Tag Archives: the medplus messenger blog

Medicare Part D Prescription Plans: What you Need to know

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Greetings! To those of you who are current clients, thank you so much for your continued business. It’s that time of year again! Medicare’s Open Enrollment Period runs through December 7th. Most of you know, during this time, a Medicare recipient may analyze how their prescription drug usage or their current Part D Prescription Drug plan may have or will be changing for the coming calendar year.

2018 DEDUCTIBLE – INITIAL COVERAGE – GAP – CATASTROPHIC THRESHOLDS

Each year, virtually every drug plan changes something material about their coverage. It may be the premium, deductible, drug tiers, copays, or the drugs they cover or don’t cover. It could be all these things. If you don’t read your ANNUAL NOTICE OF CHANGE from your current Part D plan carrier (which you are due by September 30th each year) you could be in for some surprises with your coverage in the coming calendar year!

COMMONLY OVERLOOKED DETAILS:

a) Many people get fixated on the premium and go with the lowest. It’s easy to do. They do this without factoring in applicable deductibles and copays. My lowest premium Part D plan in 2018 is $16.70 per month. Most often, the plan with the lower premium has a higher deductible and copays, so―especially if you are using expensive brand name drugs―you end up paying more for your coverage, and drugs, overall. The same applies to the plans with no deductible.

b) While an annual deductible as high as $405 may apply before your Rx drugs are available for their copays, very often, the deductible does not apply to Tier 1 Preferred Generics and Tier 2, Non-Preferred Generics. That makes a big difference for most people. This is an example of where it pays to carefully review the plan’s SUMMARY OF BENEFITS.

c) When tempted to go with a Medicare Advantage Prescription Drug plan, keep in mind you will have to accept whatever drug coverage is tied to your Medical plan. If you are using expensive drugs, that means you may not necessarily end up with your lowest cost for your drugs. As you would when you let me identify that in the “stand-alone” Part D market.

d) As I explained in a previous post―especially when it comes to brand name drugs―it pays to always ask the pharmacist “what is this pharmacy’s lowest cost for this drug?”. Often that cash price is actually lower than your plan’s copay. In which case ― just pay cash!

Part of the service I provide my clients is running their prescription drug regimen through my a program to identify whether a superior Part D Drug plan exists for them for the coming year. My goal is to have you on a plan which results in all your prescription drugs being covered at your lowest total “out-of-pocket” (TOOP) expense. TOOP is the sum of your premium, any applicable deductible, and the copays you pay for your drugs at the pharmacy counter or through the mail. If we are fortunate enough that your current drug plan still results in meeting these objectives, you simply stay the course and let your plan roll right into 2017! If it no longer results in your lowest TOOP, I will identify the plan that is and (with your instruction) enroll you in it.

Some of you have already seen a version of this (and some of you have been preemptive) and provided me your regimen. For you, I have been working most nights and weekends since October 15th providing you 2018 plan recommendations. If you received one, you need read no further unless you are yet to request that I apply on your behalf. In which case – request the application be emailed to you or – in the case of Aetna and Humana applications – simply request I apply on your behalf with your information I have on record. Please do not apply without my involvement. Mine is a volume business, and I don’t stay in business without it going through me. Even Kenton has to eat! So your business is greatly appreciated!

To accomplish this, I need each of you (who have not already done so) to respond to this email with a list of current drugs and dosages. I am quoting each person’s plan in the order received. Remember, we have until December 7th but applying early is always better than later. So, please, forward your drug regimen, and I will quote you as soon as possible.

As to those of you with Medicare Advantage Plan, who like your coverage, you need do nothing. Just keep paying the premium and let your coverage roll right into the new year. Most of my clients have Medicare Supplement. For those whose policies are no more than two years old, you can be fairly certain it remains competitively priced, and there is little to regain in changing plans. For those of you whose policy is older than two or three years, I am volunteering to re-shop* your plan, beginning in mid-January when all my client’s Part D plans and Under Age 65 health insurance is put to bed. It is simply too much to address during the Open Enrollment Period for both Medicare and Obamacare! The government puts me in the untenable role of having to process 12 months worth of business in 8 weeks. There is no point in hiring additional help. By the time I got them trained, I would have to lay them off!

