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Michael T. Braden, August 28, 2024 GENERAL MEDICARE 7 Things You Need To Know If You Plan On Working Past 65. SHOULD YOU ENROLL IN MEDICARE OR KEEP YOUR GROUP INSURANCE AT 65? Here at Braden Medicare Insurance, we are licensed, independent Medicare Brokers. We work with people contemplating retirement every day. We always enjoy hearing about a person's career and helping to set them up for their next role as the CEO of Golden Years Inc. If you’re 65 or older, you are eligible for Medicare. You may elect employer coverage instead of Medicare if you or your spouse is actively employed and your employer offers creditable coverage . Generally, if your employer has more than 20 employees, Medicare considers its Group Health Plan creditable. But, if your employer has fewer than 20 employees, then Medicare does not regard your Group Health Plan as creditable. In this case, you should consider dropping your Group Health Plan and enrolling in Medicare at 65. When you have both Medicare and employer health benefits, your employer coverage often becomes the primary payer, covering your healthcare costs first, while Medicare pays second (becomes a secondary payer). Medicare Part A (hospital insurance) is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), so it makes sense to sign up for Medicare Part A even if you still have employer coverage. While we cannot predict when we may be injured or ill, statistics show that as we age, the odds of an incident increase dramatically. For this reason, at Braden Medicare, we consistently recommend that our clients enroll in Medicare Part B while they have creditable employer coverage. We reason that enrolling in Part B starts your 180-day Medicare Supplement Initial Enrollment Period. In most states, this is the only time you can apply for a Medicare supplement without required medical underwriting and the possibility of being denied coverage. And, most Group Employer Health Plans have much higher deductibles than Medicare, especially when paired with a Medicare Supplement policy. Medicare Part B (Outpatient Insurance) has a monthly premium of $174.70 for the 2024 Plan Year. But you can choose to delay Medicare enrollment without incurring any late enrollment penalties if you have " creditable coverage"  through other insurance, such as your group employer plan. Delaying Part B without creditable coverage can result in a significant late enrollment penalty. When you retire or whenever your employer coverage ends (voluntarily or involuntarily), you have an 8-month Special Enrollment Period to sign up for Medicare Part B without penalties. You are not  permitted to have both a Medicare supplement and an employer group health plan simultaneously. This is the main reason the vast majority of people who research their options prefer to enroll in Medicare at age 65 rather than stay with their Employer's Group Health Plan.       IS IT BETTER TO ENROLL IN MEDICARE WHEN I TURN 65? EVEN IF I AM STILL WORKING? If your employer has 20 or more employees, your employer coverage is often creditable and primary. You may choose to delay enrolling in Medicare Part B without penalties. Medicare Part A is typically premium-free for most people eligible for Medicare, so enrolling in Part A during your Initial Enrollment Period is a no-brainer. Medicare Part A benefits can provide additional coverage for hospital care without any cost to you. Even if you have employer coverage, it may make sense to enroll in Medicare Part A to use your employer benefits and Medicare together. If you contribute to a Health Savings Account (HSA), be aware that enrolling in any part of Medicare (including Part A) will affect your ability to make HSA contributions without penalty. IS IT LEGAL TO HAVE BOTH MEDICARE AND INSURANCE THROUGH MY EMPLOYER AT THE SAME TIME? Is it possible to have Medicare and employer coverage at the same time? It is possible, but not advisable. If you are still employed and have creditable group health insurance through your employer, you may delay enrolling in Medicare Part A and/or Part B without facing late enrollment penalties. If you are age 65 or older, your employer must have 20 or more employees for the group health insurance to be creditable. If you are under age 65, your employer needs