Medicare Plans

12/01/2022

Metformin: How You Can Dramatically Reduce Your Prescription Drug Cost With or Without Insurance

Metformin HCL is one of the most common prescription drugs used by Medicare beneficiaries. Depending on ER or not, it can be very expensive, especially if it...

10/13/2022

Medicare initial coverage election period ICEP explained in under 1 minute
https://youtube.com/shorts/QaZqV9ND4Ns

09/28/2022

Medicare part B monthly premium for 2023 will be $164.90 (a decrease from last year's $170). Annual deductible for part B services will also decrease to $226 (from $233 last year).

07/06/2022

facts about IRMAA (Income-Related Monthly Adjustment Amount):

People having income higher than some threshold, have to pay extra for their part B premium, and part D. Medicare beneficiary pays the IRMAA directly to Medicare, not the insurance company.

IRMAA is calculated every year based on beneficiaries' tax return 2 years prior. This is unlike the late enrollment penalty (for parts B or D) which stays unchanged.

07/05/2022

Initial Coverage Election Period (ICEP) begins 3 months immediately before the individual's first entitlement to both part A and part B and ends on the later of
1) the last day of the month preceding entitlement to both part A and part B, or
2) the last day of the individual's part B initial enrollment period (IEP).

In other words, ICEP can wait, until you enroll in part B.

If you use the ICEP to enroll in a Medicare Advantage (MA) plan, you have an immediate MA-OEP (3 months) to switch to another MA plan. The MA-OEP starts the 1st month of entitlement to the MA plan.

07/05/2022

When a Medicaid beneficiary becomes eligible for Medicare, Medicare (instead of Medicaid) will cover the part D drugs.

07/05/2022

Part D late enrollment penalty applies if the beneficiary does not have part D or creditable coverage for 63 consecutive days. the penalty amount is 1% of national average part D premium for every month missed.

07/05/2022

2023 part D update:
deductible = $505,
initial coverage limit = $4660,
TrOOP (catastrophic threshold Out-Of-Pocket)=$7400

Before your OOP (including the deductible) reaches the TrOOP, you pay 25% of the drug cost. After your OOP reaches the initial coverage limit though, brand name manufacturer discount (70%) also counts towards the TrOOP.

Coverage gap (aka donut hole) means the insurance company is not paying (more precisely, only paying 5%). it's actually the manufacturer that is covering 70% of the drug cost.

In the catastrophic stage, the beneficiary pays $4.15 for generic, $10.35 for brand name or 5% coinsurance, whichever is greater.

07/04/2022

All providers are prohibited from billing QMB (Qualified Medicare Beneficiary), even if they don't participate in Medicaid.

Medicaid may provide more coverage than Medicare but they will only pay for those services furnished by Medicaid-participating providers.

07/04/2022

If you are eligible for Medicare and you are working for an employer with 20 or more employees, you must keep your group health plan because Medicare will be the secondary payer. On the other hand, if your employer has fewer than 20 employees, Medicare will be the primary payer.

Medicare is the primary payer for retirees with a group health plan.

07/03/2022

With a PFFS (Private Fee For Service) Medicare (advantage) plan, a non(Medicare)-participating doctor can charge up to 15% more than Medicare approved amount. That is the so-called 'excess charge.' The doctor will 'balance bill' you.

07/03/2022

Medicare change:
Starting 2023, Medicare enrollment during the General Enrollment Period (GEP 1/1-3/31) will go into effect the very next month after you enroll. (Before 2023, the coverage won't start until July 1.)

GEP is for people who missed their Initial Enrollment Period or Special Enrollment Period. Coverage lag or late-enrollment penalty may apply.