Tag: Special Enrollment Period

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 2023 is $164.90.
- If your 2021 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, like me, you are enrolled in Medicare Parts A and B and have deferred the Social Security benefit, Medicare sends a bill (sample below) for the Part B premium and, if applicable, any IRMAA adjustment, which can be paid by check or online.

Tags Albany NY, IRMAA, Medicare Advantage, Medicare Part B, Medicare Savings Program, Medicare supplement, Medigap, New York, Special Enrollment Period

Medicare Part C Medicare Advantage Part D Prescription Drug

What If I Missed the Medicare AEP Deadline?

Post author By Dan
Post date December 8, 2020
No Comments on What If I Missed the Medicare AEP Deadline?

This year’s Medicare Annual Enrollment Period (October 15 through December 7) was a busy time and we are grateful for the scores of individuals and couples who permitted our team of agent advisors to help with their 2021 Part C Medicare Advantage or Part D Prescription drug plan selection. (The December 7 deadline did not apply to a Medicare Supplement plan selection.)

Q: But I missed that deadline. Is there another option for me to choose a new plan for 2021?
A: Possibly. Some Medicare participants are eligible for what is called a Special Enrollment Period during which you can make a change to your Part D prescription drug or Medicare Advantage Plan. This is separate from the October 15 – December 7 Annual Enrollment Period.

Q: Am I eligible for a Special Enrollment Period?
A: Let’s look at three Special Circumstances that may apply to you. If one does, you can make changes to your Medicare Advantage and Medicare prescription drug coverage outside of the normal Annual Enrollment Period:

Are you a veteran? Many veterans may not be aware of a valid Special Election Period available by having their prescriptions filled through the Veterans Administration (VA.) Vets can use that Special Enrollment Period to enroll in a “MA only” plan – a Medicare Advantage plan with no drug benefits. Click here for more information on MA Only plans.
In New York State the State Pharmaceutical Assistance Program (*) known as EPIC can help with a portion of your drug plan’s premium and reduce prescription co-payments. EPIC members also have one Special Enrollment Period per calendar year to enroll in a new Medicare Advantage or Part D prescription drug plan. [Download the 2020 EPIC application here.]
Social Security Extra Help – Eligibility for this program is based on your income and assets. Extra Help subsidizes part or all of your drug plan’s premium and deductible and reduce prescription co-payments. With Extra Help, you may be able to make changes to your coverage one time during each of these periods:
- January – March
- April – June
- July – September

Q: Do any of these Special Circumstances apply to Medicare Supplement plans?
A: No. However three states (New York, Massachusetts and Connecticut) do require Medicare Supplement plan insurers to offer policies to Medicare beneficiaries age 65 and older through continuous open enrollment, with guaranteed issue rights throughout the year.

That means if you want to drop a Medicare Advantage plan (which includes prescription drug coverage) and return to Original Medicare with a Medicare Supplement plan; you need a Special Enrollment Period to add the third piece, your Part D prescription drug coverage.

Q: I’m not sure of my eligibility status, can you help me with my questions?
A: Yes. Simply use the form below and send a note to an agent advisor or call (518) 346-2115. We’ll discuss your options by telephone, web conference or an in person visit. And, during your Special Enrollment Period, we may be able to identify a Medicare Advantage, Medigap or Prescription Drug Plan more suited to your needs – even though the December 7 deadline has passed.

(*) In Massachusetts, the SPAP is Prescription Advantage.
(*) In New Jersey, the SPAP is PAAD and Senior Gold

Case Studies Part D Prescription Drug

New York State EPIC and Mary – a case study

Post author By Dan Alcorn
Post date May 11, 2020
No Comments on 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]

Tags Albany NY, EPIC, Medicare Part D, Medicare PDP, New York State, NY State EPIC, Prescription Drug Plan, Special Enrollment Period

Case Studies Part C Medicare Advantage Part D Prescription Drug

“Thank you for helping me change my insurance!”

Post author By Dan Alcorn
Post date February 29, 2020
No Comments on “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:

Leaving your employer’s group coverage. I see this most often with individuals working past age 65.
Like with Nancy, when you relocate outside of the service area of your current plan.
When there is a change in the level of Social Security Extra Help.
Belong to a state pharmacy assistance program such as New York State EPIC.
The January 1 through March 31 Medicare Advantage Open Enrollment Period. (Limited to those already enrolled in a Medicare Advantage plan.)

