MEDICARE MADEEASY - YEAR 2021
Medicare itself is not medical insurance. It is not a complete health coverage plan, and it was never meant to be. Medicare covers a limited portion of a qualified individual's health care costs - and a portion of other medically-related services.
What does basic Medicare cover? Under Part A, if you go into the hospital, you pay the first $1484 for the first 60 days; this is your per benefit period deductible (a new benefit (deductible) period starts every 60 days). After day 60, if you’re still hospitalized, you are responsible for the first $371 per day for the next 30 days. If still hospitalized after that, you are responsible for the first $742 per day of the next 60 days. If you are hospitalized beyond that, you are on your own; Medicare pays nothing. This $1484 deductible recurs every 60 days if you are hospitalized more than once. (A Medigap plan picks that up 100%). There is no premium for Part A if you paid into it during your working years; those who did not pay in at least 40 quarters will pay $458 per month for Part A.
If you go into a skilled nursing facility and are considered in "recovery mode" (too well to remain in the hospital but too ill to return home), Medicare picks up 100% of an approved amount for the first 20 days. From day 21 through day 100, you are responsible for the first $185.50 per day. Beyond day 100, Medicare pays nothing - you are on your own. If you are looking for long term care (an insurance plan geared toward nursing home, adult day care, assisted living facilities, home health care - maintenance level..... ), that is not part of Medicare nor is it covered by Medicare; you need to talk to your insurance agent about a "long term care plan." Like many forms of insurance, long term care coverage is never as inexpensive as it is the day you apply for it, and rates usually lock in.
Under Part B…of medical expenses, doctor's fees and outpatient hospital services, Medicare pays 80% of the "approved" amount, after a $203 per calendar year deductible. You are responsible for the other 20%, (If the doctor you see takes Medicare but does not take Medicare assignment, you may also be responsible for an additional 15% of the Medicare allowed charges.) A Medigap Plan F picks up that $203, 20% and any 15% excess; plan G picks up all but $203. The Part B premium is $148.50 per month but can be higher based on income. Everyone pays a Part B premium.
The above describes Medicare Parts A and B, the basic plan which all Medicare-qualified applicants receive. Medicare is not always automatic; in many cases you must apply for it. And to be eligible for Medicare benefits at all, you must have paid into Social Security a specific number of quarters during your working years. If you start receiving Social Security benefits before or by age 65, you are automatically enrolled in Medicare Parts A and B starting with the first day of the month in which you turn 65. Note that enrollment simply means you don't have to make formal application when you turn 65; Medicare benefits cannot be used until the month in which you turn 65. If you are working and are covered by a group insurance plan, you can postpone enrolling in Part B; then, your open enrollment for a Medicare supplement will start the month in which you enroll in Part B. Supplements themselves are not automatic; they must be applied for. If you work and receive group health, you do not want to take Part B until you are ready to leave the group plan.
Again, basic Medicare Parts A and B (not to be confused with Plans) cover a portion of actual medical costs you are likely to incur.
If you want foreign travel medical coverage.... then you will want a Medicare supplement.
MEDICARE SUPPLEMENTAL PLANS
Plan C picks up that $185.50 per day of skilled nursing facility care which Medicare Part A does not cover (beyond the first 20 days), as
well as your $1484 per benefit period hospital deductible and $203 per calendar year medical expenses deductible. It will
also provide limited coverage if you travel outside the
Plan F covers the same things as Plan C and picks up the 20% coinsurance from Medicare Part B's medical expenses. Plan F will not be offered to first-time Medicare enrollees as of 1/1/20; current policyholders will be grandfathered. Not (in my opinion) an advisable choice.
Plan G does not cover the annual Part B deductible but is otherwise identical to Plan F, and costs less. Plan G is very competitively priced, the most-frequently requested, and my personal favorite.
High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.
Plans K through M ….. have a lot of cost-sharing, which is described on the inside cover of “Medicare & You” pamphlet that you should have received. They do not pick up the Part B deductible, pick up only 50% of the coinsurance for doctors, 50% of skilled nursing facility, and provide no foreign travel or preventative wellness benefits. The out-of-pocket limit on Plan K is $5,880 and on Plan L is $2,940. Remember, with Plan F your out of pocket maximum is zero and with Plan G, it is $203.
