Dehncke Planning

08/14/2024

“People do not decide their future, people decide their habits and their habits decide their futures”

-F.M. Alexander

07/04/2024

Cheers and Happy 4th of July to everyone! Heading home from Alaska - what a special place. If you haven’t visited, put on your bucket list; it is absolutely beautiful.

Special thank you to our service men and women who have helped keep us Independent and safe. For Bless - be safe!!

07/18/2023

Exercise Tips for Summer
Looking to spend some time outside as it warms up and exercise at the same time? Follow these exercise tips for summer to make your workouts more enjoyable and safer.

Summer is one of the most ideal times of year to exercise outside. The days are longer and the weather is warmer. Whether you’re gardening, hiking, swimming, or doing more traditional workouts like going for a run or bike ride, getting in a little workout in the great outdoors is a fantastic way to enjoy the summer weather. But reaching your fitness goals won’t mean a whole lot if you hurt yourself, which is why you should learn how to exercise in the summer safely. That’s something we can help you with!

Hydrate, Hydrate, Hydrate
Exercising any time of year can result in dehydration. If you’re working hard, you’ll likely be building up a sweat, and that liquid has to come from somewhere. Hydration is critical to our health. When you combine dehydrating factors like exercise and the summer heat, it can quickly become dangerous. This is why you need to watch for signs of dehydration while you’re exercising, like thirst, headaches, cramps, or dry skin. Drinking water is a great hydration solution, and you can even try sports drinks that replenish electrolytes. Just try to avoid too much excess sugar.

You should be hydrating before, during, and after your workout to avoid dehydration.

Keeping up with your hydration is equally important to both prevent dehydration and fix it. It’s estimated the average person needs between 11 and 16 cups of water per day. You may need more if you’re exercising. For this reason, you should be hydrating before you exercise to make sure you’re not dehydrated prior to working out. You should then hydrate during your exercise, so you don’t become dehydrated. It can also help to cool you down. Finally, you should hydrate after your workout during recovery. This can replenish hydration you lost and help your body to rebound from the exertion.

Pick Prime Times to Workout
When you have to contend with the heat and sun of summer, it’s more important that you time your exercise correctly than at other times of the year. You can limit the risks by exercising when the heat and sun aren’t at their highest. For most areas of the United States, this is before 10 AM or after 4 PM.

Using the two safety time windows, the best times to workout are between 6:30 AM and 10 AM and 4 PM and 7:30 PM.

You probably don’t want to exercise when it’s dark enough to limit visibility either, especially if you’ll be jogging near a road. Using rough averages, this means you’ll want to start your exercise after 6:30 AM and before 7:30 PM. If you are going to exercise around or after sunset, make sure you’re wearing reflective or visibility gear so others can see you as it gets darker.

Check the Weather
While you may not have to worry about the cold as much as you would in autumn, the weather can still be a hazard in the summer. In fact, it can be more dangerous, with severe thunderstorms being most common between May and August. The conditions can change quickly, too, and being caught in a sudden rainstorm can be miserable and even hazardous. Whether the weather is just rainy or thundering and windy, it’s advisable to avoid exercising outside.

Avoid exercising in temperatures over 98.6°F, especially if the humidity is above 70 percent.

Storms aren’t the only worry, though. For most of the United States, summer is generally the hottest time of year. While you can take precautions for safely running in high heat, it’s highly advisable to avoid temperatures over 98.6°F, especially if the humidity is above 70 percent. Beyond that, you risk dehydration and heat stroke.

Dress for the Weather
One way you can mitigate the heat is by dressing in summer-friendly exercise attire. You’ll want lightweight and breathable outfits. Cotton and linen clothes tend to be the best, though you won’t find many linen workout clothes. Instead, you can wear exercise clothes made specifically for hot weather, which can be sweat-wicking (fabric that doesn’t absorb sweat and draws it off your body) or especially light and breathable. You’ll also want to err on the side of lighter colors, since these reflect light rather than absorb it. This can keep your clothes cooler rather than holding on to heat like some darker clothes can. Loose-fitting clothes can also be a real help since they help fresh air circular around your body. This causes a cooling effect since heat doesn’t get trapped next to your body.

Even if you’ll only be out for a little while, it doesn’t hurt to apply some sunscreen to protect your skin.

