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Part D Election Bailout

Understanding the Upcoming Changes to Medicare Part D: What You Need to Know

Would you be upset if you found out that your drug suddenly cost three times as much? How about your Part D drug plan premium on Medicare just going up three times the cost? Well, something like that was just about to happen, and you wouldn't find out about it until September or October of this year. But suddenly, there's a rescue! Something will happen to bail you out at a taxpayer cost estimated to be $7.8 billion. This story is one you won't want to miss!

My name is Christopher Westfall, and I've been helping people with Medicare for 30 years as a licensed insurance agent. In this blog, we will dive deep into the recent developments surrounding Medicare Part D and the Inflation Reduction Act, and what these changes mean for you as a beneficiary.

The Inflation Reduction Act: A Double-Edged Sword

The Inflation Reduction Act (IRA) was designed to alleviate some of the financial burdens faced by seniors, specifically regarding prescription drug costs. One of the key provisions of this act is the introduction of a maximum out-of-pocket cap of $2,000 for drugs. However, many may not realize that this cap places the financial responsibility on the insurance companies. As a result, these companies are now scrambling to adjust their premiums, leading to significant increases.

For example, the average monthly premium for Part D plans was around $43 last year. With the new changes, this figure is expected to rise significantly, with some plans showing bids from insurance companies jumping from an average of $64 per month to an astonishing $179 per month for 2025. This drastic increase has understandably caused alarm among seniors and Medicare beneficiaries.

What the Government is Doing to Mitigate the Impact

In response to the expected surge in premiums, the Centers for Medicare and Medicaid Services (CMS) has decided to intervene. They contacted the insurance companies and proposed a new plan allowing them to receive billions of dollars in subsidies. This initiative aims to reduce the financial impact on seniors, especially with the election looming.

CMS's plan will provide a $15 per member per month subsidy to participating Medicare prescription drug plans, which is intended to blunt the impact of rising premiums. However, it raises questions about the long-term implications of such a bailout. Critics argue that this approach may set a dangerous precedent where reliance on government intervention becomes the norm, particularly in an election year.

The Unintended Consequences of the IRA

While the IRA was designed to help seniors, it has resulted in some unintended consequences that could ultimately hurt beneficiaries. For one, the number of available Part D plans has decreased by 25% since 2020, leading to fewer choices for seniors. Additionally, many insurers are raising their premiums to cover the costs they are now responsible for under the IRA.

This situation is further complicated by the fact that some insurance companies have announced their exit from the Part D market entirely, citing the financial strain imposed by the new regulations. This is concerning, as fewer options mean less competition, which could lead to higher prices and reduced quality of service.

Understanding Prior Authorization Changes

Another significant change in the new regulations concerns prior authorization in Medicare Advantage plans. Prior authorization has long been a contentious issue, often causing delays in seniors' treatment. The new law aims to streamline this process, but concerns remain about its implementation.

Many experts agree that while prior authorization can be useful, it has often been mismanaged, leading to unnecessary delays. The law aims to improve the efficiency of this process, but seniors must remain vigilant and proactive in advocating for their care.

Shopping for Your Drug Plan

As a Medicare beneficiary, it’s essential to regularly review your drug plan and shop around for the best options available. With the upcoming changes, this will be more important than ever. The annual notice of change will be sent out in September, and it’s crucial to pay attention to this document to understand how your plan will change.

When shopping for your Part D plan, consider the following:

  • Review your current medications: List the drugs you take regularly and their costs under your current plan.
  • Compare plans: Use resources like StartPartD.com to compare different Part D plans side by side. This will help you find the best coverage at the lowest cost.
  • Consider your pharmacy options: Sometimes, your chosen pharmacy can impact your overall costs. Look for plans that have your preferred pharmacies in their network.

Remember, just because you had a plan last year doesn’t mean it’s the best option for you this year. Be proactive and take the time to explore your options.
The time to pick a new Part D drug plan is October 15th through December 7th at midnight. What you have chosen will take effect on January 1st of the following year. If you do nothing, the plan you had last year will continue, but the pricing, drugs covered, network, etc. may all have changed.

Conclusion

The upcoming changes to Medicare Part D are significant and could profoundly impact seniors across the country. While the government is taking steps to mitigate the rise in premiums, it’s essential to remain informed and proactive about your healthcare options. With the right tools and resources, you can navigate these changes and ensure that you are getting the best coverage for your needs.

Don't hesitate to reach out if you have questions or need assistance with your Medicare plan. My team and I are here to help you through this process. Remember, knowledge is power, and being informed is your best defense against rising costs and changes in your healthcare.

