Medicare Part D Archives - Hanover Mortgages

Apache is functioning normally

October 3, 2023 by Brett Tams

Only 3 in 10 Medicare beneficiaries shop around during open enrollment, according to a 2022 analysis from KFF, a health policy nonprofit — and only 1 in 10 Medicare Advantage enrollees voluntarily switch plans. But a 2020 analysis of Medicare Advantage plan choices by the National Bureau of Economic Research found that more than half of beneficiaries overspent by more than $1,000 due to the plan they selected.

Medicare open enrollment is Oct. 15 to Dec. 7, giving people with Medicare a chance to change plans for the upcoming year. Although potential Medicare Advantage enrollees may be swayed by $0 premiums and extra perks like vision and dental coverage, there are more important features to explore when you’re choosing next year’s coverage.

Here are some practices to avoid as you shop for Medicare Advantage this fall.

1. Thinking Medicare Advantage is Medicare

If you’re considering Medicare Advantage, understand that it’s not the same thing as government-provided Medicare. It offers the same benefits, but Medicare Advantage is run by private health insurance companies and it operates differently.

“You are essentially taking the Medicare coverage that you’ve been provided by the government and turning that in,” says Melinda Caughill, co-founder and CEO of 65 Incorporated, which offers Medicare guidance.

You can switch back to Original Medicare during each year’s open enrollment period, but you may not be able to qualify for an affordable Medicare Supplement Insurance, or Medigap, plan once you’re past the one-time Medigap open enrollment period. (Medigap helps with certain out-of-pocket costs not covered by Original Medicare.)

2. Assuming your doctors are in network

Medicare Advantage plans operate within networks of medical providers, and you usually must see in-network doctors for covered care.

“A lot of people don’t realize that — especially those $0-premium plans — they tend to have fairly confined networks,” says Emily Gang, CEO of the Medicare Coach, a site that provides Medicare guidance. “You want to double-check that your doctor is actually an approved provider in that network.”

Ask your providers what insurance they’ll be accepting in 2024, suggests Sarah Murdoch, director of client services for the Medicare Rights Center, a nonprofit consumer advocacy organization. It’s easier than trying to check each plan’s network individually.

3. Not checking your drug coverage

Like network providers, Medicare Part D prescription drug coverage can also change each year. Your drug plan might cover one of your medications differently in 2024, leaving you with more out-of-pocket costs than you expected.

“If you take even one brand name medication, your need to compare plans is incredibly high,” Caughill says. No brand names on your list? Shop around if you take five or more medications in general.

4. Buying for the dental benefits

Medicare Advantage plans usually include benefits that aren’t part of Original Medicare, such as dental, vision or hearing coverage. These extras may be appealing, but don’t let them steer your plan choice.

“First of all, it’s health insurance — so how is it going to cover your health care providers and your medications?” says Katy Votava, who holds a doctorate in health economics and nursing and is president and founder of Goodcare, a consulting firm focused on the economics of Medicare. “If you pick [your plan] for a benefit that isn’t health insurance, you’re often picking wrong. And the dental benefit is pretty limited in all these plans — it’s a couple of cleanings and some bite wings.”

5. Looking at the premium only

The majority of Medicare Advantage enrollees are in plans with no premium, meaning you pay nothing each month for the plan. “People see that $0 premium and they’re like, ‘Oh, it’s free,’” Gang says. “And it’s not.”

Research the rest of the plan’s costs before you sign up, including deductibles, copays, coinsurance and the out-of-pocket maximum, which is the most you might have to spend on covered care in a year. In 2023, the out-of-pocket max can be as high as $8,300 for in-network care.

6. Buying because your friend has it

People eligible for Medicare are bombarded by information during open enrollment, and it can be overwhelming. “They don’t shop,” Votava says. “They go with name recognition or what their friend has.”

The better choice: Focus on your own situation and find the plan that meets your needs.

If you need help, contact your State Health Insurance Assistance Program, or SHIP, for free Medicare guidance. Just don’t wait until the last minute, because appointments fill up, Votava says. “If you need individual help, you’d better get on the list.”