at least 100 employees for the health plan to be creditable. As you turn age 65, you have an Initial Enrollment Period during which you can sign up for Medicare Parts A and B. This period starts 3 months before your 65th birthday month, includes your birthday month, and continues for 3 months afterward. Use our Medicare Enrollment Period Calculator to identify your initial enrollment period. If you are actively working and covered by your employer’s group health insurance plan at this time (or your spouse’s employer’s plan), you may choose to delay enrolling in Part B without incurring late penalties if the employer plan is creditable coverage. You can also sign up for Medicare Part B without penalties during a Special Enrollment Period, which lasts for 8 months after your employment ends. SHOULD MY SPOUSE ENROLL IN MEDICARE? Enrolling your spouse in Medicare is often more cost-effective than keeping them on your employer's health insurance plan. You may find that Medicare coverage is better health insurance at a lower price than employer insurance options. Plus, employer health insurance benefits change every year. Original Medicare coverage and supplement benefits never change. It’s much easier to predict and budget your medical costs during retirement when you have Original Medicare and a supplement. BRADEN MEDICARE INSURANCE BELIEVES THAT SINCE MEDICARE PART A IS FREE, EVERYONE SHOULD ENROLL IN PART A AT AGE 65. IT'S JUST GOOD COMMON SENSE Whether or not you should enroll in Medicare Part A (hospital insurance) when you are still employed and have employer coverage depends on your specific circumstances. If you are eligible for premium-free Medicare Part A, it may be a good idea to enroll even if you are still employed and have other health insurance coverage like a group health plan. Most people become eligible for premium-free Part A at age 65 if they or their spouse have paid Medicare taxes for a specific period (usually 10 years or 40 quarters). In this case, there is generally no downside to enrolling in Part A, no matter what your employer coverage pays. If you ever need hospital care, having Medicare Part A can reduce your expenses. For example, enrolling in Medicare Part A for a lower deductible than your employer group health plan would be a practical choice. Keep in mind that if you are contributing to a Health Savings Account (HSA) and want to continue doing so, enrolling in any part of Medicare Part A will affect your ability to make HSA contributions. IF I HAVE ACCESS TO MY employer's GROUP HEALTH PLAN, SHOULD I STILL ENROLL IN MEDICARE PART B? If you have creditable coverage (are actively employed and insured through a company with 20 or more employees), then you can delay enrolling in Part B (medical insurance) without facing the expensive late penalties. Medicare does not consider all health insurance coverage creditable; there are rules and exceptions. Our Creditable Coverage cheat sheet can help you identify if your coverage is creditable. The most important factor when deciding to enroll in Medicare Part B when you have employer coverage is the fact that doing so starts your 180-day Medicare supplement Initial Enrollment Period. This is the period when you can get a Medicare supplement without concern for pre-existing conditions or your health history. After this enrollment period, an insurance company can deny your Medicare supplement application. We strongly advise people not to enroll in Part B if they will continue employer coverage, to preserve their Medicare supplement Initial Enrollment Period. Your employer health insurance plan is required to send you a Notice of Creditable Coverage once per year. You should keep these notices in case they are needed later. When you finally enroll in Medicare Part B, your employer will need to sign a form attesting that you had creditable coverage since you turned age 65. If you have difficulty getting your former employer to sign this form, those letters of Creditable Coverage you saved will come in handy. And remember that enrolling in any Part of Medicare can affect your HSA contributions. HOW DO YOU DELAY ENROLLING IN MEDICARE PART B WHEN YOU RETIRE? After retiring and no longer actively working, your employer-sponsored health insurance is no longer considered creditable coverage for