Almost another year has gone by and just around the corner the floodgates of Medicare marketing envelopes will begin. For some they technically haven’t stopped, you’ll just get more! Therefore, it’s important to know what paperwork to keep and what you can throw out. One document you’ll want to keep from your current health plan is the Annual Notice of Change or ANOC letter. Usually this comes in a booklet or folded into a letter but beefier then other envelops, expect it towards end of September.
As you’ll see in the below snapshot of an ANOC, there will be two columns to show you the differences from your current benefits and the upcoming changes for the following year. What you’ll likely not find in your ANOC is the changes to the formulary or the list of drugs that are covered by your Medicare Advantage or Prescription Drug Plan. If a medication you are currently prescribed is no longer going to be covered you should get a separate notification 60 days in advance, it will inform you of the medication no longer covered and posible alternatives to consider. Make sure you discuss these changes with your doctor or if you know you can’t switch medications perhaps you’ll need to have a formulary exception to have the plan continue to cover your medication or perhaps it’s time to shop for a new plan that will cover it.
In your ANOC don’t expect a new formulary, many times you’ll need to ask for this document (by calling customer service) or you can retrieve it from your health plans website, they will have them available no later than October 1st. Just make sure that when you are searching you are selecting the upcoming year documents, so for example this October you’ll want to search for 2022 formulary.
I find it’s easier to look for what you need if you register in your health plans website member portal. The link is likely right on your Member ID card. If you register you’ll be able to pull up your current plan documents, like your summary of benefits, formulary, claims activity and even a copy of your ID card if you happen to lose it. When my clients register to their member portal it makes it easy to research when ever there are questions regarding billing, we can easily see who has filed a claim with the health plan and who hasn’t. While that information can be discovered by calling customer service it helps to avoid the hold times.
What should you do after reviewing your ANOC letter?
I suggest you think about the past year and consider what benefits worked well and which you found to be either too expensive or didn’t cover you as much. Or it may be a good time to consider what treatments or coverage you’ll need for the up coming year. Perhaps you are considering a major surgery, dental work, maybe you’ll need new glasses or you are having a hard time paying for your groceries etc. Make sure to write these down so you don’t forget.
After you’ve identified some benefits that you may need, talk to your agent about them. It would be helpful to have your written list of concerns or benefits you think you’ll need for the upcoming year. Since there are many plans available it’ll help narrow it down to what is most important to you. Many times it may just be that you are on the best plan for you and thus you don’t need to make a change, other times there could be improvements on other plans that may offer you better benefits. Just make sure that you don’t forget to update your list of medications and doctors, that should always be reviewed before making any changes.
The 2022 plan year will include changes, that is certain. Medicare Advantage plans are continually offering new ways to keep their members healthy. Some benefits that are attractive are dental, vision allowances. Recently we’ve seen an increase in Medicare part B giveback plans, usually designed for people that are healthier. These plans will refund members part of what they pay for Medicare part B and it can be $50, $70 or more a month of refund. This refund gets put right into their social security check. Other clients have liked the healthy food cards, these are monthly allowances given to members to purchase healthy foods at their local grocery stores. Something new we’ve seen in recent years are plans offering in-home assistance with light chores, usually for those that meet certain health conditions and it’s limited to a few hours a week, but non the less helpful for great number of Medicare beneficiaries.
Are there any low income assistance programs to consider?
For some it would be a good time to review their financials and see if they qualify for any of the federal or state assistant programs. These include Extra Help or Low Income Subsidy, this program has 4 levels and it helps reduce the cost of medications for those that qualify. Ask your agent or contact social security to see if you qualify, you can also visit www.ssa.gov and apply it only takes 5-15 minutes. Another program which automatically enrolls you into the Extra Help program is the Senior Savings Program. This program is available through your home state Medicaid office, though many have the option to apply online too. With both these programs you do have to meet the eligibility requirements but doesn’t hurt to see if you qualify. The eligibility for them also changes every year so if you’ve tried in the past to apply and were not approved check again.
Our agency is here to help.
We are strictly a Medicare insurance agency, so we strive to be the best at helping our clients navigate the Medicare plan options. Our goal is to make it easy for you. Don’t have someone to help you navigate your plan options? Give us a call, we will be happy to help. Our agency has grown from just a few clients back in 2017 to over 700 clients in just 4 years. That is only possible because we work hard for our clients, we make it easy and we find them the best plan for their needs. We are not like those temporary agents that is in business one year and gives up the next, we are here to stay.
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The AEP season is upon us and now’s is the time that anyone wanting to make a change to their Medicare Advantage and Prescription Drug plan can do so. The deadline to submit a plan change is December 7th.
For those that don’t want to change their plan don’t need to do anything. The plans renew automatically, unless you’ve been informed otherwise by your plan.
What new benefits are we hearing about in the marketplace?
Healthy Food Grocery Cards
There are more and more plans offering Healthy Food card options to their Medicare Advantage members. This benefit allows members to buy healthy foods like fruits and vegetables at participating grocery stores up to the monthly allowance. For those Medicare beneficiaries that have Medicaid a lot of plans are adding this to their dual special needs (DSNP) plans, for those that have both Medicare and Medicaid.
For those without Medicaid, there are only a few plans in the Atlanta market that offer the Healthy Food Card. To be eligible for the grocery card you need to have a qualifying chronic condition (doesn’t apply to DSNP plans). We’ve attached a copy of the list of the SBBCI chronic conditions:
Some plans will have the benefit as a stand alone others are combining them with their Over-the-Counter (OTC) benefit. Meaning: they’ll give you a monthly allowance and you can either buy the OTC items or the healthy foods. Other plans have two separate allowances, one for OTC and another for healthy foods.
Continuous Glucose Monitoring (CGM)
We’ve heard that Medicare is now covering these devices more easily and thus Medicare Advantage Plans are too. The CGM offer a simple way to monitor your glucose. CGM automatically tracks your glucose levels day and night using a small sensor worn on the back of the upper arm and a monitor that lets you view your glucose levels at any time. Plans will cover these devices under the Durable Medical Equipment benefits.
Review Your ANOC
Make sure to review your Annual Notice of Change so you know what’s changing with your plan. Also don’t forget to review the formulary to make sure that the medications you take are still being covered, you’ll want pay attention to the tier level the medication is in as that will dictate how much you’ll pay.
Please don’t hesitate to reach out to us if you need help with reviewing your Medicare plan options. Happy AEP!
Yes I know I am a bit more excited about the Annual Enrollment Period (AEP) than your average person, and that’s just because I go on full throttle and get work done! Most of the year it’s pretty laid back for me but the fall comes with an avalanche of activity which includes shopping and comparing plans for our clients. As a Medicare insurance plan broker I have to help my clients make sure they are on the plan that best fits their needs. So it’s kind of a big deal…for me at least.
So we are now in the month of September, AEP is fast approaching. What should you expect to happen this month. Well it depends, if you are on a Medicare Advantage Plan or a Prescription Drug Plan you can expect something to come in the mail this month. If you don’t have a plan it’s time for you to get your ducks in a row for shopping season.
In the month of September, towards the end of the month Insurance companies will mail out the Annual Notice of Change (ANOC) letter to their Medicare Advantage and Prescription Drug Plan clients. In this document they will highlight the changes that are coming about for the upcoming year (effective January 1st). Remember these plans have an annual contract with Medicare, so they tend to make changes every year. Yes, sometimes the changes are minimal but sometimes they can be significant. Note that if you don’t currently have a Medicare Plan you can enroll during the AEP or other times of the year is you qualify.
Don’t know if you qualify? Just ask we can easily answer that question for you.
The ANOC letter will usually include information about changes to medical, drug and premium costs in your plan. These letter’s may be customized to you, meaning the company may include a list of the medications you take that may no longer be available in the list of covered medications (formulary) while others may just leave that up to you to compare. So make sure to read it carefully, take special note to what is changing as it can be mixed in with other benefits that are not changing. It’s a terrible feeling when you go to the pharmacy in January expecting to pay one thing for your medication to realize you may have to pay a lot more, so it’s best to do the homework and not get a surprise price hike! Please note that many companies will not mail you an updated formulary, you’ll need to request one from them. Specify that you want the upcoming year formulary.
Another thing that may be included for some: plan cancellation notices. What!? Yes, it’s possible that your plan may not be available in the county you live in the following year. It doesn’t happen that often but it does happen. If you get this notice, don’t get alarmed you’ll have ample opportunity to compare plans and choose one to be effective January 1st. Just make sure you follow the below preparing recommendations. Even if you forgot to make a plan election during the AEP season, you’ll get extra time to select a plan.
After you received your ANOC, what’s next? Next comes the release of plan information for all the insurance companies, that happens on October 1st. On that date all the plans benefits get added in the insurance company websites and also on the official Medicare website ( http://www.medicare.gov ) for all to see. Additionally, these insurance companies add into Medicare.gov their updated formularies (if their plan covers medications). This allows a consumer or their broker to enter their medications on the Plan Comparison tool in Medicare.gov and calculate an annual estimate of their medication costs. The site also allows you to select the pharmacy you use to fill your medications in order to get more exact pricing. This is important because some companies may have preferred pharmacy networks, meaning it could be cheaper to go to one pharmacy than another, sometimes the cost differences can be as much as double the price!
From October 1st until October 14th you cannot request a plan change, this period only allows you to compare plans. Starting on October 15th and until December 7th you are allowed to submit enrollment applications into a plan to be effective on January 1st. Of course, if you like your plan you don’t have to do anything, you don’t have to submit an enrollment application renewal as these plans renew automatically. Unless of course on the ANOC letter they told you otherwise but that’s only if the plan you had is no longer available for the following year as I already described above. If you submit multiple enrollment applications, the last application you submit will be the plan you are ultimately enrolled in for January 1st. So if you enrolled in one early on, you can still change your mind and enroll in another as long as you do it by December 7th.
So what now? Don’t be surprised on the massive amount of Marketing Materials you’ll get in the mail. Beware of these “You may not be getting all the Medicare Benefits you are entitled to” letters. They may look like they are from Medicare but in fact they are just marketing from an insurance agent trying to earn your business. While we generally want to be careful on marketing remember that some plans that are marketing are designed for a subset of Medicare beneficiaries. Say for examples those that qualify for a Special Needs Plan (SNP). This may require the person to have Medicaid (state co-pay or premium assistance) or a Chronic disease to be eligible to enroll.
If you gave a general idea of what to expect, you are now ready to prepare. Read on.
If you are in a Medicare Advantage Plan, pull together a list of the doctors that you see. Last name, first name and speciality would be ideal (e.g. Dr. Smith, John Cardiologist). This is important for a Medicare Advantage Plan as they all have networks, even if it’s a PPO plan that allows you to see providers out-of-network you’ll still want to see if they are in-network because it’ll save you money. Most PPO plans will charge you more if you go out-of-network, say a higher co-pay or co-insurance. So to make your life easier make a list that way you don’t leave a doctor out.
Common doctor specialities: Don’t forget all the specialities, some common ones are: Cardiologist, Neurologist, Orthopedic, Optometrist (eye check ups), Ophthalmologist (diseases of eye), Urologist, Gastroenterologist, Endocrinologist, Rheumatologist, Vascular Surgeon, Dermatologist, Gynecologist and Otolaryngologists or Ear Nose & Throat (ENT), Pulmonologist and Oncologist.
Update your list of medications. It’s important to compare plans by seeing how much your medications will cost or even if they are in the plans formulary. Every year these formularies can change, your medications can move from one tier to another and thus change how much you pay for them.
Brand vs. Generic – Note that many insurance companies may not cover the brand name of a medication and just cover the generic version. But what if I must take the brand name of a medication? Maybe the generic medications available give you a bad reaction. In those cases it may be possible to get a formulary exception from the insurance company to approve you to take a brand name if it’s not already in their list of covered drugs. This normally gets requested by your prescribing physician as they have to provide medical proof to the insurance company.
Here is an example of how to list your medications should look like.
Example: John’s medication list:
Lisinopril 10mg tablet 1 a day
Humalog Insulin Injection 10ml vial, 3 vials a month (you can also provide number of units a day)
Levemir Insulin Pen – 3 pens a month
Atorvastatin 20mg capsule 1 a day
By providing a month supply or a daily supply that can easily be calculated to monthly it allows you to get a better estimate when comparing plans.
As needed medication: Some medications you may take as needed, in those cases try to average your monthly use so as to get your projections cost estimates as close as possible.
Now that you have your list of medications and doctors it’s also important to factor in benefits that are most important to you. Say for example that every year you have to get a specific test, say an MRI. You’ll want to make sure to check the cost for such test on each of the plans that you are considering. In general for Medicare Advantage Plans you’ll want to make sure that all co-pays as a whole are competitively affordable. Other benefits to consider are the extras like Dental, Vision, Hearing Aid, Transportation and Over the Counter allowances just to name a few.
Checking the network: This is important because you’ll want to make sure that you can still see your doctors with the plan you selected. Also if you like a specific hospital you’ll also want to make sure that they are in-network too. Other things to consider on network is travel. All Medicare Advantage Plans will allow you to see providers nationwide for Urgent Care or Emergency services and that’s for both HMO’s and PPO plans. What becomes more important is if you’ll be traveling for long periods of time to a different state and you’ll want to have doctors in that area (ex. Snowbirds). HMO plans may have restrictions, they may not have network providers in the areas you travel to so it’s important to consider this before choosing a plan. If you’ll be traveling long periods it may be a good idea to have a PPO plan with a national network.
Star Ratings: Each year plans get a Medicare Star Rating 1 to 5. When plans are not performing to Medicare’s standard they may receive a below average rating, that would be anything below 3 stars. So what happens if a plan receives consecutive below average ratings? Their plan can be terminated and their members would have to switch to another plan. Generally if you have a plan with 3 stars and above you’ll be ok. Some plans may be too new for a rating, that happens when a new plan becomes available that hasn’t been offered in any other area by the company. This shouldn’t alarm you but make sure that you review the rating the following year just to see how they are doing.
Questions you should ask are:
What would my co-pays be for the most used services? This can include the medications you take every month and doctor you see most often or tests you have every year.
What would the costs be if I were hospitalized?
What if I have to have cataract surgery, what would that cost me?
Are there any extra benefits like Dental, Vision, Hearing and Fitness?
How much does the plan cost a month? Note that having a premium on a plan doesn’t necessarily mean it gives you better co-pays or benefits, make sure to really take a good look at the summary of benefits.
There are many plans out there so make sure to get an early start on your comparison. Some shop for plans by visiting each insurance companies sales meetings to learn about the products. This generally is not a bad idea but given current health risks with Covid-19 many will probably skip these meetings this fall. Traditionally in these sales meetings you can only hear about one or two plans the company is offering in your county so it may not help you compare more than one plan, you’ll be going to a lot of meetings! But what is nice is that you are able to hear the questions of other attendees, sometimes they do ask questions you may have not thought of. Additionally you’ll likely not have the list of doctors and formulary to compare in these meetings.
Others compare plans by visiting the insurance companies websites and checking benefits one plan at a time, there are tools within many of the companies to help you narrow down the plan you want but in my opinion these online tools are ‘just ok’ at best. Personalize comparison take more time and effort, a real understanding of your needs. Plus you’ll probably need to visit a lot of the insurance companies websites and get a feel for each of their websites. In Atlanta there are at least 8 Advantage companies offering plans and each have multiple plans. If you are shopping for a drug plan there are even more.
Lastly others work with someone like me, a Medicare Insurance Broker. Brokers are contracted with multiple Medicare insurance companies and are able to do a lot of the work for you. Don’t confuse them with Insurance company Agents, they usually just work for one company and can only offer one company set of plans. If you like to see how I work for my clients give me a call, I’ll be happy to be interviewed for the position. Our services don’t have a fee because the insurance companies we are contracted with pay us commissions for the policies that we have in-force. Each company has a standard set of commissions they must follow to pay their agents, so one company to another you don’t have differences. This helps avoid agents enrolling clients into the “highest paying” plan. Even if that was possible that would just be short sighted as a brokers success is tied directly with providing their clients the plan the best fits their needs.
So there you have it, hopefully this article can help you be ready for the upcoming AEP season. We discussed what to expect, letters and updates from the insurance companies, including massive amounts of marketing. Next we talked about preparing for the season, meaning we got to get our lists together to allow us to shop. Lastly comes the comparing, where we make sure that we are selecting a plan the fits our needs best.
We hope you have a successful AEP and if you need our help don’t hesitate to contact us.
Today all the Medicare Advantage and Prescription companies have released their 2020 plan benefits. For most the easiest way to review the changes to their current plan will be via their Annual Notice of Change (ANOC) letter. This letter was mailed out to all current members and should have arrived by 9/30/19. If you don’t have this letter or have misplaced it, you may contact your carrier to resend it or for many you will be able to access it electronically as many Insurers make them available in their websites.
The ANOC letter contains the plan benefit details for the following year. It’s an easy way of comparing your current plan with the changes coming up for 2020. Consult your agent to make sure that you understand the changes.
It’s important to do a medication cost comparison as the ANOC letters don’t give you a year by year comparison on what you can expect to pay. But it’s possible to compare your medication costs. Contact your agent to help you. There are drug price comparison tools on most Insurer websites, in addition Medicare.gov has their own. Note that it’s important that you provide the correct medication name (brand vs generic), how many you take a day, how often they are refilled (e.g., 30, 60, 90 a month, or every 3 months) and what pharmacy you go to refill them. All these details can change the cost projections significantly. ￼
For some Medicare beneficiaries their Insurer letters will notify them that their current plan will no longer be available for the following year. This is no cause for alarm, as there is plenty of time to review the options available. Some carriers will offer an alternative plan if they remove your plan from the market, the alternative option may come in a separate letter. But no matter what plan is selected, switching will require action on the part of the beneficiary. Talk to your agent to make sure that you select the plan that meets your needs.
Starting October 15th plan changes for AEP could be submitted to the Insurers, those changes will be effective January 1st 2020. For most the last day to submit applications for plan changes is December 7th.
Depending on your current needs other benefits may be more important. Think about what you may need for the following year. Perhaps you have a treatment or procedure coming up and you want to know what out of pocket costs you can expect.
Things you should compare:
Maximum out of Pocket
Network – HMO vs PPO
Referrals for HMO’s – do I need a referral to see a specialist?
Dental, Vision, Fitness, Hearing
Over the Counter (OTC)
Prescriptions – Are my medications still covered and what are the estimated cost projections?
If you like your current plan and you want to renew it with the changes you don’t have to take any action, the plan renews automatically.
Making a plan selection is very important and personal so let’s take our time to review the options, let’s ask questions and find the plan the fits your needs.
That’s right! Another Annual Enrollment Period (AEP) is right around the corner. On October 1st all Medicare Advantage and Prescription Drug Plan companies will release their 2019 plan benefits. If you already have one of these plans you’ll soon get the Annual Notice of Change where the insurers will highlight the changes to your plan for 2019.
The AEP begins on 10/15 and will end on 12/07. The last enrollment you submit during this time frame is the plan that you will be enrolled in during 2019.
Once it’s AEP – “What should I do?”
It’s that time where you’ll want to do the following:
Review the changes to your current Medicare Advantage or Prescription Drug plan.
Has the Premium Changed?
How have the following benefits changed:
Co-pays, Maximum Out of Pocket, Dental, Vision, Hearing, Deductibles, Transportation, Over the Counter, Drug Costs & Formulary
Is my plan still being offered for 2019 or will I need to change to another one?
Will my Doctors still be in-network?
Will my medications still be covered?
If you have a Supplement evaluate your monthly premium costs and ask yourself if it’s time to make a change. Will a Medicare Advantage lower my out of pocket costs?
Compare new plan options in the market.
Is there a plan that offers you more of the benefits that you need?
Lower monthly Premium
Part B premium Pay Back/Refund
Evaluate whether you can benefit from assistance of a Health Insurance Agent. They can help you evaluate the options for 2019, make your research a lot easier.
Here at Ask Gabe, Inc. we are already hard at work at evaluating ALL the plans for 2019. We will be happy to help you identify the plan the can best fits your needs. Call or Email and we can discuss how we can help you during the Annual Enrollment Period and beyond.
We work hard to help our clients every year in choosing the plan that minimizes their healthcare expenses all the while getting the most value. We are also available to help them throughout the year with any issues or concerns. So if you want an agent that cares about your needs and is available to help you when you need it, give us a call.
Since I started helping seniors with health insurance, I knew there was a need for educational seminars in my community. I’ve been working hard to contribute by scheduling educational meetings in Cobb, Douglas and Fulton county centers. The attendance at each of the events has been excellent. Two weeks ago we had 25 attend with just a couple of days notice!
The point of a Medicare educational event is to understand the different parts of Medicare, see when you are eligible and acquire general information about the Medicare products available. I also like to share information about the State programs that help lower income seniors save money on medications, part B premium and healthcare costs. There are two great programs available, one is the Medicare Savings Program and the other is called Extra Help.
If you are interested in having a Medicare Educational meeting at your center or place of employment please let us know and we’ll add it to the calendar.
There are no fee nor are products promoted at educational events.
This is a very common question and the answer will depend on several factors. While the topic can be overwhelming there is no need to over stress.
Factors that can affect the answer include:
End Stage Renal Disease (ESRD)
First you’ll want to understand how your employer group coverage will be affected once you are eligible for Medicare. Your group coverage through your employer could be affected even if you don’t sign up for Medicare when you turn 65, so pay close attention.
Coordination of Benefits
The first big thing about Medicare we need to cover, in relation to our topic, is coordination of benefits. According to Medicare.gov coordination of benefits ‘is a way to figure out who pays first when two or more health insurance plans are responsible for paying the same medical bill’. While it’s logical to think that this only applies when you have two insurances, the truth is that its not. Some group insurances could deny paying a bill just because they know you are eligible for Medicare.
The reason for this is because Medicare has set rules on who pays a bill first. An ample list of scenarios can be found on a document called “Who pays First” created by the Center for Medicare and Medicaid Services (CMS). It’s available on Medicare.gov.
Employer Group Size
What you need to know is if your employer insurance plan is suppose to pay first or not. For most is as easy as knowing if your employer group has less than 20 employees or not. If your employer has less than 20 employees then Medicare becomes the “primary payor”, which basically means that they are suppose to pay the bill first. Now here is the tricky part, this applies even if you haven’t signed up for Medicare yet. Wait, what?
Yes, if you are 65 and are eligible to enroll into Medicare your less-than-20-employee-small-group-employer policy will likely reject any bills that are sent to them. They’ll want those bills to be sent to Medicare first because “Who wants to pay a bill they don’t have to?”. So in this case if someone is turning 65, still working and their employer has less than 20 employees, they should sign up for Medicare A & B because Medicare is the primary payor. Now, can they still keep their small group insurance plan? Technically yes but one would be wise and factor in the costs of keeping both coverages, in some cases it might be a good idea but it all depends.
So what if my employer has more than 20 employees, should I sign up for Medicare if I’m still going to be covered by my employer health plan? The answer is probably not because you’ll be paying for two insurances that likely won’t save you money on your healthcare bills. If this applies to you, factor how much you’ll be paying for your employer coverage and what sort of cost-share it has (deductible, co-pays, coinsurance etc) when you get treatment. It’s also important to understand what Medicare covers and what it doesn’t. Does it include prescription drugs or do you have to buy it separately?
I did mention that there are other factors to consider, the article “Who Pays Firsts” gives more information but you are welcome to post your questions in the comments, I’ll be happy to answer them. Or if you prefer to contact us directly navigate to our contact section on top.
Join us Wednesday for an iPhone 101 Training at the Austell Community Senior Center 4915 Austell-Powder Springs Rd Austell, GA 30106 1PM
Sponsored by Ask Gabe, Inc.
With all new features it could be confusing to operate these “Smart Phones”. We’ll go through some basics but then I’ll show you how to keep up with some of the new features that make having an iPhone the “Smart” way to go.