop and compare now.

Your information is NEVER sold.

#MedicareSupplementInsurance #InsuranceAgent #GAMedigapRates

Medicare Part D |How Does it Work?

Bob Vineyard · January 13, 2020 · Leave a Comment

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.

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