This article was written by NerdWallet and was originally published by The Associated Press.

Source: nerdwallet.com

Apache is functioning normally

July 22, 2023 by Brett Tams

A Medicare Advantage plan, similar to an HMO or PPO, is type of Medicare plan that is available to Medicare enrollees. This option is also referred to as Medicare Part C. These plans are offered by private insurance companies that are approved by Medicare.

By joining a Medicare Advantage Plan, a participant essentially gets all of their Medicare Part A (Hospitalization Coverage) and Medicare Part B (Physicians Coverage). In fact, Medicare Advantage Plans are required to cover all of the services that the Original Medicare covers except for hospice care. This is because Original Medicare covers hospice care, even if the participant is enrolled in Medicare Advantage.

In addition, a Medicare Advantage Plan may offer additional coverages such as vision, dental, and / or health and wellness programs. And, most Medicare Advantage plans also include Medicare prescription drug coverage, too.

When an individual joins a Medicare Advantage Plan, Medicare pays a fixed amount of their care every month to the companies that offer these plans. These companies are required to follow strict rules that are set by Medicare.

However, each of the Medicare Advantage Plans are allowed to charge different out-of-pocket costs, and the plans may also have different rules as to how enrollees can receive their services. For example, some plans may require participants to get a referral before going to a specialist. And, these rules may change every year.

Medicare Advantage Plans also have an annual cap on how much participants will pay for their Medicare Part A and Part B services throughout the year. This annual maximum out-of-pocket amount can differ from plan to plan.

Different Types of Medicare Advantage Plans

Essentially, there are two primary types of Medicare Advantage plans. These are network and non-network. Network plans offer care to enrollees through their network of physicians and hospitals and are identified as HMOs and PPOs.

The non-network Medicare Advantage plans are a type of personal fee-for-service plan that does not require the participant to see a specific doctor or go to a specific hospital. However, the doctor or hospital that is chosen must be willing to accept the plan’s payment structure.

With a Medicare Advantage Plan, a participant may choose to stay in the traditional Medicare program or in their current managed care plan. Or, as an alternate option, the participant may choose to receive their Medicare-covered services through any of the additional following types of health insurance plans:

Health Maintenance Organization (HMO) – These plans consist of a network of approved hospitals, doctors, and other types of health care service professionals who agree to provide their services in return for a set monthly payment from Medicare. These health care providers will receive the same fee each month, regardless of the actual services that they provide.
Preferred Provider Organization (PPO) – These plans are somewhat similar to HMOs, however with a PPO, the beneficiaries do not need to obtain a referral in order to see a specialist who is outside of the network. Also, participants are allowed to see any provider or doctor that accepts Medicare. However, PPOs do limit the amount that their members pay for care outside of the network.
Private Fee-for-Service Plans (PFFS) – These types of plans offer a Medicare-approved private insurance plan. With these plans, Medicare will pay the plan for Medicare approved services while the PFFS determines – up to a certain limit – how much the care participant must pay for their covered services. In these plans, the participant handles the difference in cost between the amount paid by Medicare and the amount that the PFFS charges.
Special Needs Plans (SNP) – These types of plans provide a more focused type of health care for those who have specific health conditions. An individual who joins a SNP plan will receive their health care services as well as more focused care in order to manage their specific condition or disease.
Coordinated Care Plans (CCPs) – These plans are managed care plans that include HMOs (health maintenance organizations), PPOs (preferred provider organizations), and regional PPOs. They provide coverage for health care services either with or without a point-of-service option (the ability to use the plan or out-of-plan health care providers).
Some CCP plans will limit the participant’s choice of health care providers. Other plans may offer benefits in addition to those offered in the traditional Medicare program, such as prescription drug coverage. Still other CCP plans may limit the choice of health care providers and the supplemental benefits that may be received.
Cost Plans (1876 Cost Plans) – Cost plans are a type of HMO plan that gets reimbursed on a cost basis rather than on a capitated, or per head, amount such as with other types of private health care plans. Cost enrollees are allowed to receive care outside of their HMO and have those costs be reimbursed through the traditional fee-for-service system.
Medicare Medical Savings Account Plans (MSAs) – These types of plans will combine a high deductible Medicare Advantage Plan with a medical savings account for medical expenses. These Medical Savings Accounts consist of two parts. These are:
- A private Medicare Advantage insurance policy with a high annual deductible
- A medical savings account