Plan N is comparable to plan G but you also have a $50 co-pay for Emergency Room, $20 co-pay for doctors (after the deductible, not in addition to it) and the potential 15% excess. More popular than HDG but still requested less than 10% of the time. If someone was considering an Advantage plan, I would consider this plan first for all of its freedom of provider choice and lower out of pocket – plus zero out of pocket hospital coverage..
How much you pay for a Medicare supplement will depend on how old you are when you apply for it, tobacco usage, your zip code (and - in certain cases - if you are still medically qualified). You can be declined supplemental coverage based on health history if you wait until after you are 65-1/2 (or have been on Part B more than six months) to apply for your supplement (note: Advantage will always take an applicant, where those plans are offered, during the Annual Enrollment Period in the fall, so long as the applicant does not have End Stage Renal Disorder). Medigap (supplement) plans are available in all counties, and Advantage plans are more readily available in the more populated areas (Maricopa, Pinal and Pima counties) but a few companies offer them in rural areas.
We work with a number of both, and are always happy to provide information to you. Again, there is NO medical underwriting for a supplement (like Plan G, F or N) if applied for during your open enrollment period (none ever for HMOs). Plan F is F, G is G, no matter who the carrier; if a doctor takes one Medigap plan, he takes all. (This does not, however, apply to Advantage plans.)
The most frequently-asked question we hear is why Medicare doesn't cover prescription drugs (which Part D does, for a monthly premium) and why aren’t nursing homes covered except in a "recovery mode" and long term care isn't covered at all?
Statistically, less than 4% of all nursing home or extended care facility charges qualify under Medicare. Most of those costs are paid for by private long term care plans. The younger you are when you apply for one (rates are age-sensitive), the less such a plan costs. And you have to be in generally good health to get one.
Long term care plans cover not only nursing home but other charges, such as at-home health care, assisted living and adult day care, and other long term care-related medical expenses - services that Medicare won't provide. If you were diagnosed with Alzheimer's or Parkinson's, or any number of other physical ailments, Medicare wouldn't cover any of the custodial or facility costs - because these are not conditions from which one recovers, they are progressive or degenerative conditions.
You should receive basic information related to Medicare a few months before you turn 65 - that is when everyone starts being inundated with brochures, applications, etc. if you are not collecting social security yet then you are not automatically enrolled in Parts A and B of Medicare and need to do that as soon as possible. You must have Parts A and B of Medicare in order to get any kind of health coverage.
The sooner you have information on Medicare, the better decision you will make between now and when you need it. Best time to apply: within 15 to 75 days prior to the month in which you turn 65.
WHICH MEDICARE SUPPLEMENT SHOULD I GET?
The three most popular underwritten plans have been G, F and N. Most carriers only sell four or five supplement options, but always these three. Coverage works the same though, from carrier to carrier. Plan F is Plan F, Plan G is Plan G - only the monthly premium differs.
Our recommendation: Plan G. While F was the most popular plan until a few years ago, it didn’t make sense to pay more in premium to save less on the out of pocket. Second choice: Plan N. Eventually I see Medicare moving toward Plan N in order to secure more cost-sharing by the consumer.
WHEN IS THE BEST TIME TO BUY A MEDIGAP POLICY?
The best time to buy a Medigap policy is during your “open enrollment” period. Unoless you continue to be covered by employer group coverage – then take Part E when you turn 65 and ostpone Part B till you are ready to leave the employer health plan.
Your open enrollment period starts three months before you turn 65 (or go on Part B, if that occurs later) and ends six months after your birthday. (For Advantage plans the enrollment period ends three months after your birthday.) The plan may go into effect on the first day of the month in which you are both
· age 65 or older and
· enrolled in Medicare Part B
Once your Medigap open enrollment period starts, it cannot be changed.
During this period, an insurance company cannot:
· deny you any Medigap policy it sells
· make you wait for coverage to start, or
· charge you more for a Medigap policy because of any health issues – during your open enrollment, you don’t even answer health questions.
Most Medicare health plans cover all conditions immediately, from day one, regardless.
If you are eligible for Medicare because you are disabled or have End Stage Renal Disease, consult the Medicare & You guide book for regulations regarding the issuance of a supplement. In Arizona, you must be 65 to obtain a supplement; however, if you are on an Advantage plan due to a disability before age 65, when you turn 65, most open enrollment rules apply to you and you can then apply for a supplemental Medigap plan and leave the Advantage plan, if you wish.