Thank you for reading. Stay tuned for more updates on Medicare and healthcare changes that could affect you!

Christopher Westfall
SeniorSavingsNetwork.org

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Maximum Out of Pocket on Medicare Advantage: Explained

Table of Contents

Introduction

What is Medicare Advantage?

Medicare Advantage (Part C) is an “all in one” alternative to Original Medicare. It's like that swiss army knife you've always admired – it combines hospital insurance, medical services, and often includes prescription drug coverage. But like every tool, it has its nuances.

Why is MOOP Important?

Think of MOOP as a safety net. It's a feature that makes sure you don't end up in a free fall when it comes to healthcare costs. Ever wonder how high your medical bills could potentially go? MOOP sets that limit.

Understanding Maximum Out of Pocket (MOOP)

Defining MOOP

MOOP stands for Maximum Out-of-Pocket. Picture it as a spending cap, like the ceiling of a room, beyond which your Medicare Advantage plan begins to cover 100% of your costs.

How MOOP Works

Imagine you're filling a bucket with water (your medical expenses). Once it's full to the brim, you don't need to add any more. Similarly, once you reach your MOOP limit, you won't pay any more for covered services.

Differences Between MOOP and Traditional Deductibles

It's easy to confuse MOOP with traditional deductibles. Think of MOOP as the entire depth of a swimming pool, while the deductible is just the shallow end. Deductibles are the initial costs you pay, whereas MOOP is the absolute maximum for the year.

The Benefits of MOOP

Financial Protection

MOOP acts as a buffer. It's like having an umbrella during a rainstorm; even if it pours, you're shielded from the brunt of it.

Predictability

Knowing there's a cap on your medical expenses offers peace of mind. It's akin to knowing there's a safety net while tightrope walking; you're secure, no matter what.

Encouraging Preventive Care

Because of MOOP, people are less likely to skip important medical appointments. It's like owning a car with a warranty; you're more likely to get regular check-ups, ensuring everything runs smoothly.

Limitations and Considerations

Coverage Gaps

Like any system, Medicare Advantage with MOOP isn't flawless. It's essential to understand what's covered and what's not. It's like knowing the zones of an umbrella; some areas shield you from rain, while others might let a few droplets through.

Network Restrictions

While Medicare Advantage offers a plethora of benefits, it may come with certain network restrictions. Think of it as a VIP event; it's fantastic, but you might need specific credentials to get the most out of it.

FAQs

  1. What costs count towards MOOP? Most out-of-pocket costs related to covered services count towards MOOP. This includes deductibles, coinsurance, and co-pays.
  2. Do premiums count towards MOOP? No, monthly premiums don't count towards your MOOP.
  3. Is there a standard MOOP for all Medicare Advantage plans? No, MOOP limits can vary between plans, but there's a maximum limit set by Medicare each year.
  4. Can MOOP change year to year? Yes, the MOOP can be adjusted annually by Medicare.
  5. What happens if I switch Medicare Advantage plans halfway through the year? Your out-of-pocket expenses will reset, and you will need to meet the MOOP for your new plan.

Conclusion

Navigating the intricacies of Medicare Advantage and understanding MOOP can seem like unraveling a complex puzzle. But with the right guidance and insights, you can ensure you're adequately covered and financially protected. Remember, knowledge is power – and in this case, it's the key to sound health and peace of mind. Our office helps with all types of Medicare plans. Click here if you'd like our help.

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50 Cent Monthly Premium for Part D Drug Plan?

Outline:

1. Introduction

  • 1.1 Brief on Part D drug plan 2024
  • 1.2 Christopher Westfall's introduction and role

2. The 50-Cent Medicare Part D Premium for 2024

  • 2.1 Initial reactions and questions
  • 2.2 The reality of the low-priced premiums

3. The Need for Regular Medicare Part D Reviews

  • 3.1 Changes in Part D plans
  • 3.2 Importance of being proactive

4. A Close Look at 2024 Premiums

  • 4.1 Plan Finder tool details
  • 4.2 Comparisons across various zip codes

5. Why the Plans are so Cheap

  • 5.1 Introduction to StartPartD.com
  • 5.2 The upselling strategy by drug plan companies

6. The Medicare Advantage Plan

  • 6.1 Definition and implications
  • 6.2 Other terminologies used
  • 6.3 Making an educated choice

7. The Financial Aspects of Medicare Advantage Plan

  • 7.1 The backend costs
  • 7.2 Potential expenses for patients

8. Solutions for Medicare Advantage Plan Holders

  • 8.1 Hospital Indemnity Plans
  • 8.2 Cancer plans

9. Importance of Cancer Insurance

  • 9.1 Challenges with Medicare Advantage and cancer treatment
  • 9.2 Benefits of cancer insurance for Medicare supplements

10. Closing Thoughts on 2024 Drug Plans

  • 10.1 Authenticity of the plans
  • 10.2 Recommendations for choosing a plan

Is it really true?