Beyond the pants and shirts you wear, you can do more to help yourself when exercising in the heat. Sunscreen is a good idea anytime you’ll be out in the sun. Even if you’ll only be out for a little while, it doesn’t hurt to apply some to protect your skin. If you’re outside during the day, wearing some sort of hat to keep the sun off your face can help. The fabric may also absorb sweat from your forehead and keep it out of your eyes. A handy bandana can also work. Finally, a pair of sunglasses can also keep the bright sun from obscuring your vision and can protect your eyes from UV damage.

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If you’re looking to get fitter this summer, there’s no better excuse to get outdoors. The same reasons summer is so nice to be outside can quickly make exercising outdoors turn into a risk. You can make your summer workouts safer, more successful, and much more enjoyable by following these tips.

Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.

07/18/2023

The Annual Enrollment Period is fast approaching. If you have any questions or need help, please let me know

05/26/2023

Dehncke Insurance Services will be closed starting at noon Friday May 26th & May 29th for Memorial Day, reopening for business on Tuesday, May 30th at 9 a.m. Central Time.

04/10/2023

The Center for Medicare and Medicaid Services (CMS) finalizes changes to Medicare Advantage star ratings, prior authorization reforms.

By Robert KingApr 5, 2023 04:20pm
Prior AuthorizationCenters for Medicare & Medicaid ServicesMedicare AdvantageCMS Star Ratings

A new final rule seeks to ensure Medicare Advantage enrollees' care is not disrupted due to prior authorization.

A new final rule installs new requirements for Medicare Advantage plans to require prior authorization, such as ensuring a transition period when a beneficiary switches plans.

The Centers for Medicare & Medicaid Services released the final 2024 MA and Part D rule that introduces key policy changes. In addition to prior authorization, the rule includes changes for star ratings as well as provider directory and marketing reforms.

“With this final rule, CMS is putting in place new safeguards that make it easier for people with Medicare to access the benefits and services they are entitled to,” said CMS Administrator Chiquita Brooks-LaSure in a statement.

One of the key changes applies to the prior authorization tool insurers use to require providers to get approval before offering a certain service or drug.

The rule includes new continuity of care requirements that says coordinated care plans can only use prior authorization “to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary,” according to a fact sheet.

“MA plans cannot add additional hoops to go through before an enrollee can access to care they are entitled to under Medicare,” said Center for Medicare Director Meena Seshmani during a call with reporters.

Coordinated care plans also have to offer a minimum 90-day transition period if an enrollee under treatment switches to a new MA plan. The new plan must not require prior authorization for the course of treatment.

CMS sought to address concerns surrounding what the term “course of treatment” meant in the proposed rule. The agency said that the rule requires approval of a prior authorization request for a course of treatment that must be valid for as long as it is medically necessary to ensure there is no disruption in care and is recommended by the beneficiary’s provider.

An MA plan must also make sure to follow any national or local coverage determinations. If there is no determination in place, then an MA plan can create its own coverage criteria but must stand up a committee to annually review such guidelines.

The rule is the latest effort by CMS to address prior authorization in MA. The agency also finalized a rule that requires plans to install electronic prior authorization by 2026.

In addition to the prior authorization requirements, the latest MA and Part D rule finalizes several steps to crack down on misleading marketing practices.

CMS has prohibited ads that don’t mention a specific plan name as well as any ads that could use “words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing or misrepresents the plan,” the agency said.

The prohibition comes after some progressive lawmakers have introduced legislation to rename Medicare Advantage over concerns it could confuse seniors.

CMS also finalized new changes to strengthen plans’ role in monitoring agent and broker activity but did not finalize a proposal to change how brokers and agents share information with a third party.

“This is something we continue to explore,” said Seshmani without elaborating further.

The agency also finalized key changes to the star rating system, most notably the introduction of a health equity index in 2027 that will gauge how plans fare in improving social risk factors for beneficiaries.

11/02/2021

If you or someone you know is on Medicare, I will be posting some Q&A for general information

Question: Can my current 2021 Medicare Part D plan deny me coverage because of my high medication costs?

No. Medicare Part D prescription drug plans (PDP or MAPD) are “guaranteed issue” to all Medicare beneficiaries living within the plan’s service area. So, even if you have very high medication costs, a Medicare Part D plan cannot deny you coverage.

10/11/2021

If you are looking for a place to save money on your prescriptions, please let me know. Here are a few of this weeks prices.

08/04/2021

1. Popular questions about your 2021 Medicare drug coverage
2. 2022 Medicare Part D plan premiums projected to increase almost 5%
3. 2022 Late-Enrollment Penalties will increase slightly – max penalties reach $62.40
4. Changes in 2022 Low-Income Subsidy (LIS) state benchmark premiums
5. … and A Few Closing Notes

1. Popular questions about your 2021 Medicare drug coverage

Question: If I only use one brand-name drug that costs $375 and has a $47 copay, will I enter the 2021 Donut Hole?

