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Part D Election Bailout

Drug Plan, Medicare, Medicare News, Medicare Supplement, Part D /

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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Prosperity Life Medicare Supplement Update 2024

Medicare News, Medicare Supplement /

What is happening and why:

Letters from Prosperity Life went out to clients in February, 2024. 

The letter states that Effective March 1, 2024, S. USA Life Insurance Company, Inc. will no longer solicit business for their Medicare Supplement policy in (your state), creating a closed block of business.

These policies are guaranteed to renew, but the rates at which they will increase are concerning to us.

 Please see the letter sent to clients:

Click here to make an appointment to review your options, or wait until your policy's next renewal notice.
Using this button is much easier and faster than calling.

Book Appointment Now

State-specific guarantee issue (no underwriting) opportunities:

You can go through Underwriting to change Medicare Supplement companies 365 days per year.

What is involved in Underwriting?

 Explained here:  Click This Link

When a Medicare Supplement insurance company designates a plan as being in a “closed risk pool,” it means that the plan is no longer open to new enrollees. This can have several implications for clients who are part of these closed plans:

1. **Stable Group of Enrollees**: Since no new members can join, the risk pool (i.e., the group of individuals covered under the plan) becomes fixed. The members of this group age together, without younger, potentially healthier individuals joining the plan to balance the risk.

2. **Potential for Higher Premiums**: Over time, as the risk pool ages and the likelihood of health claims increases, the insurance company may raise premiums to cover the higher costs. Since these pools can't offset these costs with new, healthier enrollees, premiums for closed plans can increase faster than those for plans that are open to new members.

3. **Less Risk of Selection Against the Company**: For the insurance company, closing a plan to new enrollees can protect against adverse selection, where individuals with a higher likelihood of using health services disproportionately enroll in the plan, increasing costs for the insurer.

4. **Quality of Care and Service**: The level of care and service should not change for members of a closed risk pool. However, the financial health of the insurance company and how it manages its closed and open plans can affect the resources allocated to servicing each type of plan.

5. **Limited Options for Plan Changes**: Clients in a closed plan may find they have fewer options if they wish to switch to a different plan offered by the same company, as other plans may also be closed or have different eligibility requirements.

6. **Market Competition and Plan Viability**: The dynamics of the insurance market can affect closed plans. If many insurers close their plans to new enrollees, the competition and options for consumers may decrease, potentially impacting the viability and cost-effectiveness of remaining plans.

Understanding these implications is important for clients in closed-risk pools to make informed decisions about their healthcare coverage. It's also advisable for clients to regularly review their coverage and consider their options, especially during open enrollment periods, to ensure their current plan continues to meet their healthcare needs and financial situation.

Click here to make an appointment to review your options, or wait until your policy's next renewal notice.

Using this link is much faster and easier than calling.

Book Appointment Now

We are here to help.

Make sure to subscribe to our Youtube channel for Medicare updates!
CLICK HERE TO SUBSCRIBE

Senior Savings Network
1-800-729-9590

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Cigna Update 2024

Medicare News, Medicare Supplement /

What is happening and why:

Letters from CIGNA went out March 15, 2024 to affected policyholders.

 Please see this important video:

Click here to make an appointment to review your options, or wait until your policy's next renewal notice.
Using this button is much easier and faster than calling.

Book Appointment Now

State-specific guarantee issue (no underwriting) opportunities:

You can go through Underwriting to change Medicare Supplement companies 365 days per year.

What is involved in Underwriting?

 Explained here:  Click This Link

 

CIGNA has updated “Frequently Asked Questions”. 
You can see that document by clicking here.

When a Medicare Supplement insurance company designates a plan as being in a “closed risk pool,” it means that the plan is no longer open to new enrollees. This can have several implications for clients who are part of these closed plans:

1. **Stable Group of Enrollees**: Since no new members can join, the risk pool (i.e., the group of individuals covered under the plan) becomes fixed. The members of this group age together, without younger, potentially healthier individuals joining the plan to balance the risk.

2. **Potential for Higher Premiums**: Over time, as the risk pool ages and the likelihood of health claims increases, the insurance company may raise premiums to cover the higher costs. Since these pools can't offset these costs with new, healthier enrollees, premiums for closed plans can increase faster than those for plans that are open to new members.

3. **Less Risk of Selection Against the Company**: For the insurance company, closing a plan to new enrollees can protect against adverse selection, where individuals with a higher likelihood of using health services disproportionately enroll in the plan, increasing costs for the insurer.

4. **Quality of Care and Service**: The level of care and service should not change for members of a closed risk pool. However, the financial health of the insurance company and how it manages its closed and open plans can affect the resources allocated to servicing each type of plan.

5. **Limited Options for Plan Changes**: Clients in a closed plan may find they have fewer options if they wish to switch to a different plan offered by the same company, as other plans may also be closed or have different eligibility requirements.

6. **Market Competition and Plan Viability**: The dynamics of the insurance market can affect closed plans. If many insurers close their plans to new enrollees, the competition and options for consumers may decrease, potentially impacting the viability and cost-effectiveness of remaining plans.

