Tag: Special Enrollment Period

Categories
Medicare Medicare A & B

Medicare Tips: Part B

Unlike Medicare Part A, which covers inpatient care in a hospital, skilled nursing or hospice facility, Part B covers through outpatient care, services from doctors and other providers, durable medical equipment and many preventative screenings.

  • Individuals already receiving Social Security benefits are automatically enrolled in Parts A and B effective the first day of the month you turn 65.
    • At age 65, individuals choosing to delay their Social Security benefit need to contact Social Security, online or your local office, to activate Parts A and B.
    • Individuals receiving Social Security Disability benefits are automatically enrolled in Parts A and B after 24 months.
    • At age 65, those covered through their individual or spouse’s currently employed group health plan (20 or more employees) may delay Part B WITHOUT PENALTY until they, or their spouse, are no longer employed and the employer coverage ends.
  • The standard Part B premium amount in 2026 is $202.90.
    • If your 2024 Adjusted Gross Income was above a certain amount, you may pay more – an Income Related Monthly Adjustment.
    • If your current monthly income is below a certain amount, you may be eligible for the Medicare Savings Program which will subsidize the Part B premium.
  •  Paying the Part B premium
    • If you receive Social Security benefits, your Part B premium (and the IRMAA adjustment, if applicable) will be deducted from your monthly Social Security payment.
    • If you are enrolled in Medicare Parts A and B and have deferred the Social Security benefit, Medicare sends a bill for the Part B premium and, if applicable, any IRMAA adjustment, which can be paid by check or online.

 

Categories
Case Studies Part D Prescription Drug

New York State EPIC and Mary – a case study

“… a huge thanks for cluing us in to the EPIC ..program.”
“…we now estimate yearly savings to be $7,000+/-” 
“…we’d never heard of this program until one of your newsletter emails..”

When Mary became eligible for Medicare I helped her enroll in the Medicare Supplement Plan G she selected as secondary to Original Medicare.

Then we searched and found a Part D prescription drug plan that included her specialty medication in its covered drugs, known as the “formulary.” Although the specialty drug was categorized at the highest cost sharing, tier 5, its being included saved the added step and hassle of requesting a “formulary exception.” 

John and Mary’s joint income is below $100,000 so she became eligible for the New York State EPIC program. 

As John’s note to me states, once Mary’s pharmacy cumulative copayments reached her EPIC 2020 deductible level, that tier 5 specialty drug copay was reduced to $20. John estimates this saves the household about $7,000 annually.

Of course I was thrilled to hear my mention of EPIC helped John and Mary like this. I encourage every client to confirm your New York EPIC eligibility and enroll. I have included the EPIC enrollment form below and am available to assist with any eligibility or enrollment process questions. 

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Download NY EPIC application [715.73 KB]

Categories
Case Studies Part C Medicare Advantage Part D Prescription Drug

“Thank you for helping me change my insurance!”

This month I received this wonderful thank you note from Nancy. She had recently relocated and needed to find new doctors along with a Medicare Advantage plan covering those doctors and her medications.

Nancy was concerned that she would have to remain on her current plan and wait until the Annual Open Enrollment Period in order to find a new plan effective January 1 of next year!

Nancy was relieved when I let her know she was eligible for a plan change due to a Special Enrollment Period.

A Special Enrollment Period allows eligible individuals like Nancy who are enrolled in Medicare Parts A and B to make a Medicare Advantage or Prescription Drug Plan selection or change outside of the normal October 15 – December 7 time frame.

When are you eligible for the Special Enrollment Period? The 5 most frequent examples I see:

Summary:

The initial, annual and special enrollment periods are when individuals enrolled in Medicare Parts A and B can make Medicare Advantage, Medicare Supplement or Medicare Part D prescription drug plan. Please feel free to call Dan at (518) 346-2115 for a no-cost no-obligation consultation.