HOW CAN I TELL IF I AM IN MY OPEN ENROLLMENT PERIOD?
You can tell if you are in your Medigap open enrollment period by looking at your red, white and blue Medicare card. The lower right hand corner of this card shows the dates that your Medicare Part A and Part B coverage started. If you are age 65 or older, add six months to the date that your Medicare Part B coverage starts. If that date is in the future, you are still in your Medigap open enrollment. If that date is in the past, your Medigap open enrollment has ended.
WHO DO I CALL FOR LONG TERM CARE PLAN INFORMATION?
Call Chuck Carter at 602-424-7509 (877-280-2304 outside Maricopa county). Chuck travels throughout the state and works exclusively with long term care products.
Long term care plans cover not only nursing home but other charges, such as at-home health care, assisted living and adult day care, and other long term care-related medical expenses - services that Medicare won't provide. If you were diagnosed with Alzheimer's or Parkinson's, or any number of other physical ailments, Medicare wouldn't cover any of the medical costs - because these are not conditions from which one recovers, they are progressive or degenerative conditions
Don't wait until you or a loved one has a need for long term care, at home assistance, or nursing home or adult day care; once the need has been established, these plans cannot be obtained. Like any other type of insurance, it must be purchased while the individual is in fairly good health.
See last page of this document for more information on Long Term care.
WHAT IS THE DIFFERENCE BETWEEN
AN ADVANTAGE PLAN (HMO / PPO) AND A MEDIGAP PLAN?
Medigap plans are the original Medicare insurance supplement plans. Plan F, offered by all carriers who offer Medicare insurance plans, picks up 100% of whatever Medicare doesn’t pay, for services that Medicare approves. With Plan G (actually requested more than Plan F these days) you are responsible for the Part B deductible per year. Part B is anything that occurs outside of a hospital, such as diagnostics or doctor appointments, labs, x-rays, etc., and Medicare covers 80% of that - but the both Plans F and G (after the $198) pick up 100% after that, and of everything else. Plans G and F are offered by all carriers; Plan N by most.
Plan G costs about $115 to $175. Most doctors who take Medicare will take a Medigap plan, no matter which plan or who the carrier is. Unlike Advantage plans, Medigap plans are standardized. Some carriers are not gender- or zip code-specific while others may offer lower premiums in the rural zip codes than in the more metropolitan areas.
“Standardized” means that the Plan G through BCBS is the same as the Plan G through AARP which is the same as Plan G through Medico or Equitable or Aetna, etc… the only difference is price. When you see a doctor who takes Medigap plans, he sends the claim to Medicare; who your carrier is doesn’t matter, unless it is an Advantage plan; not all doctors take Advantage plans.
With a Medigap plan, you can go to any doctor, anywhere, anytime, who takes Medicare. Period. In a different town? No problem. In another state? That’s okay. Moving? Fine - your plan moves, too.
If you have an Advantage plan, that changes. When you enroll in an Advantage plan, you are still part of original Medicare but the Advantage plan works differently. Many people do not realize that.
The Advantage plan covers what Medicare covers but does not necessarily cover the all the costs for services that Medicare approves but does not pay for, whereas supplemental (Medigap) plans do.
Many doctors who take Medicare do not take Advantage plans. With an Advantage plan, you are usually restricted to the doctors in that plan’s local network. With an HMO, you select a primary care doctor (PCP) from their list of contracted providers and that is the doctor you see first whenever you need medical attention. If you need a specialist, the PCP will then write a referral so you can go see a different doctor (must remain in network). If you have an Advantage PPO you can go to any doctor on the list of participating providers without a referral, but you still have a geographical service area. However, those few carriers offering Advantage PPOs will cover you for “out of network,” usually with an out of pocket maximum of $10,000. This is a good thing if you have an Advantage plan.
When you have an Advantage Plan, that plan determines how claims are paid and how much they will pay towards them; you cannot file a claim directly to Medicare if you see a non-plan provider. It will not be covered, even if the provider takes Medicare. On any kind of Medicare plan – with rare exception - claims must be submitted by the doctor (exception: traveling overseas, a covered benefit of Medigap plans ).
