2019 Medicare Part D Insurance for The Coming Annual Period

Kristin P Sinclair – A Accu Tax Oct 8th 2018 – Rock Hill, SC – Charlotte, NC

Stand Alone Medicare Part D plans have a monthly premium, that you pay to have the plan service your prescription drug coverage needs for the annual period. You want to pay the premiums in a timely fashion when due. Choosing a plan that you can afford is one of goals that you want to achieve. Your premium costs do not go toward your out of pocket costs when you tally your drugs copays and coinsurance figures. Premium paid is one set of costs. Out of pocket costs for copays and coinsurance is a separate set of figures.

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2019 Medicare Part D Insurance for The Coming Annual Period

Kristin P Sinclair  – A Accu Tax Oct 8th 2018 – Rock Hill, SC – Charlotte, NC

Stand Alone Medicare Part D plans have a monthly premium, that you pay to have the plan service your prescription drug coverage needs for the annual period. You want to pay the premiums in a timely fashion when due. Choosing a plan that you can afford is one of goals that you want to achieve. Your premium costs do not go toward your out of pocket costs when you tally your drugs copays and coinsurance figures. Premium paid is one set of costs. Out of pocket costs for copays and coinsurance is a separate set of figures.

Medicare Part D has an annual enrollment period. From Oct 15th through Dec 7th. When you change your plan during this annual enrollment period the new coverage begins Jan 1st in the upcoming year.

If you move from one coverage area to another, say from South Carolina to North Carolina, during the annual period, you have a Special Enrollment Period to change to a plan in your new State. You will not automatically have a new plan in your new state, you need to be proactive getting this done before your SEP period has ended.

If you become eligible for extra help and receive a Low Income Subsidy to help offset a portion of your costs you have Special Enrollment Periods during the year to make some changes if your RX needs change and a formulary change is needed.

You can see the government has created protections for you as a medicare beneficiary.   But as a general rule, once you choose a plan that will be your plan for the annual period. Take the opportunity to do your research each year. Choose the plan that is most suitable for your situation, and factors you know to be the case at the present moment in time.

Each year you could see some changes to your plan. You will receive An Annual Notice of Change. ANOC describing what is changing on your plan. This notice is a good reminder to gather your medication list and review the changes coming to your current plan for the upcoming annual period.

Review medications covered on the formulary. That is the list of medications that your plan covers. This formulary also provides the cost sharing tier detail as well.

Review your local pharmacy choice, your mail order pharmacy choice. Which Tier your medications will fall into. Since medications can move from one tier to another from one annual period to the next, it is prudent to review how the formulary and tier structure will affect you in the upcoming annual period.

Schedule an appointment with a trusted resource to get some idea of plan costs, RX costs, and idea of the stages you should plan for. Call your Insurance agent, schedule an appointment to review your RX and plans that cover the medications you are taking. Kristin can be reached at:   803-329-0615. Call to schedule an appointment. While sitting down with your computer go to: www.Medicare.gov this is a great resource, but wait until the annual enrollment period to get into the program that www.Medicare.gov offers for your research. They have a lot of data they are populating into the data base. Allow them time to help you do your comparisons.

For Plans that have a deductible in 2019, $415.00 is a number you will see on many plans with a deductible. Not all plans have deductibles, some plans have deductibles on only certain tiers on the formulary. So have pencil and paper ready when you do research. Make note of things important to you.

Medicare Part D is designed to have various stages. An initial stage you will have copays or coinsurance cost sharing after any applicable deductible has been met. Most people do not leave the initial stage during the annual period. Taking generic alternatives and opting for 90 mail order can help your dollars go further. When your plan offers various tiers and mail order incentives to save.

It could be possible that you have spent $1,000.00 out of pocket, but the true cost of medication cost have reached a figure of $3,820.00. After the total drug costs reach $3,820.00 that is when the coverage gap, also known as the donut hole begins. While you are filling your medications in the coverage gap stage, the cost sharing changes. 37% coinsurance for generic drugs or 25% coinsurance for name brand drugs. The drug manufacture also pays 25% toward your medication cost for the name brand drug as well. And the other costs are paid by the plan as well.

What does this mean, well you might be taking an expensive generic drug and while you are in the coverage gap, you will pay 37% of the cost. You might be taking an expensive name brand drug and while you are in the coverage gap, you will pay 25% of the cost.

Some plans offer some additional cost sharing while in the gap. Those plans are often going to have a higher premium. And when you consider this plan design, look at the total annual costs for the factors that you can plan for. A years total cost can vary significantly based upon the plan chosen, sometimes a lower premium and use of mail order can help make your dollars go further. The medications you are taking, the formulary on the plan chosen, need to work for you, so do your research. Choose wisely grasshopper. Decide when higher premiums are going to offer a plan that saves you money. Or could a plan with a lower premium actually by years end actually have saved you more on out of pocket costs. It depends.

Once your out of pocket cost for the medications filled through the local pharmacy or through mail order, reach $5,100.00, you enter into the next stage which is called the catastrophic coverage stage. During this stage you will pay the greater of $3.40 copay for generic, (including brand name treated as generic) , $8.50 copay for name brand medications, or you could pay 5% coinsurance. If you do enter the catastrophic coverage stage, you will be in the stage until the years end. When the new annual period begins, the various stages will start again.

Kristin P Sinclair A Accu Tax, October 8, 2018

Rock Hill, SC Charlotte, NC

 

Some other thoughts, people who receive extra help to offset their RX out of pocket costs might have cost sharing that is different than others also receiving extra help, there are different types and levels of extra help. It is possible for a plan to cost different amounts for people on LIS. In the same state or area of service for a plan.

Most Medicare Part D beneficiaries do not receive extra help in the form of LIS, Low Income Subsidy however, for those who need extra help it is certainly good it is available. A Person would need to look into this to determine if they qualify annually.

Look at Star Ratings for the plans you are reviewing. If the plan is new, it will not yet have a star rating. If the plan has been around for several years, it will have a star rating for you to review.

High Income Medicare Beneficiaries. Premium Adjustments Add to the premium of your Medicare Premiums, Add to the Premium of your Medicare Part D Premiums.

by Kristin P Sinclair – A Accu Tax – October 10th 2018 – Rock Hill, SC – Charleston, SC

When you are a high income tax payer you may have additional premiums added to your Medicare premiums, as well as your Medicare Part D premiums. Both on a stand a lone plan as well as on the Medicare Part C plan with the Part D in your MAPD plan.

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High Income Medicare Beneficiaries. Premium Adjustments Add to the premium of your Medicare Premiums, Add to the Premium of your Medicare Part D Premiums.

Kristin P Sinclair  – A Accu Tax – October 10th 2018 – Rock Hill, SC –  Charleston, SC

When you are a high income tax payer you may have additional premiums added to your Medicare premiums, as well as your Medicare Part D premiums. Both on a stand a lone plan as well as on the Medicare Part C plan with the Part D in your MAPD plan.

Most people roughly 95% of Medicare Beneficiaries will not pay this additional premium, however that also means somewhere close to 5% of Medicare Beneficiaries will pay these additional sets of premiums.

This means most people will continue to pay only the Part D premium their plan charges. If you have to pay the extra amount in addition to the Part D plan premium, Social Security will use your reported IRS income to determine how much extra you have to pay. The extra amount is based on your yearly income .from two years prior income tax return reporting documents. Social Security will send you a letter if you have to pay an extra amount in addition to your monthly Part D plan premium. The charts below show the amount you’ll have to pay each month. In 2018 these figures will be adjusted for 2019.

Below are examples of the Part D premium differentials for 2018.

If your filing status and yearly income in 2016 was

Individual tax return

File joint tax return

File married & separate tax return

You pay each month (in 2018)

$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $13.00 + your plan premium
above $107,000 up to $133,500 above $214,000 up to $267,000 not applicable $33.60 + your plan premium
above $133,500 up to $160,000 above $267,000 up to $320,000 not applicable $54.20 + your plan premium
above $160,000 above $320,000 not applicable $74.80 + your plan premium

The figures above are premiums differential for year 2018 for medicare part D premiums.

So what should you expect for 2019. We are still waiting for congress to announce figures for 2019 to determine what figures will be applicable for the coming annual period.

Social Security Income-Related Monthly Adjustment Amount Notice

What is it? If you’re in a higher-income household, this notice tells you about income-related Medicare Part B and Part D premium adjustments for the coming year. It includes the information in the December BRI notices.

When should I get it?   November

Who sends it? Social Security

What should I do if I get this notice? Keep the notice.

What should I do if I disagree with the decision? Social Security will send you a letter if your Medicare prescription drug plan premium will change based on your income. This letter will tell you what to do if you disagree. For more information, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

What if my income has changed? If your income has changed and this change will make a significant difference in your income level, call Social Security. Let them know you have new information and may need a new decision about the extra amount you’ll be charged each month. Your income may have changed due to any of these reasons:

  • You married, divorced, or your marriage was annulled
  • You became a widow/widower
  • You or your spouse stopped working or reduced work hours
  • You or your spouse lost income from income-producing property due to a disaster or other event beyond your control
  • You or your spouse’s employer pension plan was reorganized, terminated, or experienced a scheduled cessation
  • You or your spouse got a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization

Do I have to pay this extra amount?

You must pay both the extra amount and your plan’s premium each month to keep Medicare prescription drug (Part D) coverage.

To get more information.

If you have questions about your Medicare prescription drug coverage or how much you have to pay, call your plan, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

If you have questions about the extra amount you are being charged based on your income, visit socialsecurity.gov, or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against.

Visit Medicare.gov/about-us/nondiscrimination/ accessibility-nondiscrimination.html, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.

If you owe the premium and fail to pay the premium you will loose your coverage. That would be a tragedy that you need to avoid. Plan ahead for obligations.   Remember that it is possible that this higher premium will be adjusted the following annual period. Since the adjusted amount is determined by the income from 2 years prior tax return. Unless a higher income is a predictable norm for your situation, many people would see a change as income changes. Sometimes high incomes can be isolated events affecting a household in only specific situations such as selling stock realizing a gain, to allocate the funds for some thing needing to be funded. Life happens, and the government is willing to listen to the circumstances.

Remember the government will take into considerations when events are an anomaly. And it is possible that the income related adjustment could be adjusted when you present the circumstances and the facts surrounding the income increase which is outside of the household norm.

Kristin P Sinclair   A Accu Tax. October 10, 2018

Rock Hill, SC   Charleston, SC

Visit www.medicare.gov to do additional research on your situation. If you had higher income in 2017 this will impact you in 2019. Look for your notification to arrive in Nov 2018.

Charitable Deductions Things to Consider

by Kristin P. Sinclair – A Accu Tax – October 6, 2018 – Rock Hill, SC – Charleston, SC

We have heard in the news that the Standard Deduction is increasing and fewer people will be itemizing on the their tax returns over the next 7 years. The higher deduction is indeed expected to be taken by many. However for people who have a Mortgage on their home paying interest, they might want to look at itemizing and decide if it is to their advantage. Have deductible gifts to charity add this to the mix. And then also, taxes paid for home, vehicles, and state taxes on their earned income. Estimated state taxes on investments and retirement income.

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2018 Medicare Part D

by Kristin P. Sinclair – A Accu Tax – October 9, 2018 – Rock Hill, SC

2018 Medicare Part D is PDP or Drug Coverage, and Medicare Part D has different stages. Some plans will have a deductible of $405.00 and then co-pays and co-insurance begins based upon your specific plan design, and cost sharing formulas. Some plans do not have a deductible to be met, and those plans could have a higher monthly premium or possibly some other format which helps to limit your exposure. But all Medicare Part D providers must meet specific guidelines and must have a plan that has been approved by Medicare. And must offer coverage for the 100 categories of medications that Medicare has determined that Medicare beneficiaries need to have coverage options for.

The initial Co-pays and co-insurance will apply until the true cost of medication covered by the Part D plan have reached $3,750.00 in 2018. Then the beneficiary goes into the next phase the Coverage Gap or Donut Hole. Your cost sharing then is a 65% discount off the cost of name-brand medication in the formulary. With your cost sharing you pay the other 35% for your medications while you are in the coverage gap. For generic drugs on the formulary you get a 56% discount of the price while in the donut whole, this means you pay the remaining 44% of the cost of your generic medication in the formulary while in the donut hole.

With your Medicare Part D Plan once your share of the out of pocket costs for the medications paid reaches, $5000.00 you enter the next stage which is called the Catastrophic Coverage Stage. In this stage, you will pay, $3.35 for generic drugs or 5% of the drug cost, and you will pay, $8.35 for name brand drugs or 5% of the drug costs on the monthly basis. Anyone who entered the catastrophic phase would see that phase throughout the balance of the annual period.

There are people who qualify for LIS or Low Income Subsidy and receive extra help from the government due to the limited amount of income and assets they have. Folks with LIS see different cost sharing levels than those who do not qualify for LIS benefits.

It is worth noting, that most Medicare Part D beneficiaries never leave the 1st stage or the co-pay stage during the annual period which occurs after any applicable deductible has been paid. Please also note that while those folks who do reach the gap or donut hole stage, those folks would pay 35% of the cost of your name brand medication while in the gap stage of coverage, the drug manufacture is also paying 35% of the cost of that same medication for your benefit. That additional amount the drug manufacture has been paying for you counts toward your out of pocket exposure, and can get you the Catastrophic stage sooner.

So Very Important – Your Formulary Choice
Why is it important to have your medication covered by your formulary for the annual period ? It is important so that you can minimize your out of pocket exposure when possible. If a medication is not covered by your formulary it is possible you could be responsible for all costs. An exception to your formulary could be agreed upon between your Medical care practitioner and your Medicare Part D provider. The exception requires your medical practitioner to provide supporting reason that an exception is a necessary option for your care and well being. Often the Medicare Part D Plan will want you to start with any available generic alternative at the more affordable rate. If necessary then to start a step by step method prior to using the more expensive medications exception. Once again your Doctor is going to be very involved in any request for an exception to a formulary.

These are good reasons to review your current medication(s) on an annual basis prior to the Annual Enrollment period of October 15th through Dec 7th. This is the time to choose the Medicare Part D Plan which best meets your medication needs for the up coming annual period. Your preferred pharmacy location should be convenient and included in your plan preferred pharmacy provider list. Since medications can change during the annual period, discuss your formulary with your health care practitioner(s). It is possible that an affordable alternative is already included in the formulary you have selected. Your Medicare Part D Plan is an important part of providing for your overall healthcare needs. Always take the time to choose wisely grasshopper!

Updated in Rock Hill SC, October 9, 2018
by Kristin P Sinclair (803)329-0615

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When is it Best to Buy a Medicare Supplement ?

by Kristin P. Sinclair – Rock Hill SC – October 9, 2018

The very best time to buy your Medicare supplement is during your Open Enrollment Period(OEP). Normally this period lasts for six months starting with the first day of the month you are 65 or older and are also enrolled in Medicare Part B. For those under age 65* there may be additional Open Enrollment Periods in certain states.

During your Open Enrollment Period an insurance company cannot refuse to sell you any Medicare Supplement Policy they offer; charge you a higher rate than that company might charge someone in good to excellent health; or make you wait for your coverage to begin. Please note that the insurance company may make you wait for up to six months for pre-existing condition coverage. That is a condition that you would have prior to your Medicare Supplement coverage starting. This period of time is called a pre-existing condition waiting period. After six months, your Medicare Supplement Policy will cover any pre-existing conditions.

If you make a change from one Medicare Supplement to another after becoming Medicare eligible, and you have not had a lapse in coverage with your prior provider; then you will have underwriting.   you can shorten, the period where a waiting period would be applicable. It is possible to shorten or eliminate any pre-existing condition waiting periods if you have Creditable Coverage before you apply.

An insurance company cannot subject you to any pre-existing condition waiting period if you have been covered by your employer health plan which is Creditable Coverage; if you are still working full time and opted to delay Part B until you have decided to move your coverage to include your Medicare Part B coverage, or if you have had at least six months of Creditable Coverage. Please note that you cannot have had a 63 day break in coverage between your Creditable Coverage and your Medicare Supplement coverage.

You need to include your letter of creditable coverage with your application unless you are new to Medicare Part B.

It is also important to keep in mind that your Medicare Supplement rights are based upon when you enroll in Medicare Part B. For those age 65 and older, your Medicare Supplement Open Enrollment Period begins when you enroll in Medicare Part B. This period cannot be change or repeated. Thus, if you have employer or union group health coverage that is as good or better than original medicare, then you may want to wait until later to enroll in Medicare Part B. Most group health coverage provides benefits similar to Medicare Part B; and also having Medicare Part B might be an unnecessary duplicate expense. Worse yet, your Medicare Supplement Open Enrollment Period might expire before you need it.

In summary, for those age 65 and over, when you are first eligible you have the right to buy any Medicare Supplement Policy offered in your state. This gives you more choices, and normally lower monthly premiums. So during the Open Enrollment Period, a person with health issues can buy a Medicare Supplement for the same lower prices as those with no health issues.

 

Kristin P. Sinclair (803) 329-0615, October 9, 2018
Rock Hill SC

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

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Social Security Retirement Estimator

by Kristin P. Sinclair – A Accu Tax – October 2, 2018

retirement how to retire

The Social Security Retirement Estimator provides you estimates based upon your Social Security earnings record. Please note that these are estimates and not a guarantee of benefits to be paid. The Social Security Administration will provide you with your actual benefit amount when you apply for benefits.

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Social Security Retirement Estimator

by Kristin P. Sinclair – A Accu Tax – October 2, 2018

retirement how to retire

The Social Security Retirement Estimator provides you estimates based upon your Social Security earnings record. Please note that these are estimates and not a guarantee of benefits to be paid. The Social Security Administration will provide you with your actual benefit amount when you apply for benefits. That amount may differ from the estimates for several reasons:

  • Your future earnings may increase or decrease from today’s estimate.
  • Benefits most likely will be adjusted for cost-of-living increases.
  • Today’s estimated benefits are based on current law, and do not account for any future changes in the law. There are concerns about benefits to be paid after 2034.
  • Military service, railroad employment, or pensions earned through work on which you did not pay Social Security tax may affect your future benefits.

When Can Use the Retirement Estimator

When you have enough Social Security credits to qualify for benefits, and when you are not currently receiving benefits on your own Social Security record. You must also not be waiting for a decision about your Social Security benefits application for benefits or Medicare benefits. Also you should not use the Social Security Estimator if you are age 62 or older and receiving benefits on another Social Security record; or if you are eligible for a pension based on employment not covered by Social Security.

Please note that when you are receiving only Medicare benefits, then you can still get an estimate. For more information please read: Retirement Information For Medicare Beneficiaries at SSA.gov.

The Social Security Retirement Estimator Link is: https://secure.ssa.gov/acu/ACU_KBA/main.jsp?URL=/apps8z/ARPI/main.jsp?locale=en&LVL=4

 

Updated in Rock Hill SC and Charlotte NC
by Kristin P. Sinclair   A Accu Tax   October 2, 2018
(803)329-0615

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Questions for Home Health Care Provider Interviews

by Donn J. Sinclair, MBA – October 3, 2018

When recovering from an injury or illness, your Medicare coverage and your Medigap or Medicare Supplement may pay some of the Home Health Care costs that you incur. When selecting a home care agency for you or a loved one, there are important questions to ask when interviewing home health care agencies.

  • Private duty home care – what year did the agency first offer that service ?
  • State licenses – are the agency staff and home health care agency properly licensed in your state ? More specifically, properly licensed to provide care level your physician ordered ?
  • Which home health care agency staff member coordinates with the patient’s physician to implement the physician developed plan of care ? The plan is evaluated and updated by the agency on what schedule ?
  • What daily notes are maintained to monitor the progress of the patient ?
  • Who and how is quality of care supervised and updated ? How frequent are unscheduled agency supervisory visits on the agency staff?
  • What are the home health care agency ongoing training mandates for their caregivers ? Who supervises the training ?
  • How and by whom are after normal business hour emergencies handled ?
  • Does the home health care agency have on staff nurses, social workers, physical therapists, and other qualified professionals available to provide needed in home care ? If not, with which providers does the home health care agency have an established working relationship ?
  • How do you obtain a written copy of the home health care agency’s privacy policy, ethics code, and mission statement ?
  • What screening techniques are used to screen caregivers ? Do these include reference checks, driving records, credit checks, and criminal background investigations ?
  • Are the home health care agency caregivers W-2 employees or W-9 subcontractors ? Are there any home health care agency incidents of failure to file payroll tax reports, or incidents where the agency failed to pay taxes on a timely basis ?

When it comes to selecting a home health care agency, you should follow the Boy Scouts motto “Be Prepared”. Make certain that you and your loved ones get the care they require and deserve. Also make certain that Medicare and your Medicare Supplement pay as they should for the care received.

 

Donn J. Sinclair, Winthrop MBA

in Charlotte NC and Rock Hill SC

October 3, 2018   (803)329-0609

 

DJS: More information is available at Medicare.gov

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