The health insurance policy does not pay for covered health care costs until the deductible has been met. Then, the medical savings account will come into play when Medicare deposits money into an account for the participant. These funds may then be used for any type of health care expense – including the participant’s deductible.

Participants in these types of plans will typically pay for their medical expenses out-of-pocket for the amounts under the deductible. In addition, there could be tax-related penalties if a participant withdraws funds from the account for any reason other than medical.

Preferred Provider Organization Demonstration Plans (PPO Demo)
Private Contracts
Cost Plans
Other Demonstration Plans
Religious and Fraternal Benefit Society Plans – Medicare Advantage plans may even be offered by religious and fraternal organizations. These organizations are able to restrict enrollment in their plans to their members.

In these cases, the plans must meet the Medicare financial solvency requirements. In addition, Medicare may also adjust payment amounts to the plans in order to meet the characteristics of the participants that are enrolled in the plan.

Who is Eligible for a Medicare Advantage Plan?

In order to be eligible to enroll in a Medicare Advantage plan, a participant must meet two conditions. These are:

They are entitled to Medicare Part A, and they are also enrolled in Medicare Part B as of the effective date of enrollment in the Medicare Advantage plan
The participant lives within the service area that is covered by the Medicare Advantage plan

There are a few exceptions, however, to these requirements. One exception is that a Medicare participant will not typically be allowed to enroll in a Medicare Advantage plan if they have end-stage renal disease that requires regular kidney dialysis or a transplant to maintain life.

If, however, a participant is already enrolled with the Medicare Advantage organization when they first develop end-stage renal disease, and they are still enrolled with the Medicare Advantage organization at that time, then they are allowed to stay in the existing plan or join another plan that is offered by this same company.

Should an individual wish to enroll in a Medicare Advantage plan, they can do so by completing a paper application, calling the plan, or by enrolling on the plan’s website. They can also go directly to Medicare’s website at www.medicare.gov.

There are specific times, however, when an individual may enroll in a Medicare Advantage plan. These include:

Initial Election Period (IEP) – This period is also referred to as the initial coverage enrollment period. Therefore, an individual may elect to enroll in a Medicare Advantage plan when they first become entitled to both Medicare Part A and Medicare Part B.This initial election period will begin on the first day of the third month prior to the date on which the individual is entitled to both Part A and Part B and will end on the last day of the third month after the date that the person became eligible for both parts of Medicare. Three months prior, the month of, and three months after, will essentially create a seven-month election period. This is the same election period as for enrolling in Medicare itself.Participants who are within this initial period of time will not need to wait for any other type of enrollment period. Their coverage will begin on the first day of their birth month. For those who are enrolled in disability coverage, there is also a seven-month window for enrollment from the time that the person receives their Medicare disability benefits.
Annual Coordinated Election Period (ACEP) – During this time, a participant may elect to enroll, drop, or change their enrollment in a Medicare Advantage and / or Medicare Part D plan. Starting in the year 2011, this period began running from October 15 through December 7 of each year. This period can also be referred to as the fall open enrollment period or as the annual enrollment period.
Special Election Period (SEP) – These are considered to be special periods of time during which an individual will be allowed to enter into or to discontinue enrollment in a Medicare Advantage plan. They may also change their enrollment to another MA plan or return to the Original Medicare plan at this time if they so choose.In addition, an individual may enroll in a Medicare Advantage plan during this time if they have recently become disabled. And / or, an individual may also begin receiving assistance from Medicaid. In this case, the individual will not need to wait until the October 15 ACEP enrollment period. There are also sometimes whereby a special election period will be allowed. These include:

The Medicare Advantage plan that the participant is enrolled in is terminated. This is referred to as being an involuntary disenrollment. This will result in involuntary loss of creditable coverage for the participant.
The Medicare Advantage company that offers the plan violated a material provision of its contract with the enrollee.
The participant moves out of the area of plan service.
The participant recently experienced a disability.
The participant meets other certain material conditions as CMS may provide. These can include a delayed enrollment due to an employer’s or a spouse’s coverage being terminated, or an involuntary loss of creditable group coverage.
The participant is receiving any assistance from Medicaid that could include the following:
- Beneficiaries who reside in long-term care facilities
- Full dual eligibles
- Partial dual eligibles
The participant meets other qualifications that are related to long-term facilities, low-income subsidy eligibility, Medicare Part D coverage, and other circumstances that give CMS the discretion to create an SEP.

Medicare Advantage Disenrollment Period (MADP) – This is the period of time in which individuals may dis-enroll from a Medicare Advantage plan and / or from a Medicare Advantage with Part D coverage plan and then may subsequently enroll in the Original Medicare plan – either with or without a Part D plan.This period runs from January 1 to February 14. And, the individual’s new coverage will become effective as of the first day of the month following the change in coverage. A participant is allowed to make one change per year from an MAPD to another MAPD or from a Medicare Supplement plan with a stand-alone PD to an MAPD.

Getting Quotes on Medicare Advantage Plans

When obtaining quotes on a Medicare Advantage plan, it is typically best to work with a company or an agency that has access to more than just one insurer. That way, you can obtain a comparison of quotes in order to determine which will work best for you. We can assist you with this. If you are ready to move forward, just fill out the form on this page.

Should you have any additional questions, we can be reached directly by phone by calling, toll-free 888-229-7522. Our experts are happy to walk you through any Medicare Advantage plan information that you may need. So, contact us today – we’re here to help.

Source: goodfinancialcents.com

Apache is functioning normally

June 15, 2023 by Brett Tams

I’m a big advocate of crunching retirement numbers to make sure someone is saving enough to retire when and how they want. One of the big variables in that calculation is how much someone will receive from Social Security. We’re all aware that the program is not on rock-solid footing. So how much should people assume they’ll receive when fiddling around with a retirement calculator?

I put that question to several experts, and their responses are below. But first, a word from our sponsor.

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As you’ll see from the responses, the experts don’t exactly agree on all the numbers, but they agree on a key fundamental point: Plan on getting less from Social Security than currently projected, but definitely plan on getting something. Here’s what they had to say:

Alicia Munnell, Director of the Center for Retirement Research at Boston College, former member of the President’s Council of Economic Advisers and Assistant Secretary of the Treasury for Economic Policy:

Social Security is going to be there for everyone — from their 20s up to their 50s. This notion that “it just won’t be there for me” is wrong. The easiest way for me to think about it is: Once the trust fund is gone, the revenues are adequate to pay 80% of promised benefits. So I would take 80% as the minimum, but it probably varies by income class. It seems that everyone is concerned with protecting the benefits of those in the lower half of the income distribution and may trim something from those in the upper half. I actually think that for the lower half you can count on 90% of what you’ve been promised and for the very high-income earners, maybe 70%.

Michael E. Kitces, MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC, CASL, publisher of The Kitces Report and Director of Research for the Pinnacle Advisory Group:

There are two easy ways to adjust future Social Security benefits to handle the possibility of Social Security reform. The first is to reduce the growth rate/cost-of-living adjustment on Social Security ]by 1%; in financial planning projections, this is most commonly done by entering a Social Security inflation rate that is 1% lower than the assumed general rate of inflation. The second option is to apply a flat reduction in future benefits by up to 25% (e.g., if benefits were projected to be $1,000/month, only assume a $750/month benefit).