Your provider must be contracted with your specific Advantage plan and he files with that carrier. What Medicare approves so will the Advantage plan. However, you will still go out of pocket for a portion of the hospital, out-patient, labs, x-rays, doctor visits, diagnostics, etc. With Advantage plans your annual out-of-pocket maximum (excluding medications, which are over and above) can top $3200, $5500…even $6500 per year (in-network), depending on the carrier. The trade-off: super-low premiums. And some people will never meet the out of pocket maximum, as they may rarely go to the doctor or hospital or have surgery.
Example: the Medicare hospital deductible is $1484 per hospitalization and re-sets itself every 60 days. Medicare itself picks up 100% (after the first $1484) per hospitalization; your Medigap plan picks up that $1484 every single time. With Advantage plans, you may pay anywhere from $195 to $295 per day per hospitalization (for the first four to 10 days, depending on plan).
In some cases, you may be responsible for the 20% of diagnostic and other out-patient services that Medicare itself would normally not pay, but that the Medigap plan would pick up at 100%. This 20% is based on the Medicare-allowable amount – which is always less than the billed amount.
Example: cancer treatment. Medicare approves chemotherapy and picks up 80% of the approved cost. A Medigap plan picks up the other 20%. Most Advantage plans do not cover that 20% – meaning, you pay it. And an average chemo treatment (retail) is over $2500 (or more) and usually consists of four to eight rounds. Medicare pays 80% of the approved cost of chemo and the patient covers the other 20% - again, based on the Medicare allowed amount, not the billed amount. So you might pay between $200-400 per treatment on an Advantage plan, while a Medigap plan pick that up 100% of that cost.
If you travel, most Advantage plans will cover
you in the
Relocation: if you move outside your service area (the area serviced by your provider network), you cannot take your Advantage plan with you. You must apply for a new plan when you move, and in Arizona, only a handful of Advantage plans are offered in rural areas. So at that time you would have a new 60-day enrollment period in which you could then apply for a new Advantage or even a Medigap plan (with no underwriting), as that might be all that is available in your area.
Losing an Advantage plan through no fault of your own gives you a “Special Enrollment Period” for either kind of plan. There is no other time you can change from an Advantage to a Medigap plan other than through a “no-fault loss” or with full underwriting. During the AEP (Annual Enrollment Period), you can change from one Advantage plan to another, no questions asked. This occurs every 10-15 to 12-7. Same with prescription plans. This enrollment period does not apply to Medicare supplements; you can move from one to another whenever you want so long as you can pass medical underwriting. .
Advantage plans are contractual. If you have an Advantage plan and seven months later decide you don’t want it, you usually cannot cancel it until the AEP. Exception: if you move outside your coverage area, per above. Again, the AEP applies to Advantage and RX plans, not Medigap plans. During the AEP you could change to a different Advantage plan or try to apply for a Medigap plan; for the latter, you will be underwritten for medical history, going back two to five years.
Advantage plans cost less than Medigap insurance plans, as you pay more out of pocket expenses on an Advantage plan - expenses that Medigap plans cover at 100%. This is called Cost Sharing: you share the cost with the carrier. You may have a limited number of providers to choose from, and you have co-pays, etc – so, you pay less premium in exchange for paying more of the expense. Advantage plans will indicate, in their literature, their maximum out-of-pocket expenses. (Again, these maximums do not include medications.) On Plan G, that annual medical care cost maximum is $203 in 2021. Plan F will not be offered after 1-2020, though people who already have those plans will be able to keep them. More people request Plan G.
Most Advantage plans include drug coverage. This is Part D coverage that is incorporated in the Advantage plan. Medigap plans offer no drug coverage but you can get a stand-alone drug plan. These cost $7-105 per month, on average. These stand-alone RX plans work the same as they do in Advantage plans.
So these are the general differences between Advantage plans and Medigap plans. Basically: flexibility, portability, coverage, benefits and overall out of pocket costs. However, many Advantage plans do offer a number of additional benefits - such as vision, hearing and dental discounts, and other discounts, such as gym memberships, etc., often at little or no additional charge.
You know that commercial that says you might be missing out on recent changes to Medicare? There have been no changes to Medicare itself in over 25 years.