Medicare. Some employers extend health insurance for some time after you stop working. However, once you stop being an active employee, your health insurance is no longer creditable. You have eight months from the date you stop working to enroll in Medicare. Don’t delay Medicare enrollment in Part B once you retire. This is a common mistake that can be costly. The late penalty for not enrolling in Part B when you are supposed to be 10% of the Part B premium for every 12 months of your delayed enrollment. This penalty is paid every month for the rest of your life. DOES IT MATTER WHO PAYS FIRST AND WHO PAYS SECOND? If your employer offers a retiree program that allows you to maintain employer health benefits, enrolling in Medicare Part B can help you avoid the late enrollment penalty, although this is not advisable. Upon retirement, if you decide to retain both Medicare and employer coverage, Medicare Part B will take on the primary role, making your employer plan a secondary payer of medical bills or secondary insurance. However, many retirees find it more useful to discontinue their employer coverage and opt for Original Medicare plus a Medicare Supplement plan. It’s frequently more affordable health insurance as well. SHOULD I ENROLL IN MEDICARE PART D IF I AM KEEPING MY EMPLOYER'S GROUP HEALTH INSURANCE? Your employer’s group health plan usually includes creditable prescription drug coverage. That gives you the option to postpone enrolling in Medicare Part D without facing any late penalties. If you have prescription drug benefits through your employer group health plan, having Medicare coverage may not provide significant advantages because the coverage does not typically complement each other. If your employer's group health plan prescription benefits are lacking, you can enroll in Medicare Part D as long as you qualify for Medicare Part A. You do not need to have Medicare Part B to sign up for Medicare Part D. Make sure to compare your employer’s group insurance with the benefits and costs associated with Original Medicare plus a Medicare Supplement (Medigap) plan, and Medicare Part D. Call us if you need help choosing the best healthcare coverage for your needs. Often, it proves to be more cost-effective and advantageous to transition away from group health insurance insurance and enroll in Medicare, while also adding a Medicare Supplement plan and a Medicare Part D plan to your health coverage. This way, a Medigap plan from a private insurance company will become your secondary payer and cover most of the gaps, deductibles, co-pays, and coinsurance of Original Medicare. If you don’t have creditable health coverage for Part D through your employer plan and you delay enrolling in Medicare Part D when you are eligible, you may face late enrollment penalties if you later decide to enroll. These penalties will increase your Part D prescription drug coverage premiums. It also makes sense to evaluate your medication needs. If you have a chronic condition or take prescription drugs regularly, double-check that your current coverage meets your needs. Medicare Part D plans vary in the drugs they cover and their cost-sharing structures. Remember that you can enroll in or disenroll from Medicare Part D during specific enrollment periods. You can enroll during your Initial Enrollment Period when you first become eligible for Medicare and during the Annual Open Enrollment Period (October 15 to December 7) each year. This provides some flexibility to adjust your health insurance coverage as needed.       IF I AM STILL WORKING AND ENROLL IN MEDICARE, WILL MEDICARE BE MY PRIMARY OR SECONDARY COVERAGE? WHETHER MEDICARE PAYS FIRST OR SECOND DEPENDS ON THE SIZE OF YOUR EMPLOYER If you reach the age of 65 and meet the eligibility criteria for Medicare while employed by a company employing 20 or more individuals, your employer group health plan will become your primary payer, and Medicare will act as a secondary payer. In this case, your employer’s plan pays first, and Medicare covers some of the costs that your employer’s plan doesn’t. If your employer has fewer than 20 employees, Medicare becomes your primary health insurance, and your employer’s plan is a secondary payer. With small group insurance, it’s highly recommended to enroll in both Medicare Part A and Part B as soon