The buzz around the Part D drug plan for 2024 has been quite significant, especially with the shockingly low monthly premium offers.

Hi, I'm Christopher Westfall. I've been helping individuals navigate the maze of Medicare all over the country. Though specific benefit information is restricted, I'm here to shed some light on what's publicly available.

The 50-Cent Medicare Part D Premium for 2024

Recent news from Street reveals that these unbelievable premiums are, in fact, a reality for 2024. It's caused quite a stir among agents and clients alike. Many are left pondering, “Is this for real?”

The Need for Regular Medicare Part D Reviews

Every year, seniors find themselves navigating changes in Medicare Part D plans. With substantial changes on the horizon, it's crucial not to overlook the details.

A Close Look at 2024 Premiums

Taking a sneak peek into 2024, I've discovered some jaw-dropping prices. Using tools like Medicare.gov or StartPartD.com, you can review these prices across various regions.

Why the Plans are so Cheap

Venturing to my site, StartPartD.com, will give you a clear idea. The attractive pricing might be a bait for upselling attempts. Don't fall for the traps.

The Medicare Advantage Plan

Many are not familiar with the intricacies of Medicare Advantage Plans. These plans can remove you from original Medicare roles and come with their own set of benefits and drawbacks.

The Financial Aspects of Medicare Advantage Plan

While the upfront costs might seem negligible, there are other costs to consider. Always be prepared for unexpected expenses.

Solutions for Medicare Advantage Plan Holders

There are various solutions, like the Hospital Indemnity Plans, to cover potential expenses. Being informed can save you from financial surprises.

Importance of Cancer Insurance

Cancer treatment can be expensive, especially with Medicare Advantage. Consider investing in a dedicated cancer insurance plan.

Closing Thoughts on 2024 Drug Plans

Yes, the 2024 plans with low premiums are legit. Always be cautious and well-informed when making your choices.


FAQs:

1. Are the 50 cent and zero monthly premium drug plans for 2024 legitimate?

  • Yes, these plans are indeed legitimate for 2024.

2. Why are the 2024 drug plans so cheap?

  • While the exact reasons vary, some companies may offer low premiums to later upsell or promote other services.

3. What is the Medicare Advantage Plan, and how does it differ from original Medicare?

  • Medicare Advantage Plans provide Medicare benefits through private companies. They often come with added services but might also have restrictions compared to original Medicare.

4. How can I best prepare for unexpected expenses with a Medicare Advantage Plan?

  • Consider supplemental plans like Hospital Indemnity Plans or dedicated cancer insurance to cover potential high costs.

5. When is the best time to review and choose a Part D drug plan?

  • You can review and enroll in drug plans between October 15th and December 7th each year. Always compare based on total out-of-pocket costs for the year, not just monthly premiums.

We help with Medicare 1-800-729-9590

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Medicare & You 2024 Guidebook

Medicare and You Book

The 2024 Medicare & You Guidebook is available and you can download it here.

When downloading the digital version, it will open in your Acrobat document reader, or in your browser. A tip for finding what you want, instantly, is to hit the Control and F button at the same time on your keyboard. This will bring up the FIND feature in your reader. 

Then, type in a word or phrase you are looking for. The reader should show you how many instances of that word or phrase exist in the entire book and you can click the down arrow to move from the first to the second, and so on.

This is how we zero in on things such as the Special Election Periods, Trial Right scenarios, Guarantee Issue Periods, and more. 

The 2024 Medicare & You book is slightly less controversial than those in the past.

 CMS (Center for Medicare and Medicaid Services) has been leaning more and more toward promoting Medicare Advantage plans and this bias has started to come through in their Medicare guide book.

In 2018, the non-profit Medicare Rights Center, in a joint letter with the Center for Medicare Advocacy and Justice in Aging, wrote a letter to the Administrator of CMS urging corrections in the proposed guidebook for 2019. 

They stated, “First, in several places, the Handbook suggests that Medicare Advantage is the less expensive alternative for beneficiaries. This is an overstatement. There are many variables determining whether enrollment in a Medicare Advantage plan may be more or less expensive for any particular Medicare beneficiary…. The repeated suggestion that Medicare Advantage can save beneficiaries money does not fairly represent these realities.”

The letter went on to point out that various descriptions throughout the book give the false impression that the benefits of Original Medicare are the same as the benefits in Medicare Advantage.