MEDICARE PART D
Part D of Medicare is the prescription drug plan. Medicare itself does not provide drug coverage, other than when you are a patient in the hospital. You, your drug plan and the pharmaceutical manufacturers cover medications. With Part D, you pay a monthly premium and then your prescriptions are broken into cost categories with correlating co-pays - usually, Preferred Generic, Generic, Preferred Brand Name, Non-Preferred Brand Name and Specialty Drugs. Each category costs more than the last, and specialty drugs are generally charged at 33-50% of what the retail rate would normally be. Mail order is often available for all (except specialty drugs) and can save you about 10% on generics versus filling at the pharmacy, it depends on the plan. Some plans charge the same either way, mail order is just for convenience.
It doesn't matter if you buy Part D through a stand-alone plan, such as BCBS, AARP/United or Humana or several others, or have it as part of an Advantage-type plan (HMO, PPO and Fee for Service), you will still have what is called the "gap." This is the point at which you and the carrier (combined) have totaled $4,130 - again, that is your portion AND what the carrier has paid. Once you hit the "gap," carriers offer 75% assistance for both brand name and generic medications. Then, once through the “gap,” you generally pay 5% of your medication costs for the balance of that calendar year. Then, in January, you start all over again. In order to get to the other side of “the gap” your personal out of pocket, including what you spent getting to “the gap”, must total $6,550. Although you'll only pay 25% of the price for the brand-name drug in 2021, 95% of the price - what you pay plus the manufacturer discount payment – will count as out-of-pocket costs which will help you get out of the coverage gap. What the drug plan pays toward the drug cost (5% of the price) and what the drug plan pays toward the dispensing fee (65% of the fee) aren't counted toward your out-of-pocket spending.
Example; Tom reaches the coverage gap in his Medicare drug plan. He goes to his pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60, and there's a $2 dispensing fee that gets added to the cost. Tom will pay 25% of the plan's cost for the drug ($60 x .35 = $15) plus 35% of the cost of the dispensing fee ($2 x .35 = $0.70), or a total of $15.70, for his prescription.
However, $51.90 will be counted as out-of-pocket spending and will help Tom get out of the coverage gap faster because both the amount that he pays ($15.70) plus the manufacturer discount payment ($36.20) count as out-of-pocket spending. The remaining $4.30, which is 5% of the drug cost and 65% of the dispensing fee paid by the drug plan, isn't counted toward Tom's out-of-pocket spending.
Some plans cost as little as $7 (those have a $445 deductible on brand name drugs) and have lower co-pays (or percentage costs), than many plans with no deductible. This may be important if you take several Tier 3 or 4 drugs. Most plans with no deductible cost $65-95 per month - but you could pay more between your monthly premium and co-pays than your drugs would have cost with plan with the deductible - especially if all you take are a few generics! However, not every drug is covered the same on every plan.
While many seniors will never get to the other side of that "gap," probably 50% will reach it. The problem isn't so much getting there, it's what to do once there. We suggest that you consider Canadian mail order once you hit the gap. Prescriptions filled anywhere other than your list of participating drug stores will not count toward "filling" that "gap" - but if you aren't going to get to the other side, who cares?
Question: “Do I really need a drug plan?” Not everyone takes a drug plan when they first turn 65. Quite a few seniors take no medications. To you, I would say, "Maybe not now" but considering how cheap some plans are, why wait? If you take just a few generics, and are getting them for $3-5 somewhere, the drug plan might not help you much – but it would keep you from accruing a penalty. You can buy Part D later, during the AEP (annual enrollment period, every 10-15 through 12-7 and referenced earlier) - and use some of the tips on Page 1 if you need medications before you get a drug plan.
Question: “If I take a drug plan once my open enrollment has ended, can I be charged more?” If you don't take Part D of Medicare in your open enrollment period, you will be charged a penalty of 1% per month (of the average drug plan cost) more for every month whereby you could have had it but didn't take it. Think for a second: one percent of $31 is 31 cents.
No one went broke paying a total of maybe $3.72 more per month because they waited a year or so to buy a plan they didn't need at the time they turned 65. After all, if you saved $432 in a year by not having Part D (that is the average annual premium for Part D), then how long would it take you to make-up that $3.72 per month penalty? About seven to eight years based on the average cost of a drug plan in 2021. But – drug plans can be pretty inexpensive. Get one when you first qualify.