As my phones will be very busy, you may want to text me during this period if it is important you speak with me right away. My cell phone number appears below. I look forward to keeping you as a client and working to limit your medical and Medicare-related insurance expenses!

Thanks so much!
Kenton Henry
Office: 281.367.6565
Text my cell @ 713.907.7984
Http://Allplanhealthinsurance.com
Http://TheWoodlandsTXHealthInsurance.com

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

*Remember – because all of you are six months past your enrollment in Medicare’s Part B – it will be necessary for you to answer a series of health questions and qualify (based on your health) for a new, replacement, Medicare Supplement policy. When the time comes, I can email you sample applications so you may review those questions.

 

Your More Affordable 2014 Health Insurance Exchange Plan is Likely to Work Like an HMO or Medicaid

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By Kenton Henry

If you have ever been covered on an employer’s group health insurance plan, you may have had to select your medical providers from a Health Maintenance Organization (HMO). If you were enrolled in a plan of this type – it was probably because it was your only option or because you were young and thought yourself bullet proof. And the reason is – most older people would not elect an HMO if given a choice. Because if your plan utilizes one – you either see a provider within the network or you have no coverage at all. Most older people know that when your health problem is anything more than a common runny nose (which is all young people believe they’re ever going to suffer from) – a person wants to be able to select their own doctor or hospital.

 
Has your income ever been at the poverty level or below? If so then you probably qualified for Medicaid. That’s the government’s health plan administered by the states for the poor. And if you were covered by Medicaid, you know how difficult it was to find doctor’s to take Medicaid, get into an appointment or see a specialist.

 
Now comes Obamacare. And when the premiums for the new health care compliant plans become available for individuals and families to choose from October 1 for a January 1 effect date – be prepared for sticker shock. Without going into projections of an unknown quantity, suffice it to say, the word on the insurance street is the cost of these plans is going to make people in most states “have a cow”!

 
So naturally, you’re going to review the lowest cost plans – the bronze or “catastrophic” options and hope they meet your needs. And when you do – you best hope you ARE young and bullet proof because you are probably going to find your selection of providers is going to be what you had available in a larger group plan HMO divided by 10 . . . or more. Be prepared to wait a long time for appointments and heaven forbid you need to see a specialist or a special procedure because–if you do–you are probably going to have to get the President to issue another of his executive orders to make it happen.

 
And what if you’re not young and bullet proof? Get used to rationing. Because Obamacare doesn’t like specialists and who do you want to see when you have a serious problem? Who do you think is going to authorize a more sophisticated (expensive) procedure? I love my family doctor but when he thinks I need a more expensive procedure – he refers me to a neurologist or an orthopedic surgeon, etc. But be prepared for your new health plan pre-certification department to tell you – “There must be a pill for that.”

 
In conclusion, you’d better hope you qualify for the subsidy so you can add all or a portion of your premium to the national debt. If not . . . be prepared to pay Cadillac prices for what at best will be an Oldsmobile.

 
(For more a perhaps more objective take on this – go to:
THE WALL STREET JOURNAL; BUSINESS AUGUST 14, 2013:
Many Health Insurers to Limit Choices of Doctors, Hospitals
By Anna Wilde Mathews @ http://online.wsj.com/article/SB10001424127887323446404579010800462478682.html

 

http://allplaninsurance.com

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage

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07.26.2013

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage
Op Ed:
In an ultimate case of hypocrisy (which would be hysterical were it not foretelling a travesty of monumental proportions about to be inflicted on the American people) the Union of IRS employees wants no part of the Obamacare and the Affordable Care Act (ACA)! The Union urges its members to write their congressmen expressing reservation about being forced out the Federal Health Benefits Program and into the insurance exchanges scheduled to be up and functional by October 1. The Federal Health Benefits Program is the “Cadillac” health plan we have always heard federal employees enjoy at our expense. In the meantime, many of us will be forced to give up our current health insurance and providers to acquire what they dictate is right for us. The very representatives who passed and will enforce the legislation and mandates say it is good enough for you and me while not wanting to accept it for themselves. They want no part of the very thing they are forcing down our throats!
We cannot make this up people! And you’re not outraged? Or are you?
(For more details, please see our first feature article below.)

