HIGH SCHOOL CLASS OF ’72! – MEDICARE IS HERE FOR YOU!

By Don Kenton Henry – editor, broker

Fellow classmates of the High School Class of 1972! Congratulations! It’s been thirty-six years since we graduated and went on to build careers and raise families. During this time we dutifully paid into Social Security and paid Medicare taxes. Most of us will be turning age 65 during the next year if we have not already done so. As such, we will be “aging into Medicare”. Never, in my life, have I looked forward to getting older,―until now. Because―as such―I will be eligible for Medicare and finally have an alternative to the Under Age 65 Affordable Care Act (ACA) marketplace for health insurance purposes. As a Medicare-related, private insurance specialist,―knowing all my plan options―along with knowing which plans I will enroll in―I am elated to finally being able to take advantage of the following benefits not currently available to any of us not currently on Medicare:

I know I will I be able to go to any doctor or hospital that sees Medicare patients. Additionally, I will be out of nothing―or virtually nothing―for my Medicare eligible medical expenses, per se, throughout the calendar year! (By “per se”, I mean aside from the out-patient prescription drug costs I will pay at the pharmacy counter.)

Even those of you who have had the benefit of employer-based group health insurance through throughout your working career ― have to had to meet a significant deductible before insurance benefits apply to your major medical expenses. In recent years, that has probably been at least $1,000 and, probably, more. Then you have been responsible for additional costs (coinsurance) thereafter!  Compare that to your share of a maximum of $183 per calendar year, should you go with the plan option I will most likely recommend for you!

Regarding Part D prescription drug plans ― you will have approximately three dozen to choose from. Each of these covers some drugs but does not cover others. And vice versa. The plan that is best for your spouse or neighbor is not necessarily the best plan for you. Our objective is to: (1) cover all your prescription drugs and (2) do so at your lowest possible total cost for both the plan and your prescription drugs for the calendar year. “Total Cost” is the sum of your plan premium, any applicable deductible, and your copays or coinsurance for your Rx drugs.

*If you would like me to identify your lowest cost Part D Medicare Prescription Drug Plan for 2019 email me, at Allplanhealthinsurance.com, a list of your current drug regimen and dosages. I will do so in the order received and forward the results via email.  

CHANGES TO MEDICARE PART D DRUG PLANS IN 2019:

  1. A) Stage 1, the Medicare Part D “Yearly Deductible Stage” is going to require a Medicare recipient member meet as much as a $415 deductible, up from $405. This does not mean a drug plan will increase your deductible, or even charge one in the first place. It simply means the Center For Medicare Services has informed the drug plans they may charge as much as that amount.
  2. B) Stage 2, the “Initial Coverage Stage” is going to $3,820. This is the limit your, and the plan’s, drug cost must reach before you enter the “Coverage Gap”.
  3. C) Your liability for your drug costs has been diminishing each year since 2011. This year, you will pay 25% of the cost of brand-name drugs, plus a dispensing fee, and 37% of the price for generic drugs.
  4. D) When your year to date personal drug costs reach $5,100 you enter the “Catastrophic Coverage Stage”. Therein, you will pay $3.40 of a drug that is treated like a generic and $8.50 or 5% of the cost of the drugwhichever is higher for all other drugs.

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MEDICARE PART B 2019

There has been no announcement on whether Medicare Part B’s calendar year outpatient deductible of $183 will be changing.

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CONSIDERING MEDICARE SUPPLEMENT VS MEDICARE ADVANTAGE to cover those medical expenses not paid by Medicare? Refer to today’s FEATURED ARTICLE 1 on “Denials of Care” below then call me for my opinion on one vs the other.

Should pharmacists be subject to a “gag” clause preventing them from telling you a lower cost for your drug is available at the pharmacy counter? See FEATURED ARTICLE 2, below:

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THOUGHT FOR THE DAY:

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Turning age 65 in April, I am right in this with you. I share a kinship, not only with my personal HS classmates, but everyone of my generation. I began my career out of college as social worker and then―believe it or not―a pharmaceutical sales person. I understand the perspective on brand name vs generic drugs, both from the drug companies’ and the consumer’s standpoint. (If you’d like to me to share this with you, off the record, please call me.)   I still like to help people and I get great satisfaction from ensuring I keep my client’s drug and medical costs to a minimum.

