News

Medicare Out of Network (Advantage Plan Confusion)

November 30, 2022

Medicare out-of-network confusion continues to remain a big issue with Medicare Advantage plans. A recent letter that was sent out by The Mayo Clinic (Florida location) has caused quite a bit of uproar due to the facility urging Medicare beneficiaries to reevaluate staying in a Medicare Advantage plan. In addition, the letter reminded Mayo Clinic patients that they do not participate as an in-network facility and will no longer schedule patients who have a Medicare Advantage plan that would classify The Mayo Clinic as ‘out-of-network”.

Mayo Clinic letter — The Mayo Clinic reminds Medicare patients that they are out of network with most Medicare Advantage plans.

Earlier this year a survey released by MedicareGuide.com found that 4 out of 10 Medicare Advantage enrollees believed that they do not have to stay in-network for care. This is very alarming since the network restrictions are one of the key ways that Medicare Advantage plans keep overall costs down. Consumers are not understanding that you are trading the flexibility of provider access for low to no premiums and being restricted to use only providers in the plan’s network.

Many retirees who enroll in a Medicare Advantage plan do so for the low-cost premiums and ‘extra benefits’ they would receive not typically found in Original Medicare. A large percentage of those retirees do not understand that they are in essence signing over their Medicare benefits for Parts A & B to a private insurance company. Those amounts typically come in around $1,000 per month on average (before bonuses that the insurance company may get) for non-special needs plans (SNPs) or dual eligible plans (DSNPs). Both SNP and DSNP plans get paid an even higher amount from Medicare. According to the Medicare Trustees report, in 2019 payments to private Medicare Advantage plans were approximately $321 per enrollee higher than what Medicare would have spent on these same folks if they had been in traditional Medicare (Parts A & B). While $321 per enrollee for the year might not seem like a large amount of money, the total for increased spending by Medicare for these folks equates to an estimated $7,000,000,000.00 (seven billion dollars) in additional costs to the Medicare program. For 2022 it is expected to swell to $12,000,000,000.00

DENY…DENY…DENY!

Medicare Out of Network Denied — Be careful of going out of network in a Medicare Advantage plan!

With this much additional money being spent, one would assume that more benefits are being paid out on behalf of enrollees. That assumption is wrong. In fact, one of the most common reasons for Medicare Advantage enrollees wanting to return to original Medicare comes when a prior approval for a procedure is delayed or even denied. In the 2022 Office of The Inspector General (OIG) report there was a concern for “the incentive for Medicare Advantage plans to deny beneficiary access to services and deny payments to providers in an attempt to increase profits.” One would think with all the additional money coming into Medicare Advantage plans that there would be a focus on reducing the out-of-pocket costs enrollees face. Sorry to say that is not always the case.

Did you know in a Kaiser Family Foundation report, over 50% of the Medicare Advantage enrollees would incur higher out of pocket costs for a 7-day hospital stay than those with Original Medicare?

Takeaway

As we have said many times over, Medicare Advantage plans are not bad if enrollees fully understand the tradeoffs. For those younger Medicare beneficiaries who are possibly in better health, the likelihood of them needing prior approval for a high costing procedure or facing a lengthy stay in the hospital are lower than older Medicare beneficiaries whose health is likely to continue to decline. It is vitally important that Medicare Advantage enrollees understand that their coverage is being provided by private insurance companies and not Medicare itself. Unlike Original Medicare, where they would not face having to get prior approval for most services or be limited to a certain network of doctors, Medicare Advantage plans use these to reduce costs and increase profits. We believe that there is nothing wrong with this since private insurance companies are a business that must make a profit. Where we find issues is when the enrollees do not fully understand the limitations and restrictions of these Medicare Advantage plans and how the benefits are affected in an out of network situation. To discuss what plan options work best for your individual needs, contact us at (800)924-4727 to get a dedicated advisor to review your current situation.

Changes to Medicare Part D Prescription Plans

August 22, 2022

Changes to Medicare Part D Plans

Medicare Part D Prescription Plan news. Look for changes to Medicare Part D Prescription Drug Plans over the next few years.