Admin. – Kenton Henry
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FEATURE ARTICLES:
Washington Examiner
IRS employee union: We don’t want Obamacare
BY JOEL GEHRKE | JULY 26, 2013 AT 11:45 AM
TOPICS: ANALYSIS BELTWAY CONFIDENTIAL

National Taxpayer Employee Union officials are giving members a form letter expressing concern…
IRS employees have a prominent role in Obamacare, but their union wants no part of the law.
National Treasury Employees Union officials are urging members to write their congressional representatives in opposition to receiving coverage through President Obama’s health care law.
The union leaders are providing members with a form letter to send to the congressmen that says “I am very concerned about legislation that has been introduced by Congressman Dave Camp to push federal employees out of the Federal Employees Health Benefits Program and into the insurance exchanges established under the Affordable Care Act.”
The NTEU represents 150,000 federal employees overall, including most of the nearly 100,000 IRS workers.
Like most other federal workers, IRS employees currently get their health insurance through the Federal Employees Health Benefits Program, which also covers members of Congress.
House Ways and Means Committee Chairman Dave Camp offered the bill in response to reports of congressional negotiations that would exempt lawmakers and their staff from Obamacare.
“Camp has long believed every American ought to be exempt from the law, which is why he supports full repeal,” Camp spokeswoman Allie Walkersaid.
“If the Obamacare exchanges are good enough for the hardworking Americans and small businesses the law claims to help, then they should be good enough for the president, vice president, Congress and federal employees,” she also said.
“The NTEU represents Internal Revenue Service employees who have the responsibility to enforce much of the health insurance law, especially in terms of collecting the taxes and distributing subsidies that finance the whole system,” said Paul Kersey, director of Labor Policy at the Illinois Policy Institute.
“IRS agents will also collect data and apply penalties for those who fail to comply with many of Obamacare’s requirements,” Kersey said.
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Polls Identify Americans’ Disapproval Of ACA.
In continuing coverage, the Washington Times (7/26, Sherfinski) “Inside Politics” blog reports on a Fox News poll which shows that 53% of respondents would choose to repeal the Affordable Care Act, given the choice between keeping the law in entirety or overhauling it. The piece also reports on a separate poll, from CBS News, which found that “fifty-four percent disapprove of the law and 36 percent approve of it.”
The National Journal (7/26, Shepard, Subscription Publication) reports on the findings from the new United Technologies/National Journal Congressional Connection Poll which found that “opponents of President Obama’s health care law overwhelmingly believe the Affordable Care Act will worsen the quality of their care.” Further, more of the law’s supporters than not “don’t think it will improve their health care.”
Klein Extols Opportunities Brought By ACA. Washington Post blogger and MSNBC political analyst Ezra Klein writes about the coming “opportunity to change American health-care forever,” in a piece for Bloomberg News (7/26). He explains that the Affordable Care Act “carries the potential for both huge profits and huge social benefits,” as long as “Washington can stop bickering over the politics long enough to pay attention.”
Wonkblog Explores Former Republican Alternative To ACA. The Washington Post (7/26, Matthews) “Wonkblog” reports on a former Republican plan to “replace” the Affordable Care Act, proposed in 2009 by Sen. Tom Coburn (R-OK) and Rep. Paul Ryan (R-WI). Known as the Patients’ Choice Act, the law was “a credible way of covering almost all Americans,” picking up 13 co-sponsors in the House and seven in the Senate. After describing the central aspects of the bill, pointing out its similarities with the ACA.
Papers Offer Opposite Opinions On Repealing ACA. In an editorial, the Colorado Springs (CO) Gazette (7/26) encourages Republicans to work to defund the Affordable Care Act, because “most Americans don’t want” it. The paper argues that “perhaps nothing would give our country’s economy a greater jump-start than” stopping the law “in its tracks.”
However, in an opposing editorial, the Ogden (UT) Standard-Examiner (7/26) asks Congress to “respect” the Affordable Care Act. Although the paper has “problems” with the law, it argues that implementation “should not be hijacked through the inappropriate use of a filibuster, or the House refusing to vote for its funding.”