To assist you in this, I represent virtually every “A” rated (AM Best Rating) Medicare Supplement Plan and most of the Medicare Advantage and Part D Prescription plans I feel worthy of your consideration for 2019. I bring thirty-two years of experience in the industry to provide you an objective comparison of your options, simplify the enrollment process, and ensure you maintain the right plans for yourself, thereafter. I charge no fee for my services. I am compensated directly by the insurance company whose product you elect to utilize, and then―if, and only if―you elect to acquire that product through me. The key to you is―you are charged no more for that product than if went through the door of that insurance company to acquire it on your own. Additionally, when you call, text or email me, you know you are communicating with someone who knows your history and has a vested interest in keeping your business. Which means keeping you happy. This as opposed to a different faceless person at the other end of a toll-free number.

SoClass of ’72! Open enrollment begins October 15th for Medicare plans (and November 1st for your Under Age 65 family members in need of health insurance for 2019). Please call, text, email, or visit my websites for information and assistance. I’m certain our life experiences and objectives are much the same and I know peace of mind when it comes to our healthcare and costs is integral to our quality of life

Kenton Henry – Agent, broker, editor                                                                          Office: 281.367.6565                                                                                                  Text My Cell @ 713.907.7984                                                                                          Email: Allplanhealthinsurance.com@gmail.com                                  http://Allplanhealthinsurance.com                                  http://TheWoodlandsTXHealthInsurance.com          https://HealthandMedicareInsurance.com

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*FEATURED ARTICLE 1

BLOOMBERG

Private Medicare Plans Faulted by Watchdog Over Denials of Care

By  John Tozzi

September 26, 2018, 11:01 PM CDT

A new federal watchdog report warns that privately run Medicare health plans used by millions of older Americans may be improperly denying patients medical care.

Federal auditors have found “widespread and persistent problems related to denials of care and payment in Medicare Advantage,” the privately administered plans that insure more than 20 million people, according to the report from the Health and Human Services Office of Inspector General.

Medicare Advantage plans collect a fixed fee from the government for taking care of patients 65 or older who qualify for traditional Medicare coverage. The fixed per-patient rates the government pays may give plans “an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,” the report said.

Medicare Advantage plans have become popular with consumers because they combine traditional Medicare benefits with additional coverage, such as vision, dental care, and prescription drugs.

The program paid $210 billion to Medicare Advantage plans last year. Companies including UnitedHealth Group Inc.Humana Inc., and Aetna Inc.are the largest sellers of the coverage. Enrollment in Medicare Advantage has roughly doubled in the past decade, and one-third of Medicare patients are now covered by the private plans.

In 2016, Medicare Advantage plans denied 4 percent of requests to approve treatment before it was provided, known as prior authorization, and 8 percent of requests for payment after treatment, according to the report.

Only 1 percent of patients disputed the insurers’ denials, but in those cases, the decisions were overturned three-quarters of the time, according to the report.

Improper denials “may contribute to physical harm for beneficiaries if they’re not getting access to services that they need,” said Rosemary Rawlins, the inspector general’s team leader on the report. Patients and doctors can also be harmed financially if not reimbursed for appropriate care, she said.

If plans aren’t providing the care they’re contracted to, it risks wasting taxpayers’ money. The government “has already paid to cover beneficiaries’ health care,” Rawlins said. Not every denial is an indication that patients are being blocked from needed treatment, however.

“You wouldn’t expect the denial rate to be zero,” Rawlins said. “Part of managing care is denying care that’s not needed.”

There’s a lot of variation in how often Medicare Advantage plan denials were overturned. In 2016, seven Medicare Advantage contracts had almost all of their denials reversed on appeal — more than 98 percent. Another 69 contracts had denial rates above 90 percent. The report doesn’t name specific companies or plans. Individual insurers can have more than one Medicare Advantage contract with the government.

Problems with denials of care aren’t isolated to a few plans, however. The Centers for Medicare and Medicaid Services, or CMS, audits different organizations each year, “but consistently find problems related to denials of care and payment,” Rawlins said.

The CMS audits are one of many factors that affect health plans’ star ratings, which are intended to help Medicare patients shop for plans based on quality. But starting in 2019, as the result of a change by CMS, the audits will no longer be a factor in the ratings, “which diminishes the usefulness of the star ratings system as a tool for beneficiaries,” the report said.