When the guidebook was first read by many of our clients, they found it to be confusing, contradictory, and inaccurate to their experience with Medicare. This again points to the benefit of using an independent Medicare professional who can interpret the realities of Medicare and how it works in the real world. This only comes from experience.

We are here to help and our service is always free.
1-800-729-9590

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Diabetes and Medicare Advantage

Differences between Original Medicare vs. Medicare Advantage

If I have diabetes, should I choose Original Medicare or Medicare Advantage?

The answer to this question depends on how important individualized care is to you.

Medicare Advantage plans are typically bundled, all-in-one plans that are made as a ‘one size fits all’, with a prescription drug plan included.

However, Original Medicare is set up for you to choose a supplement plan along with a prescription drug plan tailored to your individual needs.

The American Journal of Managed Care published a study pertaining to the difference in treatment of diabetes between Original Medicare and Medicare Advantage.

In the study, they concluded that in order to achieve savings, Medicare Advantage enrollees are more likely to be treated with cheaper medications, such as Metformin and Sulfonylureas, rather than receive costly, newer medications, compared to Original Medicare. This means Original Medicare affords you the opportunity to have the drugs that might best suit you.

In this video, we review the study and explain some of the differences between Original Medicare and Medicare Advantage. We also discuss why this decision is so important if you or someone you know has diabetes and are searching for the best plan.

If you would like help finding the best Medicare plan for you, please reach out. Our help is 100% FREE to you.

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How to Leave a Medicare Advantage Plan

In the first quarter of every year, seniors often discover that the plan they signed up for during the Annual Enrollment Period does not suit them.
Their doctors may have already left the network. Hospitals they thought participated might have dropped out already.

Still, some seniors have now had the time to review the Summary of Benefits and looked closely at how chemotherapy is covered by Medicare Advantage.

This is often quite a shock, when, not only must they use only network providers (in the case of the HMO), but the plans typically only pay 80% of the cancer treatment costs.

That's the “Advantage” they've been sold for the often-zero premium.

Regardless of the reason, Medicare says that the first quarter is the opportunity to go back to original Medicare or change to a more-appropriate Medicare Advantage plan.

Steps to Cancel a Medicare Advantage Plan

From January 1 to March 31, Medicare now calls this the “Open Enrollment Period.”

A more appropriate name would be the “Disenrollment Period“. Those without a plan cannot obtain one, so it is not open by any stretch.

If you wish to go from Medicare Advantage to a Medicare Supplement, here are the steps:

  1. Apply for a Medicare Supplement
  2. Wait for the Underwriting Approval from the Supplement company
  3. When approved, make an application for a Part D plan.
  4. When the Part D plan starts, it automatically cancels the Advantage plan

This process ensures that you do not prematurely cancel the only insurance you may be able to qualify for. By using an independent Medicare broker, like the Senior Savings Network, you can find out what Medicare Supplement companies will likely approve your application and guarantee that you will not be paying too much for the same coverage that is offered by all of the Medicare Supplement companies.

Careful: Do Not Act in Haste!

Far too often, we get calls from seniors telling us that they became angry with the details of their Medicare Advantage plan and have already called their company and told them to cancel it. This is the wrong move.

In a worst-case scenario, that Advantage plan MAY be the only insurance you can have and, having something is better than nothing at all. So let an independent professional advise you on which plans are available in the market and which ones are most likely to approve you.

We would be happy to help with this process.


You can contact us securely here or by calling us at 1-800-729-9590.

1-800-729-9590

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What’s Covered App for Medicare

It is now easier than ever before to find out what is covered on original Medicare by using a free app for your smartphone. While this app is not perfect, it is continually being updated by Medicare.

It is important to note that this application will not work for anyone on a Medicare Advantage, otherwise known as a Part C plan. Why? Because Medicare Advantage plans are not “original Medicare” but are private insurance whereby original Medicare is waived for the period that you are on the “Advantage” plan. 

Medicare Advantage plans can have more restrictions and limitations and require referrals and plan approval before many procedures can be approved. So, if you are on original Medicare, or using original Medicare with a Medicare Supplement, or Medigap plan, this app will come in handy, should you wish to check to see which procedures are covered by Medicare.

At the Senior Savings Network, we help seniors with their Medicare plan choices from coast to coast with our free broker services. 

If you would like help picking the best Medicare insurance plan for you, call us at 1-800-729-9590.

 
Try the “What's covered” mobile app!

 


   Downland What's covered on app store  Downland What's covered on play store

The app is an official program from Medicare. This website, the Senior Savings Network, and its employees, are a private organization not employed by Medicare and offer licensed advice and support for seniors in 46 states.

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