Big news for retirees when it comes to a provision passed in the Inflation Reduction Act of 2022. Medicare beneficiaries will now have a cap on the maximum out of pocket they will pay for their prescriptions in a given year. Of course, the changes in Part D prescription cost sharing will not be immediate, but rather will be spread out over the coming years. Here is when everything is proposed to begin and what you can expect in the way of benefits.

Prescription Out of Pocket Costs Capped

Full savings benefit set to begin in 2025 and the maximum out of pocket costs for prescriptions will be set at $2,000.
The cap on prescription drugs will apply to those enrolled in stand-alone Part D prescription drug plans or thru the prescription benefit found in most Medicare Advantage plans.
The $2,000 cap is not guaranteed to remain level. While there are not immediate plans to have the cap rise over the years, it could.
If your current prescription benefit plan has a deductible, then that amount will also count towards the overall annual cap.

What To Expect Each Year

As it looks right now there will be no major changes to Medicare Part D prescription plans from the newly passed legislation for the remainder of 2022 and all of 2023. Beginning in 2024 Medicare beneficiaries will no longer have any out-of-pocket costs once they reach the catastrophic coverage level. Currently in 2022 this amount is $7,050 in out-of-pocket costs. So instead of now having to pay 5% of the prescription costs during the catastrophic level, there will no longer be any more out of pocket expenses.

Starting in 2025 all current levels above $2,000 in out-of-pocket costs will be phased out for Medicare beneficiaries. In addition, all Part D plans must offer an option that allows you to spread out the prescription costs over the plan benefit year. Why would you enroll in this option? The simple answer would be if you are someone who takes an expensive drug each month, you would not have to come up with a large amount of money at one time when first getting it filled, but rather spread those monthly amounts over the year. You would still be capped at $2,000 out of pocket expenses but wouldn’t have to possibly come up with a major portion of that in one month for a particular drug or combination of drugs (example would be someone who take multiple high-cost prescriptions each month).

Other Changes To Expect With Your Medicare Part D Prescription Plan

Beginning in 2024 your Part D premium cannot increase more than 6%.
Beginning in 2023 co-pays for insulin (30-day supply) to be capped at $35
Beginning in 2023 will no longer have out of pocket expenses for certain vaccines (ex. Shingles vaccine).

Still have questions on how these changes to Medicare Part D Prescription plans impacts you, we can help! To read more about Medicare Parts and How They Work click here.

Social Security Increase for 2023

July 25, 2022

Have you heard the big news that there is going to be a large Social Security Increase (COLA) in 2023? It is estimated that it could come in around 10.5% due to rising inflation. What does this mean for the average retiree?

The average retired worker receives about $1,665.00 each month. If the full 10.5% increase takes place, then that same retiree will start receiving an extra $174.83 each month. This would bring their payment to around $1,839.83. As you can imagine this will be very beneficial in helping offset the rising costs of goods due to inflation. This increase will be the largest increase since 1981 which was 11.2%.

To view the Automatic Cost of Living Adjustments since 1975 click here and scroll to the bottom of the page.

If you are like me and really enjoy the old Clint Eastwood cowboy movies, you will remember the classic…The Good, The Bad, and The Ugly. While we have just discussed The Good about the increase, now we must take a look at the other areas.

The Bad

For those retirees that receive lower than the average Social Security payment each month and qualify for other benefits due to having a lower income, could be pushed out of those programs with a large Social Security increase to their check. Here are just a few income based programs that could be impacted:

The Supplemental Nutrition Assistance Program (SNAP) which provides benefits for seniors to purchase needed food items.
The Home Energy Assistance Program (HEAP) which provides money to senior to help offset the cost of their monthly utilities.
Property Tax Exemptions are offered in many states for low-income retirees.
Prescription Assistance Programs thru the state to help pay for Part D prescription drug plans.

Finally, many states also have pharmaceutic assistance programs along with programs from drug manufacturers that offer assistance as well based on income.

The Ugly

The amount of Social Security benefits that are exempt from taxes is still the same since 1984. This means that any increase above the payment threshold is going to end up being taxable. So if the monthly payment increase pushes an individual above $25,000 or a married couple above $32,000 for the year then this will trigger a taxable event on the income above these thresholds.