Yes, in December. If your retail drug costs average $375 a month, you will exceed your Medicare plan’s $4,130 Initial Coverage Limit in early-December and enter the 2021 Donut Hole. Remember, your plan’s full retail drug cost is what counts toward entering the Donut Hole. Your $47 copay has no impact on entering the Donut Hole, but will count toward exiting the Donut Hole and entering the Catastrophic Coverage phase.

When will you enter the Donut Hole? If your average monthly retail drug costs are over $345, you will enter the Donut Hole sometime during 2021.

Remember, even though the Donut Hole is considered “closed”, the Coverage Gap still remains the third part of your Medicare Part D coverage where you pay 25% of retail for all formulary medications and it is possible that you will pay more for your drugs during the Coverage Gap as compared to what you paid during your Initial Coverage phase.

Question: What will I pay for my $375 brand-name medication when I reach the Coverage Gap?

You will pay around $94 in the Donut Hole. Once you enter the 2021 Donut Hole, you will pay 25% of the retail price for your brand-name medications – assuming that your Medicare prescription drug plan does not provide any additional Gap Coverage. However, you will get credit for 95% of the brand-name retail drug cost toward meeting your $6,550 total out-of-pocket threshold (TrOOP). So, you will pay $94 for your $375 brand-name formulary medication and receive $356 credit toward meeting your TrOOP. If you purchase a generic medication in the Donut Hole, you will also pay 25% of the retail price, but only what you pay will count toward your out-of-pocket threshold.

Question: Where can I see how close I am to the Donut Hole?

Your plan’s Explanation of Benefits letter. Each month, your Medicare prescription drug plan sends you an Explanation of Benefits letter showing a summary of your drug purchases and how close you are to entering your Medicare Part D plan’s Coverage Gap or Donut Hole.

Question: If I reach the Donut Hole, am I allowed to use a drug discount card instead of my Medicare Part D plan?

Yes. Medicare Part D plan coverage is voluntary. So, if you find a pharmacy discount program or drug discount card that saves you more than the 75% Donut Hole discount, you can buy your formulary prescriptions without using your Medicare prescription drug plan. But a drug discount card cannot be combined with your Part D coverage.

Question: Will I receive the 75% Donut Hole discount on non-formulary drug purchases?

No. Only Medicare Part D prescription medications found on your formulary receive the 75% Donut Hole discount. Non-formulary medications, bonus drugs, and medications excluded from the Medicare Part D program, do not qualify for the Donut Hole discount – and your non-formulary drug purchases do not count toward meeting your $6,550 total out-of-pocket drug spending threshold (TrOOP).

Question: If my drug plan agrees to cover a non-formulary drug, will I then receive the Donut Hole discount on this drug?

Yes. If you are using a non-formulary medication that is not excluded from the Medicare Part D program, you can ask your Medicare plan for a Formulary Exception – a type of Coverage Determination that adds a non-formulary drug to your Medicare Part D plan coverage. If approved, your medication would then receive the 75% Donut Hole discount when you enter the Coverage Gap.

Please remember, if your Medicare Part D plan denies your formulary exception request, you have the right to appeal your plan’s decision.

2. 2022 Medicare Part D plan premiums projected to increase almost 5%

In a recent press release, the Centers for Medicare and Medicaid Services (CMS) projected that 2022 Medicare prescription drug plan premiums will increase 4.9 percent. CMS estimates the average basic monthly premium for Medicare Part D prescription drug plans will increase to approximately $33 from the 2021 average basic premium of $31.47.

CMS calculates the average projected premium by analyzing stand-alone Medicare Part D prescription drug plan (PDP) premiums and premiums from Medicare Advantage plans that include prescription drug coverage (MAPDs) – both weighted by plan enrollment.

Question: Does the CMS premium projection mean that I will pay more for my 2022 Medicare Part D plan?

Not necessarily. The average premium estimated by CMS suggests that you should be able to shop around and find a 2022 stand-alone Medicare prescription drug plan (PDP) or Medicare Advantage plan that includes prescription drug coverage (MAPD) with about the same monthly premium as your current plan.

Remember, even if your Medicare drug plan premium remains stable – this does not mean that your 2022 Medicare plan’s coverage will stay the same. Your Medicare drug plan's prescription coverage, including which drugs are covered by your plan and at what cost, usually changes every year, even if your monthly Medicare plan premium remains the same.