The inspector general recommended that CMS increase its oversight of Medicare Advantage plans and give patients better information about violations. The agency concurred with the findings.

A CMS spokesperson said in an email that the agency is committed to “strong oversight and enforcement of the Medicare Advantage program to ensure that plans are delivering care to Medicare beneficiaries” as required.

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FEATURED ARTICLE 2

WASHINGTON EXAMINER

Senate unanimously passes bill banning pharmacy ‘gag clauses’ in Medicare

by Kimberly Leonard

 September 05, 2018 03:03 PM

The Senate unanimously passed a bill Wednesday that would ban Medicare insurers from enforcing “gag clauses” that forbid pharmacies from telling customers about cheaper ways to buy drugs.

The Know the Lowest Price Act is intended to help patients covered under Medicare to find out if their prescription would cost less if they were to pay for it out of pocket rather than through their insurance plan.

“Passing this bill and eliminating gag clauses gives patients more power to lower their healthcare costs,” Sen. Bill Cassidy, R-La., who helped introduce the plan, said in a statement. “It makes prices transparent so patients can save money with less expensive prescriptions.”

The new rules explicitly apply to Medicare Part D, which pays for prescription drugs, and to Medicare Advantage, a healthcare plan managed by private insurers. Medicare is the program covering adults 65 and older and people with disabilities.

In the complexity of the system that involves pharmaceutical companies, drug reimbursements, middlemen known as pharmacy benefits managers, and health insurance companies, patients can sometimes end up paying more while others in the chain pay less. Private health insurers and pharmacy benefits managers use “gag clauses” in their contracts to prohibit pharmacists from informing customers that they can save money if they don’t go through their health plans.

Another bill passed in committee, known as the Patient Right to Know Drug Prices Act, would provide the same protections for people who have private health insurance coverage. The Trump administration has called for Congress to undo the gag clauses and pass other measures to help reduce what patients pay for drugs.

LOWER YOUR MEDICARE SUPPLEMENT PREMIUMS NOW

Medicare clients and friends of Kenton Henry and All Plan Med Quote,

Greetings! Please take a few minutes to read this in its entirety. Whether you have Medicare Supplement through me, or another agent, what I am proposing could save you up to 20%, or more, of what you are currently paying for coverage.  

To those who are current clients – thank you so much for your continued business. We made it through another Prescription Drug Plan Open Enrollment Period which ran, as always, from October 15th through December 7th. During that time (for those who requested assistance) I shopped for your best value in a 2018 Part Medicare Drug Plan. It is my goal to keep my clients in the lowest “total cost” drug plan available to them, and I moved many of you to that plan. Others were in that plan already, and I advised them to stay the course.

It was a very hectic period for everyone in my industry, made more hectic because it overlapped with the Open Enrollment Period for Under Age 65 (Obamacare) health plans. Personally, it was all I could do to meet everyone’s need as well as possible without hiring additional staff. A staff which I would only have to have let go―at the end of the 8 weeks. This, most as soon as I had them adequately trained. For those who have Medicare Supplement policies, I advised you that, once this busy period was over, I would be in a position to re-shop your Supplement plan to see if there is a better value for you. That time has come.

If you have had your Medicare Supplement policy three or more years, you have had a series of premium increases. These usually correspond with your policy anniversary and, hopefully, they have been reasonable. But, the reality is, you may now be paying more than necessary for equivalent or ideal coverage. I say “ideal” because things have changed. Many of you are with Supplement Plan F. This is because, historically, it was considered the best value. In 2016 that changed in that the Center For Medicare Services (CMS) informed the insurance companies they were phasing out plan F and mandated they cease offering it in 2020. At that time, those who have plan F will be “grandfathered“. In other words, they will be allowed to keep theirs. But no new plan F policies will be issued.

With this mandate, the insurance companies re-priced plan G, which is the second most comprehensive plan after plan F. Plan F pays all eligible expenses for a calendar year. The only thing plan G does not pay is the $183 Medicare Part B calendar year out-patient deductible paid by plan F. So―yes―if you have plan G―you will pay the first $183 for out-patient care each year. (This will most likely be for your first doctor’s visit and perhaps a portion of the second). But, guess what? Your annual premium savings is probably going to be as much as twice that deductible. Therefore, plan G makes better financial sense than F.