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Christie Slams ACA At GOP Governors’ Meeting.
The Newark (NJ) Star-Ledger (7/26, Portnoy) reports that in a discussion with fellow Republican Governors in Aspen, Chris Christie of New Jersey on Thursday called the Affordable Care Act a “sad legacy” for President Barack Obama. During the talk, Christie said that while he has expanded Medicaid under the law, “he twice vetoed health exchanges.” Criticizing the law, Christie said, “This is what happens when you use Parliamentary maneuvers to jam an absolute sea change in American life down the throats of the American people with bare majorities and not one Republican vote.”
Jindal, Walker Say ACA Is Not Workable. In an op-ed for the Wall Street Journal (7/26, Jindal, Subscription Publication), Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker write that the ACA is not workable and predict chaos as the Oct. 1 deadline for health insurance exchanges to launch. The Governors argue that while delaying implementation off the ACA is a good idea, outright repeal of the law would be better.
New Jersey Policy Analyst Discusses ACA Benefits. NJ Today (7/26) carries video of an interview with New Jersey Policy Perspective Senior Policy Analyst Raymond Castro, who discusses the benefits of the Affordable Care Act to “New Jersey residents and business owners.” In the interview, Castro drew attention to the law’s subsidies, available to those purchasing insurance on the state’s exchange, calling them “the most important part of the reform.” Castro also pointed out that New Jersey stands to “save a lot of money” under the ACA, as the Federal government will take over a large chunk of costs.
Panels Answer ACA Questions In Utah And Alabama. The Salt Lake (UT) Tribune (7/26) reports that on Thursday, a “panel of Utah health care advocates, experts and state policy leaders answered questions” about the Affordable Care Act in “a televised town hall” event. The article links to recorded versions of the event.
Alabama Live (7/26, Berry) reports that the Chamber of Commerce of Huntsville/Madison County held a panel Thursday morning to inform “several dozen professionals” how the Affordable Care Act “will impact their small businesses in Madison County.” Led by Small Business Administration Alabama District Director Tom Todt, the Affordable Care Act 101 seminar “featured an overview of the Small Business Health Care Tax Credit, Small Business Health Options Program (SHOP) and Employer Shared Responsibility for Employee Health Coverage.”

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White Castle Considering Upping Part-Time Hires Due To ACA.
The Huffington Post (7/26) reports that in response to the Affordable Care Act’s employer mandate, White Castle “is considering hiring only part-time workers in the future,” its Vice President Jamie Richardson said in an interview Thursday. Richardson insisted, though, that “the restaurant chain has no intention of firing members of its current full-time staff or reducing benefits.”
The Los Angeles Times (7/26, Lopez) reports that in an interview with NPR Wednesday, Richardson further outlined his plan to deal with ACA implementation, saying, “As we look to the future, when the new healthcare law takes effect, we are considering at that point, for new hires, letting those people know upfront, ‘Hey, at this point we’re only able to hire part-time team members.’”
Brooks-LaSure Speaks At Senate Hearing On ACA. Bloomberg BusinessWeek (7/26, Clark) reports on Wednesday’s Senate Committee on Small Business and Entrepreneurship hearing on concerns about the Affordable Care Act. According to the article, “the big questions…didn’t have easy answers.” Will, when asked whether “all health exchanges will be up and running as scheduled on Oct. 1,” HHS Deputy Director Chiquita Brooks-LaSure “said she expects all exchanges will be up and running.”
Survey: Business Owners In New England More Optimistic About ACA. The Boston Globe (7/26, Reidy) reports that a new survey out of Deloitte LLP shows that “mid-size companies in New England seem to be more optimistic about containing health care costs than their national counterparts.” Overall, 60% of executives “cited rising health care costs as a major obstacle to US growth,” while only 46% did in New England.