Bottom line: A low monthly premium does not necessarily mean you are enrolled in the most affordable Medicare drug plan. So, be prepared to review your 2022 Medicare plan options starting in early-October.

Question: Will my 2021 Medicare Part D plan inform me about any changes to my 2022 plan coverage?

Yes. Every Medicare Part D plan or Medicare Advantage plan is required to send current plan members an Annual Notice of Change letter (ANOC). This 11+ page document details how the plan is changing in 2022. You should receive an ANOC in the mail by late-September. Medicare plan members should also review the Medicare plan's 2022 Evidence of Coverage (EOC) document mailed in early-October - or made available electronically for download. The EOC is a 140+ page document that includes detailed information about the Medicare plan's 2022 coverage.

3. 2022 Late-Enrollment Penalties will increase slightly – max penalties reach $62.40

If you have accrued a Medicare Part D late-enrollment penalty, you can expect a slight increase in 2022. The late-enrollment penalty (LEP) is an additional monthly cost paid by Medicare Part D beneficiaries who were without some form of creditable prescription drug coverage for more than 63 days.

The LEP is calculated each year by Medicare using the annual base Medicare Part D premium, and the 2022 base premium is $33.37, a slight increase from the 2021 base premium of $33.06.

Remember, people in certain situations are not assessed a late-enrollment penalty, including:
• People who qualify for Medicaid or the Medicare Part D financial Extra-Help program.
• People who have some other form of creditable prescription drug coverage, such as VA, TRICARE, or employer/union drug coverage.
Please note: If your late-enrollment penalty was not accurately calculated or was wrongly assessed, you can appeal your penalty.

Question: What will I pay for my 2022 late-enrollment penalty if I was without any prescription drug coverage for five years?

$20 per month. Your late-enrollment penalty is calculated by taking the number of months you were without creditable prescription coverage (in this example, 60 months) multiplied by 1% of the national base Medicare Part D premium ($33.37 in 2022) or 60 x $0.3337 = $20.03 rounded to the nearest $0.10.

4. Changes in 2022 Low-Income Subsidy (LIS) state benchmark premiums

The 2022 Low-Income Subsidy benchmark premium is the maximum premium subsidy allocated to cover monthly Medicare Part D premiums for people who receive full Extra-Help - and is calculated per CMS Part D region.

Bottom line: If you qualify for the Medicare Part D Low-Income Subsidy and enroll in a basic Medicare Part D plan with a monthly premium at or below your state’s benchmark, you should have a $0 monthly premium.

In 2022, two regions will lower their Medicare Part D LIS benchmark premium slightly and 32 CMS Part D regions will increase their benchmark.

Here are a few state highlights of the 2022 LIS benchmarks:
• New Jersey will see the largest benchmark decrease with a 2022 LIS subsidy of $37.07 as compared to $37.33 in 2021.
• New Mexico will have the largest benchmark increase with a 2022 LIS benchmark of $34.31 as compared to $28.17 in 2021.
• Idaho and Utah will have the highest 2022 benchmark premium of all CMS PDP regions at $42.93.
• Texas continues to have the lowest benchmark premium at $25.10.
Please remember that the actual number of 2022 Medicare Part D plans qualifying for the state’s LIS $0-premium will not be known until the 2022 Medicare Part D plan designs are released this fall. However, in 2021, we found that many states offered more $0-premium qualifying LIS plans as were offered in 2020.

5. . . . and A Few Closing Notes

Reminder: Protect yourself against the summer heat and humidity.
Be sure to drink plenty of water, stay in a cool area during the hottest times of the day, and seek assistance if you become overheated.

Is the 2022 Medicare Part D plan information already available?
No, the 2022 Medicare plan information is not yet publicly available. Although some Medicare Part D and Medicare Advantage plan providers have already shared a preview of their 2022 Medicare plans with their agents and brokers, detailed 2022 Medicare plan information will not be released until late-September or early-October.

06/21/2021

“We are dedicated to informing and educating the Individual and Medicare-eligible consumer throughout their journey. We assist you with your options by reviewing your current doctors, prescriptions, and offering you a plan based on their needs.”

Please contact us with any with questions.
www.dehnckeinsuranceservices.com

Dehncke Insurance Services is a Grove Heights, MN insurance agency specializing in Health Insurance, Medicare and Funeral Planning. Contact Bob Dehncke for a free quote.