as you are eligible. If you do not enroll in Medicare once you qualify, your employer coverage may refuse to pay your claims. That’s why enrolling in Medicare Part B is essential to avoid any gaps in coverage. Remember that failing to enroll in Medicare Part B when you become eligible for Medicare will also result in a hefty late penalty, as your small employer’s group health coverage will not qualify as creditable coverage for Medicare. When it comes to Part D, this Medicare plan usually doesn’t coordinate well with the employer’s drug plan, so we don’t advise keeping that insurance and Medicare. I LOVE MY HSA HOW DOES MEDICARE WORK WITH HEALTH SAVINGS ACCOUNTS? Once you enroll in any part of Medicare (Part A or Part B), you can no longer contribute to your HSA. This includes not only new contributions but also any employer contributions. So if your employer plan provides an HSA option while you have both Medicare and employer coverage, you typically won’t be eligible to choose it. If you continue to make HSA contributions after enrolling in Medicare, you may incur tax consequences. While you can’t contribute to your HSA after enrolling in Medicare, you can still use the funds you’ve accumulated in your HSA to pay for qualified medical expenses, including Medicare premiums, deductibles, co-payments, and coinsurance, including Part B, Part D (prescription drug coverage), and Medicare Advantage premiums (if applicable). Using HSA funds for these expenses is tax-free. If you plan to retire and transition from employer coverage to Medicare, make sure to coordinate the timing to avoid any gaps in coverage and to understand how the shift affects your HSA contributions and withdrawals. After your Medicare Initial Enrollment Period (IEP), when you sign up for Medicare, Part A coverage will start retroactive to your date of application. Part A will begin either 6 months before your application date or the first day you were eligible for Medicare, whichever is sooner. This can disrupt your health savings account contributions. If you are enrolling in Medicare after you have turned age 65, keep this in mind to stop your HSA contributions before the Medicare Part A start date. If your spouse is covered by your group insurance and their Medicare coverage is not yet active, they can still make contributions to their Health Savings Account (HSA) as long as the contributions are made in their name. IS IT POSSIBLE TO HAVE A MEDICARE ADVANTAGE PLAN WHILE KEEPING MY EMPLOYER INSURANCE It is possible to have both Medicare Advantage and employer-provided insurance simultaneously, but this is not an efficient health care coverage option and presents essential considerations . When you have both a Medicare Advantage plan and employer insurance, Medicare Advantage typically becomes your primary insurance, and your employer coverage becomes secondary. Consider the costs versus the benefits of both options. Make sure to explore our other posts on Medicare Advantage plans and why they may not be the best option for many people as a primary payer. For example, a Medicare Advantage plan will have limited networks that may not be the same network as your employer plan. Plus, these networks change regularly. You may also need to wait for authorization to see a specialist or to proceed with specific procedures under a Medicare Advantage plan. Beware that many Medicare Advantage plans include prescription drug coverage (Medicare Part D). If you have employer prescription drug coverage, you are not permitted to use both at the same time. There will be coordination-of-benefits issues that need clarification . DO I REALLY NEED TO HAVE SUPPLEMENTAL INSURANCE IF I AM CHOOSING ORIGINAL MEDICARE? Whether you need supplemental insurance with Medicare depends on your individual needs and financial situation. Medicare provides substantial coverage for many healthcare services, but it does not cover all costs, and there can be out-of-pocket costs. For example, it doesn’t cover prescription drugs, routine vision and dental care, or long-term care. In those situations, you may need a secondary payer. Medigap plans are offered by private insurance companies and designed to fill in the gaps in Original Medicare coverage. They can help cover deductibles, copayments, and coinsurance. In this case, Original