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.

Tags Albany NY, Buffalo NY, EPIC, Medicare Advantage, Medicare Part D, Medicare supplement, NY State EPIC, Social Security Extra Help, Special Enrollment Period

Case Studies Part D Prescription Drug

A Medicare Advantage case study.

Post author By Dan
Post date March 1, 2019
No Comments on A Medicare Advantage case study.

If you, a loved one, friend or neighbor has experienced “sticker shock” with your Medicare Part D prescription drug co-payment, the following case study may interest you.

Earlier this week, I received this message from an Albany New York County couple: “We were talking with our neighbor Kathy about the sudden and unaffordable cost of our medications. She said you helped her and you might be able to help us change our Medicare plan.“

I called back and confirmed a time to get together for a complimentary review of their current plan, the doctors they see and medications they are currently taking.

Why ask about the medications?
In Medicare Part D terminology, generic medications are typically categorized as Tier 1 or 2 medications and brand name medications as Tiers 3, 4 or 5. The higher the tier, the higher the cost to the consumer.
Both the husband and wife are taking generic but also a few brand name medications.

But there’s more.
Similar to the deductible we pay for our auto or home insurance, many Medicare Part D plans include a deductible; that is, we pay the full cost of the medication up to a certain level. Most Part D plans don’t apply any deductible to the lower cost Tier 1 and 2 medications and limit the deductible to Tiers 3, 4 and 5 medications. So, for many, if your medication list is all Tier 1 or 2 generics, the deductible amount may not apply to you.

So what happened here?
The couple showed me their current Medicare Advantage HMO cards and, sure enough, I confirmed there is a $295 deductible applicable to the brand name tiers 3, 4 and 5 medications. But, the couple insisted, they never paid this before. That seemed odd so I did a little research and discovered their plan did not include any drug deductible in 2018. Something had changed.

Annual Notice of Change (ANOC) letter.
Their Medicare Advantage plan, sometime in September 2018, sent the ANOC letter advising members of the plan changes effective January 1, 2019. This notice is required by federal rules. The couple didn’t recall this notice and when asked if their agent had reached out to alert them, the reply was “we don’t have an agent.” I explained how I host early October conference calls to go through with my clients any plan changes announced in those ANOC letters.

And when the couple went to the pharmacy for a 90 day supply refill, that’s when they each faced the $295 deductible; which they did not plan for.

“We can’t afford this and don’t think we can change our plan after January 1. Kathy said you know how to do that.”

Yes, most Medicare beneficiaries know about the October 15 through December 7 Annual Enrollment Period yet few are aware of other enrollment periods available throughout the year. This couple was pleasantly surprised their neighbor Kathy mentioned and I confirmed how they could change their Medicare Advantage plan after January 1.

The solution?
It took some research time but we found a replacement Medicare Advantage plan i) with a monthly premium at or less than their current plan, ii) that their primary and specialist doctors participate with and iii) with a drug tier structure that does not impose a deductible on their current brand name medications.

And more good news. Because the husband and wife are income eligible to be enrolled in the New York State Pharmaceutical Assistance Program (EPIC), their monthly plan premium will be 100% subsidized and their brand name copay amounts no greater than $20.

“Dan, can we make this plan change effective for tomorrow, March 1?” Yes, both husband and wife applications were processed electronically for the requested March 1 (next day) effective date.

Some reminders from this case:

1) Many Medicare Part D beneficiaries are not aware of which tiers their medications are assigned to.
2) Medicare Advantage plans are required to send a notice 90 days before the effective date of any change.
3) Plan formularies are not alike. For example, a medication listed as in one tier plan A can be categorized in a different tier level with Plan B. .
4) Part D plan deductibles are not alike. Some plans have $0 drug deductible, others apply a deductible to Tier 3, 4 and 5.
5) There are several enrollment periods available throughout the calendar year.
6) New York State residents enrolled in a Part D plan should consider NY EPIC.
7) Having a local agent versed in plans available in your area can help.
and
8) I love these cases. A referral from a satisfied client results in two new satisfied clients.

Tags Aetna Medicare, Albany NY, Annual Notice of Change, ANOC, EPIC, Humana, Medicare Part D, Medicare PDP, New York State, NY State EPIC, Open Enrollment Period, Prescription Drug Plan, Social Security Extra Help, Special Enrollment Period