The reason for these adjustments — a 1% reduction in cost-of-living adjustments or a maximum 25% cut in future benefits — is simply because these in fact are approximately the magnitude of adjustments required according to analysis by the Congressional Budget Office about what is necessary to render the Social Security system solvent again. Alternatively, the 25% reduction in benefits also represents the amount that benefits would decline in approximately 25 years, if we do nothing to fix the system, and the Social Security trust fund is exhausted. Notably, though, because Social Security is largely a pay-as-you-go system — with taxes on workers being used to pay benefits for retirees — even exhaustion of the Social Security trust fund results in “merely” a 25% reduction in future benefits, NOT a total loss (as it would with a pension fund that fully pays its benefits from accumulated funds). To the extent that any of our Social Security woes are solved at least in part with tax increases — not just benefits cuts — the necessary reduction for solvency would be even less than a 25% benefits cut.

Eric Tyson, former financial planner (one of the first to charge by the hour) and author of Personal Finance for Dummies and Investing for Dummies:

There’s a lot of fear-mongering and pundits taking extreme views like “Anybody under 40 shouldn’t count on Social Security!” That’s just ridiculous. Of course you’re going get Social Security. It may not be what your parents got, but you’re going to get it.

Back when I was doing individual financial planning, I noticed that in the Social Security projections that they assumed benefits were going to grow 1% faster than the rate of inflation. I think part of that was because of the underlying assumption that your employment income would be on that kind of trajectory. I told clients whom I worked with to look at benefits in today’s dollars, rather than it was going to grow beyond the rate of inflation.

Tiya Lim, Director of Institutional Advisory Services at the Buckingham Family of Financial Services, co-author (with Larry Swedroe) of The Only Guide You’ll Ever Need for the Right Financial Plan:

Current beneficiaries should continue to receive their benefits without any reductions. With the baby boomer population being such a large segment of the voting population, it would be very difficult to take away their benefits. The one feature that may be at risk for current beneficiaries is the Cost of Living Adjustment (COLA). There has been talk of either freezing benefits or adjusting it to be linked to a different measure than CPI-U. If the Social Security Administration decides to freeze benefits at current amounts, that could be very detrimental to retirees who are very susceptible to inflation. In a low inflationary environment like this, it’s less of an issue, but should the economy start expanding again, then retirees with benefits that are not adjusted for inflation will have to rethink other assets in the portfolio.

But for now, we know that current beneficiaries will continue to receive their benefits without any significant changes. The SSA is looking for ways to ensure payments will be paid by doing simple things like ending paper statements, ending paper checks, and closing loopholes like the “interest-free” loan. It is also likely that the amount of taxes going into the system will have to increase and the full age of retirement will have to rise. It has been done before and when done far in advance (affecting future beneficiaries 20 to 40 years down the line) there is less opposition.

Scott Burns, financial columnist and Chief Investment Strategist at AssetBuilder, Inc.:

I believe the real squeeze will be on Medicare. There are two reasons for this. One is that Medicare is the elephant in the room; it accounts for most of the longterm problem. For example, the current unfunded liabilities of Medicare Part D, the Prescription Drug plan, are about the same size as the unfunded liabilities of the entire Social Security program, and Medicare Part D is only a small part of Medicare.

The other reason is that it will be a lot easier for the politicians to weasel out of Medicare commitments because they aren’t nearly as clear as the promise of a monthly check. It is quite possible that we could reduce Medicare spending dramatically and have zero effect on life expectancy or even on disability-adjusted life expectancy.

Cutting Social Security benefits is another thing altogether. Tell the young their future benefits will be much smaller, but their taxes will be much higher, and we’ll have an American Spring. [Warning: After you read that article, you may be inclined to vote for Scott Burns for president.] Tell the old their benefits will be cut today and we’ll have blood in the streets. There are simply too many people totally dependent on Social Security benefits to cut them directly. They could, however, be reduced indirectly by making them fully taxable. Taxation of benefits now affects about 30% of retirees, so broadening their taxability would increase the number of retirees whose benefits were taxed, but it would still be more likely to fly than reducing benefits.

This doesn’t mean the weasels won’t weasel. The current discussion of
How do you include Social Security benefits when deciding how much you’ll need to retire? Have these experts changed your opinion on how much you’ll receive in benefits?