Medicare will be your primary payer, and Medigap will be your secondary payer. WRAPPING THINGS UP I hope this article, "7 Things You Need to Know About Working Past Age 65," was helpful . We enjoy hearing from readers of our articles, and we would be happy to answer any additional questions you may have about Medicare. Here at Braden Medicare Insurance, we are passionate about serving our clients. We listen, ask insightful questions, and present options for your consideration . At Braden Medicare Insurance, the client is always in control. Our job is to do all the heavy lifting and take the stress away from our clients. Medicare Insurance is essential and personal. This is why we believe that everyone approaching 65 should always work with an Independent Medicare Broker in their area. Please feel free to text or email me, or pick up the phone and give us a call whenever you have a few minutes to chat.

Michael T Braden June 4, 2024, MEDICARE PART D I wrote my first blog article about the Amazon Pharmacy shortly after Amazon purchased PillPack. I think for individuals who take multiple medications, and in particular, medications at different times of the day, this is a game-changer, and it is a lifesaver for many Medicare Beneficiaries across the country. And today, I am excited to share with you another great service, for all Medicare Beneficiaries courtesy of the Amazon Pharmacy and RxPass.   Last Month, Amazon announced the expansion of eligibility for its RxPass prescription medication program. This program allows Medicare beneficiaries to receive unlimited popular, generic (Tier 1 & Tier 2) prescription medications for just a $5.00 Subscription Fee Per Month. OVER 50 GENERIC MEDICATIONS FOR $5 PER MONTH, NOT $5 FOR EACH PRESCRIPTION, JUST $5 PERIOD! * Amazon Prime members, get all of your eligible medications in one monthly subscription Just $5.00 A Month For Your Generic Medications, delivered to you by Amazon Prime! AMAZON'S RxPass HAS YOU COVERED While other savings programs charge for each medication, Rx Pass is always $5 a month —no matter how many generic prescription medications you take.   AMAZON RxPass HAS A LOW FLAT FEE ON 50 GENERIC MEDICATIONS FOR SENIORS. Every Amazon Prime Member who is a current Medicare Beneficiary can join RxPass and begin to take advantage of these unbelievable savings. SUBSCRIBE FOR JUST $5 PER MONTH Just one monthly price for all of your eligible medications . EASILY SEARCH FOR YOUR MEDICATIONS ON AMAZON When searching on Amazon, we’ll show you when a medication is included with RxPass. AMAZON WILL DELIVER YOUR MEDICATIONS DIRECTLY TO YOU Your medication is packed securely and discreetly, with status updates. REMEMBER.........YOU HAVE TO BY AN AMAZON PRIME MEMBER TO JOIN RxPASS RxPass is exclusive to Amazon Prime members. You’ll need to sign up for Amazon Prime before you can subscribe to RxPass. Plus, you’ll get all the other great benefits of being an Amazon Prime member—including free 2-day delivery, exclusive deals, and prescription savings.   RxPASS IS AN EASIER AND SIMPLER WAY TO GET YOUR RxPASS IS A BETTER WAY TO RECEIVE YOUR PRESCRIPTION MEDICATIONS   DID YOU KNOW THAT THE AVERAGE AMAZON PRIME MEMBER SAVES 47% BY USING RxPASS? COMPARE THE AMAZON PHARMACY GENERIC PRICING FOR GENERIC MEDICATIONS TO YOUR PRICE AND GOOD RX. SEE IF THE AMAZON Rx PASS CAN SAVE YOU MONEY? INCLUDES MORE THAN 50 OF THE MOST COMMON PRESCRIBED GENERIC MEDICATIONS FAST, FREE DELIVERY TO YOUR DOOR      MORE WAYS TO SAVE BY USING AMAZON PHARMACY   DID YOU KNOW THAT AMAZON HAS A FULL-SERVICE PHARMACY? THE AMAZON PHARMACY MAY BE USED AS YOUR PREFERRED PHARMACY BY MOST MEDICARE PART D PRESCRIPTION DRUG PLANS. IF YOU TAKE MULTIPLE MEDICATIONS, ESPECIALLY IF YOU TAKE THEM MULTIPLE TIMES PER DAY, YOU SHOULD ASK ABOUT AMAZON PILLPACK. WITH AMAZON PILLPACK, EACH OF YOUR MEDICATIONS COMES SEPARATED AND DATED IN ITS CONVENIENT EASY-TO-OPEN PACKET. YOU MAY BE WONDERING.......... . IS RxPASS A GOOD OPTION FOR YOU? If you’re a Prime member and you are paying more than $5 a month for all of your generic medications, RxPass could help you save. RxPass isn’t insurance, but it can be helpful for those without insurance or when insurance doesn’t cover certain medications. Many people with diabetes, high blood pressure, and anxiety will find their medications eligible with RxPass.     