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Changes To Medicare Part D: What To Look For

Tuesday, December 1st, 2015

During Medicare Open Enrollment, which lasts from October 15 until December 7, beneficiaries can join or switch Medicare Part D prescription drug plans. It is a good idea to review your plan during this time, because Part D plans can change how much you have to pay and whatLittman Krooks Retirement Planning is covered, and you may want to look for a better deal. Here are some things to look for:

  • Which drugs are covered. Make sure the prescription drugs you take are covered by your plan, and review the covered drug list for any plan you consider. Most plans have a formulary, or list of covered drugs, which may include different cost tiers. Drugs may move from one tier to another.
  • Premium amount. Check to see what your premium will be for 2016 under your current plan, and make sure it is acceptable considering your out-of-pocket costs.
  • Copays and deductibles. The tradeoff for a low premium may be high deductibles and copays, so you may want to shop around and compare. Keep in mind that plans may not charge a deductible higher than $320 in 2015 or $360 in 2016.
  • Donut hole coverage. If you and your plan spend $3,310 on covered drugs, you enter the coverage gap. Use the Medicare Plan Finder to estimate drug costs to see when or if you will enter the coverage gap. If you need additional coverage in the coverage gap, look for plans that offer it.
  • Mail-order or preferred pharmacy benefit. Consider which pharmacies you prefer and which you might be willing to use. You may be able to save money with a mail-order pharmacy or with 90-day prescriptions. Different plans may have mail-order pharmacies, preferred pharmacies or network pharmacies.

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Making Changes to Medicare Part D Coverage

Tuesday, December 2nd, 2014

Medicare open enrollment is October 15 through December 7.  During this time, Medicare beneficiaries can make changes to their Medicare Part D coverage. Reviewing one’s options can ensure optimal coverage of prescription medications.

The key factors to review during open enrollment are:

  • Premiums – Some Medicare Part D plans will see a substantial increase in monthly premiums, while a few may actually decline in cost.
  • Medication coverage – Plans can alter which drugs are covered each year. In addition, some plans require prior authorization before covering certain drugs.
  • Co-payments and coinsurance – In 2015, all Medicare Part D plans will use tiered cost-sharing, in which the copay for a drug depends on the drug’s classification in the tiered system.
  • Preferred pharmacies – Most plans offer lower co-payments at in-network pharmacies.
  • Deductible – Some plans will be lowering their deductibles in 2015. It is important to compare the lower deductible to the higher premium that such plans often carry.

 

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Choosing A Medicare Advantage Plan

Monday, November 10th, 2014

Medicare beneficiaries have a choice in health plans. They may choose Medicare Part A (hospital insurance) and Part B (physician and outpatient coverage), which together are also known as traditional or original Medicare, or they may choose Part C, a Medicare Advantage plan, which replaces Parts A and B. Medicare Advantage plans also usually come with their own prescription drug plan, thereby replacing Medicare Part D as well.

Medicare Advantage plans are offered by private health insurance companies that contract with the government to provide Medicare benefits. Most of them are managed care plans similar to preferred provider organizations (PPOs) or health maintenance organizations (HMOs). Medicare Advantage plans may cost more than traditional Medicare, but they may also offer additional benefits. It is important for beneficiaries to understand the options in order to make the best choice for their circumstances. For many, traditional Medicare is the default choice, but there are reasons why beneficiaries may prefer Medicare Advantage.

Some people may prefer the way Medicare Advantage plans handle prescription drug coverage. Most of them include prescription drug coverage in the cost of the plan, so the extra cost of Medicare Part D can be avoided. However, the total that beneficiaries pay depends on what prescriptions they have. The Medicare Plan Finder at Medicare.gov can help individuals determine how much they would pay for prescription drugs under various plans.

Another reason people choose Medicare Advantage plans is the limits on out-of-pocket spending. Under traditional Medicare, there is no out-of-pocket maximum, but Medicare Advantage plans are restricted to a cap for out-of-pocket expenditures. Whether a beneficiary would meet that cap depends on individual circumstances. In addition to the cap, Medicare Advantage coinsurance payments may be structured in a more beneficial way.

Beneficiaries may also choose Medicare Advantage because they want vision or dental plans included, or they want an alternative to purchasing “Medigap” coverage to pay for costs that traditional Medicare does not cover. Individuals should examine the costs and benefits of plans carefully to determine the right choice for them.