Couple the yearly inflation of your policy premium by the three-year mark―with the fact you may be in plan F―and I can probably save you substantial premium dollars if we move you to plan G based on new first-year rates. Or― if you have had your plan G three or more years―we can attempt to move you to a lower cost plan G.

Is there a catch? Yes. The catch is―because you are now past your period of “Guarantee Issue” which, in general, ended six months after you turned age 65 and entered Medicare Part B. This means you now have to answer health questions and be approved for new coverage based on your health history. While approval is not as difficult as it used to be for those applying for under age 65 health insurance, you are going to have been in at least moderately good health and had no major illnesses in the last two years or more. I want you to ask yourself if this applies to you. If so, I would like to see if we can move you to a lower cost Medicare Supplement Plan.

Here is an example of the typical health questions you must answer “negative” to be approved – taken from what is currently one of the most competitive Medicare Supplement policies:

OPTION I: at lower rates than OPTION II

  1. Have you been prescribed or taken any prescription medications within the past 12 months? If “YES,” please indicate below.

If “NO,” indicate “None.” Agent – This is to assist in preparing the Applicant to answer questions in sections 3 through 5.

APPLICANT A

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

APPLICANT B

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

  1. Personal History Questions:
  2. Have you ever been diagnosed with diabetes?
  3. Have you ever:
  4. been advised by a physician to have or are you currently waiting for an organ transplant?
  5. been diagnosed with, treated, or advised to receive treatment for Alzheimer’s Disease, dementia,

mental incapacity, organic brain disease or any other cognitive disorder?

  1. been diagnosed with, treated or advised to receive treatment for Lou Gehrig’s disease (ALS),

Huntington’s disease or any terminal medical condition?

  1. been diagnosed with, treated or advised by a licensed member of the medical profession to

receive treatment for Systemic Lupus, Osteoporosis with Fractures, or kidney disease or failure

requiring dialysis?

  1. used insulin to treat or control diabetes?
  2. had any type of Diabetes with Complications including retinopathy, neuropathy, nephropathy,

peripheral vascular disease, heart disease, stroke, transient ischemic attack (TIA), high blood

pressure, or skin ulcers?

  1. been in a diabetic coma or had or been advised to have an amputation due to disease or disorder?
  2. been diagnosed with, treated or advised to receive treatment for Cirrhosis, Emphysema, Chronic

Obstructive Pulmonary Disease (COPD) or other chronic pulmonary disorders?

  1. been diagnosed as having or told by a medical doctor that you have AIDS, HIV, or ARC disorders?
  1. been diagnosed, treated or advised to receive treatment for any neurological disease or disorder

such as Myasthenia Gravis, Multiple or Lateral Sclerosis, or Parkinson’s disease?

  1. Within the past 2 years have you:
  2. been advised to or do you currently use a wheelchair?
  3. been advised to enter or do you reside in a nursing home, assisted living facility, long term

care facility, received hospice, attended an adult day care facility, required home health care, or

been bedridden?

  1. been admitted to a hospital 3 or more times or are you currently admitted to a hospital?
  2. been diagnosed, treated or advised to receive treatment for cancer (other than basal cell carcinoma)?
  3. been diagnosed, treated or advised to receive treatment for alcoholism or drug abuse, mental or

nervous disorder requiring psychiatric care?

  1. been diagnosed, treated or advised to receive treatment for heart attack, coronary or carotid artery

disease (not including high blood pressure), peripheral vascular disease, congestive heart failure

or enlarged heart, stroke, transient ischemic attacks (TIA) or heart rhythm disorders?

  1. been diagnosed, treated or advised to receive treatment for degenerative bone disease impacting

multiple joints, crippling/disabling or rheumatoid arthritis or been advised to have a joint

replacement?

  1. been advised to have surgery, medical tests, treatment or therapy that has not yet been performed

or undergone testing by a medical professional for which the results have not yet been received?

  1. Have you been advised by a physician that surgery may be required within the next 12 months for

cataracts or have you used or been advised to use oxygen equipment, respirator or a catheter?

If any question in 3, 4 and 5 is answered “YES,” please STOP. The Applicant is NOT eligible for underwritten Medicare Supplement.