HOW DOES THE RxPASS WORK? RxPass is a benefit for Prime members that gives subscribers access to the most common generic medications for a flat fee of $5 a month. Subscribers can get all their prescribed generic prescription medications on the RxPass list filled as often as they need for one flat monthly fee. RxPass offers auto-refill so that you get all your eligible prescriptions automatically for $5 a month. Which medications are included with RxPass? YOUR RxPASS SUBSCRIPTION INCLUDES MORE THAN 50 GENERIC MEDICATION, S COVERING MANY COMMON AILMENTS. Not everyone is eligible to subscribe to RxPass. Why? RxPass does restrict eligibility based on insurance and the state where medications will be shipped. People with state-funded insurance such as Medicaid and CHIP are not eligible to sign up for RxPass right now. Additionally, RxPass is not currently available to send medications to California, Minnesota, Texas, and Washington. However, the Amazon Pharmacy  is still available in all of those states. DO YOU HAVE TO BE AN AMAZON PRIME MEMBER TO USE RxPASS? Yes, RxPass is exclusively an Amazon Prime member benefit. If you’re not a Prime member, you must join Prime before subscribing to RxPass. HOW OFTEN WILL YOU BE CHARGED? The subscription fee for RxPass will be charged to your selected payment method on the first of each month. When you subscribe, you’ll be charged a prorated amount for your first month and charged on the first day of the following month. What if I decide to cancel? You can cancel RxPass anytime. You will still be able to use RxPass for the rest of the month you’ve paid for, and you will not be charged again.ca n still You ca n still   CURRENT AMAZON Rx PASS MEDICATIONS Allopurinol Amlodipine Amlodipine Amoxicillin Atorvastatin Azelastine   Benztropine Bupropion Er Bupropion Cephalexin Cyanocobalamin Cyclobenzaprine Cyproheptadine Donepezil Doxazosin Doxepin Doxycycline Doxycycline Monohydrate Dutasteride Escitalopram Estradiol Ezetimibe - Simvastatin Finasteride Fluticasone Furosemide Glipizide Glyburide - Metformin Glyburide Micronized Hyoscyamine Disintegrating Tablets Hyoscyamine Sublingual Tablets Lamotrigine Lisinopril Losartan Methimazole Mometasone Multivitamin With Fluoride Naproxen Nystatin - Triamcinolone Ointment Nystatin Cream Omeprazole Ondansetron Disintegrating Tab Ondansetron Tab Oxybutynin Phenytoin Piroxicam Pramipexole Quetiapine Ramipril   Renal Caps Soft gel Risperidone Rizatriptan Ropinirole Rosuvastatin Sertraline Sildenafil Sotalol Subvenite Tamoxifen Terazosin Tizanidine Triphrocaps Venlafaxine THIS MIGHT BE A BIG HELP TO MANY MEDICARE BENEFICIARIES   While Rx Pass is available for Medicare enrollees, that does not mean you should disenroll from your Medicare Part D plan. Because the RxPass is limited, it is not considered "Credible" by CMS. So, this should be viewed as an addition to your current Stand-Alone Part D plan or your Medicare Advantage Prescription Coverage.   Rx Pass has been designed to work seamlessly with your current Part D Prescription Drug plan. RxPass is specifically beneficial for those Medicare beneficiaries who have several generic medications. So instead of paying several small co-pays or co-insurance amounts for each medication, they can receive all of their Generic Medications (Provided they are specified on the list above) for just $5 per month, regardless of how many they take.    These medications are safely delivered to your door free of charge every month. If your medication is not covered by Amazon Rx Pass, you should continue to use your Medicare Part D Prescription Drug plan, just like you always have at your favorite "Preferred Pharmacy" for your particular plan. There are several benefits for both the Medicare program and enrollees when using Rx Pass. However, the most notable benefits include cost savings and convenience. DID YOU KNOW THAT THE AMAZON PHARMACY HAS BEEN AROUND FOR YEARS? AND THEY ARE AN APPROVED VENDOR FOR MOST MEDICARE PART D PRESCRIPTION DRUG PLANS? THEY ALSO OFFER CUTTING-EDGE TECHNOLOGY LIKE THEIR INDIVIDUALLY WRAPPED AND LABELED PILL PACKS.   However, on the other hand, while Rx Pass offers many benefits, there are some potential challenges and considerations to keep in mind: LIMITED LIST OF GENERIC MEDICATION AS OF JULY 2024:   At present, