2017 Medicare Part D

2017 Medicare Part D is PDP or Drug coverage, and Medicare Part D has different stages. Some plans will have a deductible of $400.00 and then co-pays and co-insurance begins based upon your specific plans cost sharing formula. Some plans do not have a deductible which needs to be met, and those plans could have higher monthly premiums – or possibly some other format which helps to limit your exposure. Co-pays and co-insurance will apply until the true cost of the medications covered by the Part D plan have reached $3,700. Then you go into the Coverage Gap stage. Your cost sharing then is a 60% discount off the cost of name-brand medications in the formulary. With your cost sharing you pay the other 40% for your medications while you are in the coverage gap. This gap is often referred to as the donut hole. For generic drugs on the formulary you get a 49% discount. This means you pay the remaining 51% 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 $4,950 you enter the next stage which is called the Catastrophic Coverage Stage. In this stage, you will pay $3.30 for your Generic medications in the Formulary or $8.25 for the Name Brand medications on the formulary. Or you instead pay, 5% of the cost for your meds while in catastrophic stage, in the Formulary while you are in the Catastrophic Stage.

Why is it important to have your medications 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 you could be responsible for the total cost of that particular medication. An exception might be agreed upon with your plan and your medical practitioner. The exception requires your medical practitioner to provide supporting reasons that an exception is a necessary option for your care and well being. Often your 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.

This is a very good reason that you review your current medications 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. 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. Choose wisely grasshopper !

Updated in Rock Hill SC

by Kristin P. Sinclair
(803)329-0609
December 14, 2016


2017 Medicare Update

The 2017 cost sharing figures for the original Medicare have been provided by Congress. Many of us have some additional coverage which helps limit our out-of-pocket exposure. This coverage may be a Medicare Supplement, Medicare Advantage, or Retiree health benefits, and in some instances Medicaid,. The following figures may be helpful to know….

2017 Part A deductible for Each benefit period
Inpatient Admission to a Hospital $ 1,316.00 Days 1 through 60.
2017 days 61 through 90 co-insurance per day for each benefit period $329.00 per day.
2017 Days 91 and beyond $658.00 co-insurance for each of the 60 lifetime reserve days.

Skilled Nursing Facility 2017 Cost Sharing Days
Day 1 through day 20 you pay $0.00. That is correct Medicare pays those days
Day 21 through 100 you pay $164.50 per day co-pay after you pay your co-pay share cost sharing Medicare pays the balance Days 21 through 100.

Most Medicare beneficiaries do not look forward to that cost sharing for days 21 through100 in a nursing home. Many of us choose to have a Medicare Supplement or Medicare Advantage plan to help limit our financial exposure.
Please note: That after day 100 in the nursing home Medicare does not offer additional benefits. You will be paying for those additional days out of pocket, or with your Long Term Care Policy benefits. The exception could be for those who have both Medicare and Medicaid, or for those who qualify for Medicaid, the state and federal partnership will pay based upon the schedule your state has established.

2017 Medicare Part B deductible is $183.00 for the 2017 annual period
Once the deductible has been met, Medicare normally will pay 80% of the Medicare eligible out patient care Medicare Part B eligible expense. Remember that there is no cap on your cost sharing. This is a very important reason to plan ahead and get your Medicare Supplement also known as MediGap coverage, or MAPD also known as Medicare Advantage coverage in place. Phone Kristin at 803-329-0609 to discuss plans.

Those becoming Medicare Part B eligible in 2017 your Monthly premium for Medicare part B will be $134.00 for most people. There will be some of us whom will pay more based upon our income from 2 years prior. There will be some folks who pay less based upon their income and assets. The people whom became eligible for Medicare Part B in a prior year, your premiums will be based upon a different set of numbers. Your income will determine how much you pay for your base premium.

Updated in Rock Hill SC

by Kristin P. Sinclair
(803)329-0609
April 4, 2017


Medicare Supplements 2017

Let’s look at what a Medicare Supplement is. Well it is a Supplement to the Original Medicare program. Let us look at this idea a little further. For this review we are going to look at figures familiar for 2016. Since Medicare deductibles and cost sharing are still being reviewed by Congress for 2017.

In 2016 When a Medicare Beneficiary has both Medicare Part A and Medicare Part B, they can purchase an additional insurance plan called a Medicare Supplement to help fill in the Gaps in Original Medicare.