While such a large increase (if the full amount goes thru) seems like there is going to be so much extra money going into a retiree’s pocket, that simply is not the case. With the current inflation rate being around 8.6%, the increase is pretty much a wash. In addition, while inflation is coming in at 8.6%, certain primary goods such as food costs have climbed at a much higher rate, so there really will not be any ‘extra’ money going into anyone’s pocket.

What Can You Do?

Maybe your concern is simply having as much money in your pocket at the end of the month as possible. With the rise of inflation we have also started seeing the rise of interest rates. While savings account interest rates are still extremely low, there are CD type annuities that are paying much higher interest rates. Many of our 5 year multi year guaranteed annuities are paying out over 4.00% which can help bring in additional income if needed. To get a personalized annuity quote click below.

Another way to increase your monthly income is by seeing if you can lower your current Medicare Supplement rates. Many of our clients have been able to lower their older Medicare Supplement plan rates by a substantial amount. As always with Senior Benefit Services there is no cost or obligation to get a quote from us. It’s FREE and you have absolutely nothing to lose.

Medicare Annual Election Period 2023: Part 2

July 21, 2022

As promised, in this part we will be talking about the Joe Namath and JJ Walker television commercials, and why when things sound too good to be true…they usually are!

In Part 1 we started discussing the Medicare Annual Election Period and what kind of changes you can make to your existing coverage. We discussed the initial prep work that you could start doing in regard to your prescriptions. In Part 2 we are going to look at why you might need to change your Medicare Advantage plan and some of the common questions and the confusion surrounding the commercials we see on television with Joe Namath and JJ Walker.

Why would you need to change your current Medicare Advantage plan?

Keep in mind that most Medicare Advantage plans have a built-in prescription drug plan component. Sometimes Medicare Advantage plans remove drugs from their formulary that they once covered. An example would be that you are on Crestor, but the plan replaces that drug with the generic Rosuvastatin. You might decide that you want to continue to take Crestor. At this point you would need to either find another Medicare Advantage plan that covers this prescription or be willing to pay for Crestor out of pocket.
If you have recently been put onto a new prescription or have to switch to a different prescription you need to make sure that it will be covered in the upcoming plan year formulary.
Medicare Advantage plans also make increases to their daily hospital co-pays which can expose you to a large amount of money out of pocket. While many of our clients use a hospital indemnity plan to help offset these expenses, you will still want to know what your financial exposure is each time you would have to go into the hospital.
In certain situations, a Medicare Advantage Plan carrier may decide to not renew their plan in a certain county(s) or even a whole state. If this were to happen you would need to find a new Medicare Advantage Plan or you prefer to switch back to original Medicare and get a Medicare Supplement and stand-alone Part D prescription plan.
Finally, remember that physicians and other providers are not required to participate in any plan’s network. If you are in an HMO and your doctors decide to no longer accept that plan, then you will need to find another doctor or another plan which they accept. If you are in a PPO and your doctors decide to no longer accept that plan, then you have an extra option. A PPO plan will allow you to see a doctor who is out of network, but you will usually have to pay a higher amount of the expenses than you normally would if they were part of the plan’s network.

The Medicare Annual Election Period is where you can make the needed changes to your Medicare Advantage Plan.

Do you need to change your current Medicare Supplement plan?

No, the Medicare Annual Election Period is for changes to Medicare Advantage and Part D Prescription drug plans. You can look at switching your Medicare Supplement plan to another Medicare Supplement plan at any time of the year. If you would like a free, no-hassle, no-obligation price comparison then we have you covered!

Are you required to make any changes during the Annual Election Period?

No, if you are satisfied with all your current coverage the way it is, then there is nothing for you to do. To see what changes you can make during this period check out our article here.

What if you decide that you want to switch from a Medicare Advantage Plan to a Medicare Supplement plan?

The first thing you will want to do is contact Senior Benefit Services to find out if you can qualify health wise for a Medicare Supplement. Keep in mind that the Annual Election Period allows you to switch back to Original Medicare, but it does not guarantee you acceptance into a Medicare Supplement plan.