 

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Retirement Benefits: How Social Security, Medicare and Retirement Accounts Change in 2014

Thursday, January 30th, 2014

Medicare, Social Security retirement benefits, and individual retirement accounts all change in small but important ways in 2014, and people too young for Medicare will have new health insurance options. Here is what is changing.

First, thanks to the Affordable Care Act, people retiring before age 65 can now purchase health insurance on the new state health insurance exchanges. People can no longer be denied health insurance because of a pre-existing condition, and subsidies may be available for low and middle income earners.

For people on Medicare, the Part D prescription coverage gap has lessened in effect. Once a Medicare beneficiary has spent $2,850 on medication, then there is a gap until catastrophic coverage kicks in after $4,550 in costs for medication. In that gap, beneficiaries were required to pay 79 percent of drug costs, but that decreases to 72 percent in 2014.

Social Security benefits go up by 1.5 percent in 2014, due to the annual cost-of-living increase. The average increase will be $19 per month for individuals and $31 per month for couples who are both receiving benefits.

Social Security taxes increase for some in 2014. Workers usually pay 6.2 percent of their income into the system until they reach the $113,700 tax cap for the year. For 2014, that cap rises to $117,000.

Finally, the income limits for those eligible to contribute to individual retirement accounts (IRAs) and 401(k)s have increased. Investors who have workplace 401(k)s and also want an IRA can claim a tax deduction for IRA contributions until their adjusted gross income (AGI) reaches between $60,000 and $70,000, an increase of $1,000 over last year. For married couples, the income limits are now between $96,000 and $116,000. The income phaseout range for investors whose spouses have a 401(k) is up $3,000 from last year, to between $181,000 and $191,000. For Roth IRAs, the income phaseout range increased by $2,000, to between $114,000 and $129,000, or for married couples between $181,000 and $191,000.

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New York Medicaid and Medicare Part D: Working Together

Wednesday, May 8th, 2013

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.”

While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in New York must receive their prescription drugs via Medicare Part D.

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each  medication. If an individual has full Medicaid coverage and resides in a nursing home, he or she will not be required to pay anything for covered prescription drugs.

Medicare’s State Pharmacy Assistance Program (SPAP) for prescription drug coverage is determined by each state.  New York State’s Medicare’s State Pharmacy Assistance Program may determine that a patient should receive additional coverage when they join the Medicare Prescription Drug Plan, or may require the patient to enroll in a separate state program for prescription payment assistance.

Clients of New York Regular Medicaid must receive health care services through their managed care plan. Regular Medicaid in New York is available to single adults, childless couples at lower income levels, caretaker adults, the elderly, the disabled, and children, subject to some restrictions. Regular Medicaid may also provide retroactive coverage.

 

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Senior Citizens Advised to Review Medicare Part D Plan Selections Before December

Wednesday, October 26th, 2011

As the end of the year gets closer, it is a critical time for a senior citizen to review their Medicare Part D plan. Medicare has an open enrollment period from mid October to December 7 of this year to make all selections for 2012. Every year prices can fluctuate for a plan, so it is critical to weigh your options for deductibles, prescription prices, and the overall monthly premium.

Seniors should not delay in signing up for Medicare. Failing to join a Medicare drug plan at 65 years old or going more than 63 days without prescription drug coverage can cause Part D premiums to skyrocket and late enrollment penalties.

Individuals that are eligible for Medicare often have an average of two to three dozen Medicare Part D plans to choose from depending on their state of residence. Adequate research ahead of time and speaking to a skilled elder law attorney will help an individual plan for health care needs and costs as well as protect assets from being depleted.

U.S. News and World Report notes that Medicare Part D plans can often fluctuate in pricing every year from 4 to 14 percent increases, for example. Individuals with yearly income of $85,000 or higher will also see higher premiums. Senior citizens do not need this surprise that can affect their wallet and livelihood.

Retirees should check that the plan they pick for 2012 has the prescription drugs and pharmacy they need and the doctors they are used to going to at a reasonable cost. Beware of having to pay out pocket or being responsible for higher co-pays before the final selection is made.

Littman Krooks LLP counsels seniors and families to access government benefits as well as plan for health care needs and personal decisions. Our New York City, White Plains and Fishkill elder law attorneys and estate planning attorneys are accomplished in comprehensive planning for a senior’s golden years. To learn more about New York elder law, visit http://www.littmankrooks.com/elder-law/.

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