Understanding these implications is important for clients in closed-risk pools to make informed decisions about their healthcare coverage. It's also advisable for clients to regularly review their coverage and consider their options, especially during open enrollment periods, to ensure their current plan continues to meet their healthcare needs and financial situation.

Click here to make an appointment to review your options, or wait until your policy's next renewal notice.

Using this link is much faster and easier than calling.

Book Appointment Now

We are here to help.

Make sure to subscribe to our Youtube channel for Medicare updates!
CLICK HERE TO SUBSCRIBE

Senior Savings Network
1-800-729-9590

Cigna Update 2024 Read More »

Presidential Candidates: on Medicare

Medicare News, Medicare Supplement, Podcasts /

Presidential Candidate Questions on Medicare

 

1. “Can you explain your stance on the current state of Medicare in the United States? What would you say are its most significant strengths and weaknesses?”

2. “Many Americans are worried about the sustainability of Medicare. As a Presidential candidate, what steps do you propose to ensure Medicare's long-term viability?”

3. “How will your administration address the high cost of prescription drugs, which has a significant impact on Medicare beneficiaries?”

4. “What are your plans to improve access to Medicare for the most vulnerable populations, such as the elderly, the disabled, and those in rural areas?”

5. “Medicare Advantage plans are growing in popularity, but there is debate about their cost-effectiveness and the quality of care they provide. What is your stance on Medicare Advantage, and how will it influence your policy-making?”

6. “Should there be a cap on out-of-pocket expenses for those using Medicare? If so, what do you think would be a reasonable limit?”

7. “Some argue that expanding Medicare to include vision, dental, and hearing care is necessary. What is your position on expanding Medicare's coverage?”

8. “There have been proposals for ‘Medicare for All' as a solution to America's healthcare issues. What is your position on this idea, and how do you believe it would impact the overall healthcare system?”

9. “Medicare fraud is a significant issue, costing taxpayers billions of dollars each year. What measures will your administration take to tackle this problem and improve program integrity?”

10. “Do you believe that the age of eligibility for Medicare should be lowered, or should there be alternatives to cover those who are younger and uninsured?”

These questions are of major importance to the more than 54 million actual voting seniors on Medicare.


Christopher Westfall
1-800-729-9590
[email protected]

Presidential Candidates: on Medicare Read More »

Medicare & You 2024 Guidebook

Medicare and You Book

Medicare, medicare advantage, Medicare Supplement, Part D /

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

Medicare & You 2024 Guidebook

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Diabetes and Medicare Advantage

Medicare, medicare advantage, Medicare Supplement, Part D /

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

Medicare, medicare advantage, Medicare Supplement /

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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Does the Mayo Clinic Accept Medicare Supplement Plans?

medicare advantage, Medicare Supplement /

Can you use your Medicare Supplement plan at the Mayo Clinic? Yes.
Depending on which Medicare Supplement plan letter you have, you may or may not be responsible for paying “Excess Charges”.

As of 2020, Mayo Clinic in Florida accepts full Medicare Assignment.
This means that they will not bill Excess Charges. Those on Medicare Supplement Plan N will not see an additional bill for Excess Charges when visiting the Mayo Clinic in Florida.

The Arizona Mayo Clinic facility does not (yet) accept Medicare Assignment, so those on Plan N might see an Excess Charge billed from Mayo in Arizona.

Medicare Supplement plans only supplement what is APPROVED by original Medicare. If Medicare approves the procedure and pays their 80%, the Supplement plan, also known as Medigap, will fill in the remaining portion, subject to your deductible and possible co-payment, depending again on which Medicare Supplement plan letter you signed up for.

In this video, we go over the details of how Medicare and Medicare Supplements are accepted at the Mayo Clinic. Also, for those on a Medicare Advantage plan, you must look very closely at your plan and communicate with Mayo on it, as these private plans are most often not accepted at centers of excellence like the Mayo Clinic.

See the video:

Need help with Medicare insurance?
Click here for our free help!

Does the Mayo Clinic Accept Medicare Supplement Plans? Read More »

What are Excess Charges with Medicare?

Medicare Supplement /

Are you concerned with how excess charges might impact your Medicare plan? This video answers that:

Important to note, in addition to this video, that Medicare Advantage plans have nothing at all to do with these billing scenarios. The scenarios, including everything having to do with Excess Charges, only apply to original Medicare and/or Medicare with a Medicare Supplement policy. Medicare Advantage participants are not free to see any original Medicare provider and have restrictions, exclusions, co-pays, etc. in addition to original Medicare.

Mentioned in the video:
https://www.kff.org/medicare/issue-brief/paying-a-visit-to-the-doctor-current-financial-protections-for-medicare-patients-when-receiving-physician-services/

Physician Compare at Medicare:
https://www.medicare.gov/physiciancompare/

Getting the most out of Physician Compare tool:
https://www.youtube.com/watch?v=lI91Cp2Xwu4

We help folks with supplemental Medicare benefits, from coast to coast, and our service is completely free.

 To reach us for Medicare-related benefits help, call toll-free 1-800-729-9590

What are Excess Charges with Medicare? Read More »

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