Let us look further, a Medicare Beneficiary is admitted into a hospital for between 1 and 60 days. Medicare is going to have a $1,288 deductible that the Medicare Beneficiary is responsible for paying for that hospital visit in the year 2016. When the Medicare Beneficiary has already purchased a Medicare supplement or MediGap policy. Then that policyholder can have a policy that will help pay the Medicare Part A deductible and co-pay sharing based upon the plan design selected.

If that Medicare Beneficiary is still in the hospital for days in excess of the 60 days, then the Original Medicare has additional cost sharing for each additional day up to a maximum number of days of hospitalization. The Medicare supplement or MediGap policy will help pay the additional out-of-pocket cost sharing up to the amounts allowed by plan designs for Medicare Supplements. Even after day 91, and later having utilized the additional 60 lifetime reserve days, your Medicare supplement is still there helping to pay for additional days even once Medicare has paid what they will pay, and have stopped the Medicare’s portion of cost sharing. Those Medicare Supplements have letters which are standardized plans, Plan A, Plan B, Plan C, Plan D, Plan F, HDF, Plan G, Plan K, Plan L, Plan M, and Plan N.

What do I mean by Standardized? Well essentially the federal government has stipulated that Plan A is Plan A, no matter from which company your purchase your Medicare Supplement. Same holds true for Plan N. Plan N is Plan N no matter from which company you purchase your plan. However, some companies do add what can be called Value Added Features. These can provide you with additional features which could be very beneficial to you.

The greater Cost Sharing that your policy pays, then you should expect that the plan will have a larger premium than a plan with which you accept a larger amount of cost sharing. That certainly makes sense. We know health care has a cost associated with it. The more cost sharing your company plan absorbs, then your premiums are higher. The less cost sharing you expect your companies plan absorbs for your benefit, then the lower your premium.

Let us look at a very simple basic comparison. Plan F is very comprehensive you will have very little cost sharing other than your premium unless you were to authorize treatment options not covered by Medicare. But if you select a High Deductible Plan F, HDF, you know that you are agreeing to share up to a set amount in medical care, until you have paid OOP to the annual threshold. And your premium is considerably smaller as a result. That certainly makes sense.

It is important that you select a plan, that you can afford the monthly premium, because if you fail to pay your premium, your policy will end. If instead you continue to pay your premiums when due and continue to live in the state the policy is applicable; you can keep your plan. No annual change needed. No need to make an annual review if you are pleased with your plan and the premium is workable for the plan you selected.

We did not mention Prescription Drug coverage did we that will be covered under a new topic PDP.

Updated in Rock Hill SC
by Kristin P. Sinclair (803)329-0609
November 10, 2016


Medicare Supplement Plans

Medicare supplement plans help fill the gaps in Medicare coverage. Let me help you choose a program best suited for your needs and peace of mind. Let’s talk about which doctors and pharmacies you want to use. Plus you may qualify for special discounts on health-related products, services and other extras that make it easier and more affordable to live a healthy lifestyle, including:
Kristin-Photo_website-downsize

      • Freedom to Travel Across the Country
      • Choose Your Doctors and Hospitals that Accept Medicare
      • Fitness, Wellness, and Vision Savings
      • Ask About Rate Stability History

For Real Live Personal Service
Phone Kristin at (803) 329-0609


Questions for Home Health Care Provider Interviews

Medicare, and your Medigap or Medicare Supplement may pay some of the Home Health Care costs 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.

  • What year did the agency first offer private duty home care ?
  • Are the agency and home health care staff appropriately licensed to deliver the level of care ordered by your physician ?
  • Who at the agency coordinates with the patient’s physician to implement the plan of care the physician developed ? How often is that plan evaluated and updated ?
  • Is a daily journal maintained to monitor patient progress ?
  • How is quality of care supervised ? How frequent are unscheduled supervisory visits ?
  • What ongoing training is agency mandated for their caregivers ?
  • How are emergencies handled after normal business hours?
  • Are nurses, social workers, physical therapists, and other qualified professionals available to provide in home care if needed ?
  • Will the agency provide you a written copy of their privacy policy, ethics code, and mission statement ?
  • How are caregivers screened ? Does this include actual reference checks, driving records, and criminal background investigations?
  • Are the caregivers agency employees or W-9 subcontractors ? Are their any agency incidents of failure to file and submit payroll reports and taxes on a timely basis ?

Like the Boy Scouts say, “Be prepared”. Make certain you and your loved ones get the care they require, and that Medicare and your Medigap or Medicare Supplement pay as they should for the care received.

Updated by Donn J. Sinclair, Winthrop MBA
in Charlotte NC and Rock Hill SC
December 17, 2017 (803)329-0609