If your health allows you to qualify for a Medicare Supplement plan, then you will also need to enroll into a stand-alone Part D prescription drug plan. It is important to find a plan that will cover all your prescriptions at the lowest total out of pocket costs.

While this can sound a bit overwhelming, Senior Benefit Services will make it extremely easy and do the heavy lifting for you.

Wouldn’t I get more benefits if I call the 800# on the Joe Namath commercial?

Nope! Before we get into the commercial themselves, keep in mind that many times these commercials are not for an insurance agency, but rather what is called a lead aggregator. A lead aggregator runs these commercials and when a consumer calls in, they are transferred to an agent or call center that has paid for a lead. This means you could end up talking to just about anyone without knowing their background or experience.

Let me be perfectly clear, we have nothing against Joe Namath or JJ Walker. They are being paid to do a commercial and read a script. They likely don’t even know very much about what they are reading, so lets be sure not to blame them or accuse them of being in the wrong.

As for the commercials themselves, they are more of a blend of different types of plans rather than one specific plan. What this means is that some of the benefits might be for those who are on both Medicare and Medicaid due to having a low annual income. If you are not on Medicaid then you will not be able to get those benefits.

Also, you need to understand that some benefits might only be available in certain plans that are in certain counties of the state you are a resident of. The easiest way of understanding this would be to think of a big box gym such as Gold’s. Let’s say that in the state of Florida they have 50 locations, but the only location that has not only all the latest equipment, but has an indoor pool, tanning beds, daycare, and saunas is located in Orlando. Instead of coming right out and telling you this in the commercial, they talk about all of these wonderful amenities in hopes that you will at least go visit your local Gold’s Gym. In other words, they want to get you in the door. The same goes for these Medicare Advantage commercials where they sole focus is to get you to call in so they can sell the lead to someone. None of the plan benefits that are discussed in the commercial might be available in the county you reside in, so they will simply try and sell you another plan. The sole purpose of the commercial is to get you to call. Too bad you wouldn’t get to talk to Joe Namath or JJ Walker.

Learn About Common Scams That Target Seniors

Instead of dealing with this type of nonsense, wouldn’t it be much better to call Senior Benefit Services and find out what is available to you based on where you live? There is no pressure, cost, or obligation to work with us.

Call (800)924-4727 or click here today to get honest information without any pressure or misleading information. Our agents make Medicare easy!

Upcoming Medicare Annual Enrollment Period 2023: Part 1

July 18, 2022

Don’t panic, you still have about 3 months left before we enter the Medicare Annual Election Period. How will you know it is getting closer? Well, you will see an increase of Joe Namath and Jimmie Walker telling you all about the benefits you could be getting from Medicare. Don’t worry, in one of the later parts of this series I will touch a little bit more on the commercials and how they are not really what they appear to be.

What You Can Do During the Annual Election Period (AEP)

You can leave traditional Medicare and enroll into a Medicare Advantage Plan
You can disenroll from a Medicare Advantage Plan and return to traditional Medicare and get a stand-alone Part D Prescription Drug plan.
You can change your stand-alone Part D Prescription Drug plan to another stand-alone Part D Prescription Drug plan.
You can change your Medicare Advantage Plan to another Medicare Advantage Plan.

For a full list of what you can do during the different enrollment periods check out our article here.

Your Window of Opportunity to Make a Change

The dates for the Medicare Annual Election Period are set in stone. You can make any of the changes discussed above from October 15^th until December 7^th. If you decide on December 12^th that you need to change your stand-alone Part D prescription drug plan because a prescription you are taking will no longer be covered, then you will basically be stuck in that plan for another year

How do you know if there are going to be changes to your existing plan?

Medicare Advantage and Part D carriers are required to send out each year what is called an Annual Notice of Change (ANOC) packet to all their policyholders. The carriers must send the ANOC package in the mail to you by September 30^th.

I can’t tell you how many times we hear about folks either throwing these away or simply not even opening them. Don’t do this! While there is quite a bit of information in the packet, most of the major changes are listed on the first page. It is vitally important that you read over this prior to October 15^th so you will have time to contact your agent and book time to review any changes that need to be made to your current coverage when the Medicare Annual Election Period rolls around.

Start Preparing Now

Yes, even though we are 3 months away from the Medicare Annual Election, there are things that you can do now.

Make a complete list of your current medications. Be sure to include the full name of the prescription along with the dosage, quantity and strength on your list.
Make a note beside any prescription that your doctor has informed you that could be changing in the future.
Have this list with you when you meet with your agent during the Annual Enrollment Period.In Part 2 we will discuss what you should do if you have a Medicare Advantage plan or a Medicare Supplement plan during the Medicare Annual Enrollment Period. As promised we will also dive a bit into the commercials, we all see and how they can be a bit misleading.

What if I have questions now?

If you are already a client of Senior Benefit Services, then please contact your personal agent immediately. For those folks who are not a current client but wish to start receiving the personalized attention they deserve, simply call (800)924-4727 or click here and one of our friendly staff members will connect you with your own personal advisor.

What are Medicare Flex Cards? Flexcard for Seniors

July 15, 2022

What is a Medicare Flex Card?

If you have spent any time in front of the television, you have likely seen a commercial or two about a Medicare Flex Card. While you might not remember the actual term being used, you likely do remember the advertisement of getting around $2,800 pre-loaded on a ‘debit’ type of card that can be used to pay for certain medical expenses. While this sounds like a windfall of money for seniors, the advertisements gloss over quite a bit of important information.

So…what the heck is a Medicare Flex Card anyway? To make this as easy as possible to understand, this money does not come from the federal government. The money is part of a benefit that can be paid out by a private insurance company. Furthermore, the card is not available to folks on a Medicare Supplement plan, but rather must be enrolled in a Medicare Advantage plan. That caveat alone knocks out the majority of seniors who could qualify for the money. On a Medicare Advantage plan that offers a flex card, the funds can be used for such things as:

Prescriptions
Durable Medical Equipment
Other medical expenses such as dental, vision, and hearing
Plan Deductibles and Copayments

You may be saying to yourself, “I am already on a Medicare Advantage plan, so how do I get a flex card?” This is where it gets even a bit more interesting. Not all Medicare Advantage plans offer a flex card as a benefit. While the commercials don’t point this out, the reality is that even if a carrier does offer a flex card as a benefit, they don’t have to offer it on all their Advantage plans and can even limit it to plans in specific zip codes. In addition, a number of insurance companies limit this benefit to those individuals who qualify for a Dual Eligible plan, which means that you must have a low enough income to qualify for both Medicare and Medicaid.

Even When Things Fall Into Place….There Is Still No Guarantee

Let us play devil’s advocate here and say that an individual happens to live in a zip code that has one of these plans available and it is not a Dual Eligible plan. This means that you could sign up for this plan and get a quick extra $2,800!? Not necessarily. You have to understand that since it is not Medicare providing this benefit but rather the private insurance company, the amounts can be up to $2,800. Don’t you just hate that phrase…’up to’? One insurance company might offer $300 while another offers $400, and then another might offer $500.

Should You Enroll in a Medicare Flex Card plan?

First things first. Do you understand the difference between a Medicare Advantage Plan vs a Medicare Supplement plan? If not, then the answer is definitely hold off until you do. Let’s say you do know the difference between these types of plans, then the next thing you need to do is look at the plan’s prescription drug formulary. A formulary is the complete list of covered prescriptions and also what tier they will fall into (the tier determines how much your co-pay or coinsurance will be). If the plan does not cover all your prescriptions, then it might very well be a bad choice. After checking your prescriptions, you are going to want and make sure your doctors are part of the plan’s network. If not, you might have to make the decision to switch doctors or pay the full bill out of your own pocket. Last but not least, you are going to want to compare the plan’s other benefits to determine how much your different co-pays, co-insurance, and even maximum out of pocket costs are going to be.

The Final Word

Instead of trying to figure this out all on your own or take the word of a possible misleading commercial, you can simply reach out to Senior Benefit Services where we will put you with your own personal advisor that can give you all the information that you need to make an informed decision. Feel free to call us at (800)924-4727 or click here to request an advisor to contact you directly.