Take note of that last line. If you answered “yes” to any of these questions you are not going to be approved for the lowest cost plan of your choice. However, this does not mean I cannot get you approved with a new plan. I have a second company whose underwriting requirements are significantly more lenient. There are far fewer health questions to be answered, and no information regarding prescription drug use is requested. Mostly, this company is concerned with whether you have been hospitalized in the last 90 days and have you suffered any major health issues in the last 2 years. If you can answer “negative” to these, you will be approved at their lowest cost. Answer in the affirmative and you may still be approved but at a higher premium. Either of these premiums may or may not be lower than your current premium.  This company’s health questions appear next. Only consider them if you feel you would not qualify for Option I:

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OPTION II: BUT AT RATES HIGHER THAN OPTION I (BUT WHICH MAY STILL BE LOWER THAN YOUR CURRENT PREMIUM)

4A. Within the past 2 years, did a medical professional provide treatment or advice to

you for any problems with your kidneys?

Yes No Not Sure

4B. Within the past 2 years, did a medical professional tell you that you may need any of

the following?

  • hospital admittance as an inpatient
  • joint replacement
  • organ transplant
  • surgery for cancer
  • back or spine surgery
  • heart or vascular surgery

Yes No Not Sure

If you answered YES or NOT SURE to any question in Section 4, we will contact you for further information.

5A. Within the past 90 days, were you hospitalized as an inpatient (not including

overnight outpatient observation)? Yes No Not Sure

5B. Are you currently being treated or living in any type of nursing facility other than an

assisted living facility? Yes No Not Sure

5C. Has a medical professional told you that you have End-Stage Renal (Kidney) Disease

or that you require dialysis? Yes No Not Sure

Answering YES to any question in Section 5 will result in a denial of coverage.

If your health status changes in the future, allowing you to answer NO to all of the

questions in this section, please submit a new application at that time.

If you answered NOT SURE to any question in Section 5, we will contact you

for further information.

*This company has LEVEL 1 RATES (lower) for clients who answer “No” to the health questions. And LEVEL 2 RATES (higher) for those who have not provided a response which would result in a declination but

did answer “Yes” to any question in Section 6. This last scenario would result in you being approved but at a higher rate which may be higher or lower than what you are currently paying for Medicare Supplement insurance.

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Based on all this, if you feel optimistic, here is what I would like you to do:

To save the time required to pull your file (for current clients), please provide me the following in response to this email:

 

1) Your name

2) Your residential zip code

3) Your birth date

4) your tobacco usage

5) Your current Medicare Supplement Company and plan letter designation, e.g., F or G

6) For which new plan would like to seek approval? The lowest cost (harder to be approved) plan or the higher cost plan with less stringent approval criteria?

7) What is your current Medicare Supplement Premium?

Upon receipt, I will quote both options. The first will be for your lowest cost plan G option (unless you request a different letter designation). When I quote, I will include the application for that plan unless you have informed me it is appropriate to seek approval for the higher cost option. That option will be your second quote and, where you have indicated it is appropriate, I will include its application.

As to those of you who have Medicare Advantageyou are locked into your current plan for this calendar year. We can re-shop your coverage this fall (October 15th to December 7th) for 2019. To that end―and for those who have Medicare Supplement plans and simply cannot bear the premium increases and / or cannot qualify for new Supplement coverage―I have a new website for those willing to accept the copays and provider limitations of Medicare Advantage. You will be able to get quotes and apply for these options this fall. Click on this link or – if necessary – copy and paste into your browser:

https://medicareful.com/AgentKentonHenry

I anticipate this letter will generate an increase in activity on my part. As such, my phones may be very busy. If it is important you speak with me right, and  convenient for you, you may want to text me during this period. My cell phone number appears below. I look forward to keeping you as a client or acquiring you as one in the first place. I commit to working to limit your medical and Medicare-related insurance expenses and providing the best of service. Thank you for reading and carefully considering this correspondence.

Sincerely,

Kenton Henry

Office: 281.367.6565

Text my cell @ 713.907.7984

Email: Allplanhealthinsurance.com@gmail.com

Http://Allplanhealthinsurance.com

Http://TheWoodlandsTXHealthInsurance.com

For the latest in health and Medicare relative news, follow my blog @ Https://HealthandMedicareInsurance.com