http://allplaninsurance.com

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Can we really say we didn’t see the cuts to Medicare Part B coming? (These are described in the Houston Chronicle, our feature article below.) Last year the administration made the decision to cut $716 billion from Medicare over the next ten years. $156 billion of this is predicted to come from Medicare Advantage. If you are a Medicare Advantage policyholder, did this news somehow fail to appear in your “Annual Notice of Change” which arrived last October? If so–could this be because we were in the middle of a Presidential election and cuts to your Medicare Advantage Plan might not have helped someone’s re-election? Fortunately for me, I have always encouraged my clients to enroll in Medicare Supplement to fill in their gaps in Medicare if it was at all affordable.
Admin. – Kenton Henry

*OBAMACARE CUTS

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Feature Article:
Houston Chronicle Medicare Part B, life and death
By Michael Hazel | July 19, 2013 | Updated: July 21, 2013 7:04pm
Across Texas, seniors with serious medical conditions could soon lose access to the medical treatments they need.
Right now, in an effort to trim federal spending, lawmakers are considering cuts to Medicare Part B, the component of Medicare that covers cancer treatments and other medicines that are administered by physicians. Lawmakers must reject this proposal and work to balance the budget without restricting access to medical care.
Under Medicare Part B, health care providers purchase drugs that require administration by the provider and are later reimbursed by Medicare, after administering the treatments in their office, according to a preset formula.
For almost a decade, physicians have been reimbursed the average sales price (ASP) of each medicine plus an additional 6 percent. That extra 6 percent helps to cover costs related to the shipping, handling and storage of the drugs, in addition to health care providers’ other overhead and administrative costs.
The federal “sequester,” which took effect in April, has in effect reduced Medicare Part B’s payment formula for drugs from ASP, plus 6 percent, to ASP, plus 4 percent. Now, some lawmakers want to cut that reimbursement rate even further. Such reductions could mean big problems for Medicare patients.
Medicare patients in Texas are understandably worried. John Peterson, a patient at Texas Oncology who’s been battling leukemia for 12 years, is concerned about future treatments. “I have a lot of exotic drugs that we have Medicare pick up the cost … it’s been a life saver,” Peterson told News Channel 25 in Waco. He fears Part B reductions will make continuing treatments at his current cancer center impossible.
Such reservations are not unfounded. Further Medicare Part B cuts could very well force cancer clinics to start closing. According to the Community Oncology Alliance, approximately 240 oncology clinics have closed in the past four and a half years and another 400 are struggling financially.
“Without adequate reimbursement, providers will close their doors, forcing patients to either forgo treatment or be relocated to inpatient facilities, many outside their communities or region,” reports the National Patient Advocate Foundation.
Such closures are particularly problematic in states like Texas, because our state is home to so many rural residents. With fewer community clinics available, rural Texans will have to travel far distances to other centers or hospitals for treatment. For those suffering from life-threatening illnesses, unnecessary travel is exactly what they should be avoiding.
Treating patients in hospitals instead of doctors’ offices is also far more expensive. Milliman, a respected actuarial firm, found that a chemotherapy patient who receives treatment at a hospital costs Medicare about $600 more per month than a patient who is seen at a physician’s office.
For Texans like John Peterson, Medicare Part B is a matter of life and death. It’s unacceptable that politicians in Washington are considering further reductions to the program’s payments for Part B drugs.
Texas’ representatives should make certain that patients can continue to access the medical care they need.

Michael Hazel is the incoming president of Texas Nurse Practitioners.


http://allplanhealthinsurance.com