Source: getrichslowly.org

Apache is functioning normally

June 10, 2023 by Brett Tams

Some people who already receive Social Security benefits are automatically enrolled in Medicare when they turn 65. That’s not the case for everyone, though. People who haven’t started collecting Social Security will need to register for Medicare, but signing up doesn’t have to be challenging. Here’s what you need to know about enrolling in the government insurance program. If you’d like personalized retirement advice, consider working with a financial advisor.

What Is Medicare?

Medicare is a federal health insurance program for people 65 and older, as well as those with disabilities and specific diseases. It’s intended to help provide affordable health care to people who have low incomes or limited resources either due to retirement or disability.

Medicare has three main parts:

Medicare Part A covers hospital expenses such as inpatient stays, hospice care and some home health care.
Medicare Part B covers medical expenses like doctors’ services, outpatient care, preventative care and medical supplies.
Medicare Part C, also known as Medicare Advantage, covers health care related to dental, vision and hearing.
Medicare Part D covers prescription drugs.

For most people, Part A is free and Part B requires you to pay a premium. The standard monthly premium in 2023 is $164.90. Parts C and D are accessed via a Medicare-approved plan for which you will also pay a monthly premium. These premiums will vary depending on the provider and plan you choose.

When Are You Eligible for Medicare?

Leaving aside the minority of Medicare recipients with disabilities or diseases, most will become eligible to enroll in Medicare when they turn 65. You can sign up for Medicare three months before you turn 65.

That period starting three months before you turn 65 is called the Initial Enrollment Period. It lasts seven months, ending three months after the month in which you turn 65. If you miss this Initial Enrollment Period, you’ll have to pay a monthly late enrollment penalty that goes up the longer you wait.

If you sign up before the month in which you turn 65, your Medicare coverage will start the first of the month in which you turn 65. So if your birthday is June 16, and you sign up on May 15, your coverage will begin on June 1.

There’s also a General Enrollment Period each year from Jan. 1 to March 31. Again, your coverage will start the first of the month after you sign up and you may need to pay a late enrollment penalty if you don’t qualify for a Special Enrollment Period. You may qualify for a Special Enrollment Period if you missed your Initial Enrollment Period because of a natural disaster or emergency, got inaccurate or misleading information from your health plan or employer, as well as a few other extenuating situations. In such cases, you can fill out and submit a form to ask for a Special Enrollment Period.

Are You Automatically Enrolled in Medicare at Age 65?

According to the U.S. Centers for Medicare and Medicaid Services, if you live in the United States and are already getting Social Security payments, you’ll be automatically signed up for Part A and Part B of Medicare when you become eligible. So if you’re already claiming your Social Security benefits, you may automatically receive a packet with more information on Medicare a few months before you turn 65.

If you’re not yet getting Social Security benefits or aren’t eligible for them, you won’t be automatically enrolled and will need to complete an application or reach out to the Social Security Administration.

How to Enroll in Medicare

If you’re not already receiving Social Security benefits but need to enroll, there are a few steps to the process. First, make sure you know when your Initial Enrollment Period begins and ends so you can enroll in that time frame and avoid a penalty.

Second, you can sign up online at the Social Security website, which the official Medicare website notes is the fastest and easiest way to register. You can also enroll by phone by calling the Social Security Administration at 1-800-772-1213. If you’d like to enroll in person, find your local Social Security office for the address and hours of operation.

Bottom Line

If you’re already receiving Social Security, you’ll likely be automatically enrolled in Medicare once you hit age 65. But if you haven’t yet started your Social Security payments yet, you’ll need to enroll in Medicare online, by phone or in person.

Retirement Planning Tips

If you’re not sure whether you’ve saved enough for retirement, our retirement calculator can help you get a better sense of where you stand. Use it to determine your estimated Social Security benefits, how much money you need to retire and how much annual income you’ll need in retirement.
A financial advisor can help you plan for Social Security, Medicare and retirement. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.

Source: smartasset.com