However, if you do not get it during your open enrollment (you have six months to get a drug plan starting three months prior to your birthday month and ending three months after the first day of your birthday month) you must wait till the Annual Enrollment Period, see next paragraph.
Question: “What if I decide I want part D after my open enrollment period has ended?” There is an Annual Enrollment Period for Part D of Medicare every October 15 - December 7. You may apply then.
Question: “What if I don’t take the drug plan and end up needing medications before the next enrollment period?” Utilize the tips below.
Note: if Medicare itself doesn’t approve a specific medication, most plans won’t cover it. Not all drug plans cover all prescriptions, and not all medications are approved by Medicare or all drug plans.
Question: “Can I cancel or change from one drug plan to another?” Yes, every October 15 - December 7th you can make application for a new plan to start on January 1st. Drug plans are contractual, till the end of the year.
Question: “If I have an Advantage plan, can I still buy a drug plan?” Only if your Advantage plan is considered a Medicare H.S.A. or PFFS plan - and there are limitations, at that. If the Advantage plan contains drug coverage, you may not enroll in a separate Medicare drug plan. There would be no benefit, anyway.
Note: if you go onto Medicare and have an existing H.S.A. account, you may deduct the cost of the Part D premium as well as your Part B premium from your H.S.A. account - but not your actual health plan premium.
Feel free to call if you have questions about or are interested in a Part D Medicare drug plan. I do recommend getting a drug plan when you go on Medicare, even if you take no medications.
You cannot continue to contribute to an H.S.A. account once on Medicare.
PRESCRIPTION HINTS AND HELPS
First of all, whether you are 25, 45 or over 65, prescription costs can be a bear. Some carriers won't cover certain drugs, some drugs haven't been in wide spread use long enough to be approved by various carriers, some are excluded due to sheer cost….. but there is help!
There are many avenues to saving money if you don't have a health plan that covers your particular medication needs - or if you don't have a plan at all.
First….. doctor's samples. Almost every prescription that a doctor can write has been given to him in sample form, by pharmaceutical reps. If nothing else, a doctor should be able to give you a two week to two month supply of samples. Some doctors have kept patients going indefinitely on samples.
Second….. ask if the prescription comes in a generic form. It is surprising how many doctors just write out the prescription for the brand name, even when there is a generic.
Third….. if you take a medication that is in a breakable tablet form, ask your doctor to write it for double your usual strength with the instructions to break it in half. The price difference between 20 and 40mgs of a drug is often less than 20%. Sometimes, there is no difference.
Fourth….. shop around! Many of the stores have those wonderful $3-4 generics. For the most part, the least expensive retail store I have seen for brand name is Costco and Sam’s Club. Go to their websites and check out any of your prescriptions - you may be surprised by some of those rates. You do not need to be a member of either store to use their pharmacy.
Fifth….. I’ve never heard a horror story
about prescriptions filled in
Sixth….. we send free discount cards to those who don’t take drug plans. But they won’t keep you from the penalty. In addition to the card we can send you, try www.GoodRx.com. And it doesn’t hurt to have more than one discount card. I have used these myself on brand name.
Seventh….. Canadian mail
order. For some reason, some folks think this isn't around anymore. The
only ones complaining about Canadian mail order are the "middle men"
involved in the distribution of prescription drugs who won't get their
"cut" if you buy your prescription outside the
Try www.candrugstore.com. This is a very
easy-to-use website, they are open Saturdays, and on
the Canadian west coast. Their number is 866-444-6376. They do
not order from
Did you know… the patent on brand name
drugs is only good in the US. Many of the US-based pharmaceutical companies
manufacture their medications in other countries - in their own facilities.
Many drugs that are available only in a brand name here are already available
Eighth….. if you are low income or simply have some really costly meds, you can contact the manufacturer directly and ask if they participate in any prescription assistance programs. Many do and none advertise this. All it takes is for you and your doctor to fill out a form and send it in. Many drugs costing in the $75 to $500 range are dispensed at little or no charge by the manufacturers.
Bear in mind, many brand name and some generics are manufactured in China, regardless of where you buy them. There have been a growing number of recalls on prescription drugs manufactured in China that contain heparin. The Internet is a valuable tool is keeping up with this type of information.
Did you know… more than half the prescriptions filled in pharmacies are made outside the United States; your box may say “Distributed by….” or “Packaged by….” but won’t say “Manufactured in….” the USA.
IRMAA Adjustments for 2021
How Income Affects What You Pay for Part B and Part D (Drug Plan) of Medicare
(from the www.medicare.gov website)
The standard Part B premium amount in 2021 will be $148.50 (or higher depending on income). You will pay the standard premium (or higher) if:
* You enroll in Part B for the first time in 2021
* You don’t get social security yet
* You’re billed directly for your Part B premiums (meaning not deducted from social security) * Your modified adjusted gross income as reported on your IRS tax return from two years ago is above a certain amount. If so, you’ll pay the standard premium and an Income Related Monthly Adjusted Amount. IRMAA is an extra charge added to your premium.
If you are in one of these four groups, here is what you will pay:
File indiv tax return File joint tax return File married & separate tax return You pay each month
$ 88,000 or less $176,000 or less $ 88,000 or less $148.50
Above $88,000 up Above $176,000 Not Applicable $207.90
to $111,000 up to $222,000
Above $111,000 up Above $222,000 Not Applicable $297.00
to $138,000 up to $276,000
Above $138,000 up Above $276,000 Not Applicable $386.10
to $165,000 up to $330,000
Above $165,000 up Above $330,000 Above $ 88,000 up $475.20
to $500,000 to $750,000 to $413,000
$500,000 and above $750,000 and above Above $413,000 $504.90
Likewise, here is what you pay in addition to your Prescription Drug Plan premium:
File indiv tax return File joint tax return File married & separate tax return You pay each month
$ 88,000 or less $176,000 or less $ 88,000 or less Plan prem. plus
Above $88,000 up Above $176,000 Not Applicable $ 12.20
to $111,000 up to $222,000
Above $111,000 up Above $222,000 Not Applicable $ 31.50
to $138,000 up to $276,000
Above $138,000 up Above $276,000 Not Applicable $ 50.70
to $165,000 up to $330,000
Medicare Fraud and Abuse - As Medicare fraud escalates, premiums increase
is a health coverage plan run by the
A high percentage of health suppliers, institutions and providers of Medicare run things by the book, respecting Medicare rules. On the other hand, there’s that small percentage that is intent on committing fraud and has learned how to con Medicare out of millions of dollars annually. The main people who get stung by the fraud are actually the legitimate members. They feel the effect of the fraud by the premium going up.
Much Medicare fraud turns out to be an honest mistake: a typing error, incorrectly-filled form or conversational misinterpretation. With all the Medicare paperwork, there’s bound to be problems.
If you notice it is just a simple error, your provider should resolve things after these errors have been discussed. Nevertheless, if you then receive bills for services you never received or that you thought were free, there may be a real case of fraud.
There are various forms of Medicare fraud. A few of these are: providers claiming to be a Medicare representative, billing Medicare when the service is free, being billed for services you did not receive, and scaring you into buying more expensive medical equipment.
Thankfully, the government is not giving up without fight. They are enforcing Medicare by [trying to] make sure only trustworthy decent medical suppliers, providers and institutions are used. They have also included Centers for Medicare and Medicaid Services (CMS), Medicare providers (e.g., hospitals, doctors, facilities, etc), the receivers of Medicare, consumer protection agencies and federal law enforcement. But, the numbers are too big to be the sole responsibility of these agencies.
Medicare members now have the duty to look out for fraud. They should keep a close watch for extra charges, incorrect Social Security / Medicare numbers, billed services that were not provided and anything else that looks out of the ordinary.
If you suspect fraud, first let the doctor try and sort things out as it still may be a legitimate error. If the discrepancies are not resolved, then call the Medicare provider who dealt with the doctor’s claim. There is a hotline for the Inspector General’s office, 1-800-447-8477 (HOT-TIPS). Be sure to keep as much evidence as possible - notes on conversations, documentation, dates, phone numbers, etc.
Help stamp out Medicare fraud, it only hurts the honest folk.
PHONE SCAMMERS USING SO-CALLED “OBAMACARE” TO TARGET SENIORS
They say what you don’t know can’t hurt you. But, an on-going scam is banking on seniors having a limited knowledge of so-called “Obamacare” and thinking it affects their Medicare benefits.
According to consumer watchdogs, scammers try to fool consumers, in many cases seniors, into giving up personal information by claiming they have been selected to receive a tax subsidy.
The phone solicitors, often pretending to be federal government workers, tell people they can get all signed up by giving them their bank and Social Security numbers. Better Business Bureau officials say the fact that few seniors know much about the Affordable Care Act only helps the flim-flammers.
If you give personal or private information to these callers, there is little you can do after the fact to un-do the damage, which could lead to identify theft or worse. If you know anyone who has ever been a victim of identity theft, it can take months to years to un-the do damage.
There’s not going to be much change related to the Affordable Care Act in 2018 and little that impacts those on Medicare. Obamacare does not affect your ability to qualify for / buy a Medicare supplement. Seniors should hang up on callers sounding like they are offering something for nothing, or an “advance insight” into anything related to Obamacare and indicating that they can sign you up. These callers are not agents or broker and are not related in any way to Medicare.
Keep in mind, these scammers get your name, address, phone number and possible birth date from the Internet; it is all there and it is all free. BUT – they do not have your banking information or any other pertinent information, so do not be fooled by the request to verify your [whatever] number. If they were legitimate, they would not need you to verify anything.
So if you get these calls - hang up.
We are in the midst of a significant intergenerational transfer of wealth, as trillions of dollars are being passed from aging parents to their baby-boomer children. But there is a second, significant movement of money that no one is talking about. That wealth won’t go to the heirs but rather to the health care system—specifically, caregivers, assisted living facilities, and nursing homes.
The reason is simple: more than 90 percent of Americans have no plan in place to cover the potentially enormous costs of long-term care.
Watching an inheritance slip away
As they age, people who planned to bequeath money to family members may instead have to divert their income to health care providers or liquidate assets to pay for uncovered health care expenses. Children who are expecting an inheritance may be shocked and disappointed to find that their parents are spending as much as $50,000 to $150,000 per year for long-term care expenses. In some cases, there may be little left to inherit.
It’s difficult enough to witness the deteriorating physical or cognitive health of a loved one. But to realize that it may also directly impact your financial future can be quite hard to take. It’s all too easy for an heir’s judgment to become clouded as he or she tries to preserve the parent’s assets.
Questions to consider
If you are considering a plan for long-term care, ask yourself these questions:
· How would you feel if your plans to bequeath money to loved ones were significantly altered by events that might have been foreseen?
· How would you feel about spending thousands of dollars per month, indefinitely, for uncovered health care expenses?
· Would you be happy seeing your retirement income diminished to pay for unexpected costs?
And here is the most telling question of all: Would you want your own parents to have (or do you wish they’d had) a long-term care policy?
solution for every situation
The best way to ease everyone’s worries is to put a long-term care plan in place. Several types of long-term care strategies are available, including traditional policies, which require annual premiums, as well as linked-benefit policies, which provide both long-term care coverage and a death benefit if long-term care is never needed. There are also cost-sharing options, which offer lower benefits but cover the difference between expenses and retirement income. Although some people won’t qualify for long-term care insurance due to health problems, there is an appropriate solution for almost everyone.
Besides preserving bequests and inheritances, a long-term care policy can provide other life-changing benefits, including:
· An income stream. By paying for covered expenses, a long-term care policy enables your retirement plan and legacy plan to play out as expected. In a family’s time of turmoil and need, think of the difference a monthly check for, say, $6,000 or $10,000 might make.
· A choice of where to get care. Most people wish to stay in their homes. A long-term care policy offers the freedom to get care where you want, rather than making a nursing home the only option.
· “Concierge services.” A long-term care policy is priceless at the time of claim. Besides receiving several thousand dollars each month to cover the cost of care, you get the services of a care coordinator, who can help you develop a plan of care, hire the right people as caregivers, and assess the home for safety.
· Peace of mind. A long-term care policy removes the temptation to decrease care to protect an inheritance.
In short, if you value your legacy plan and want to feel good about taking care of your loved ones, a long-term care plan can go a long way toward protecting your wishes.
Melissa has retired and her partner, Chuck Carter, can assist you. He is a financial consultant located at 2720 E. Camelback Road Suite 200 Phoenix, AZ 85016. His direct number is 602-424-7509.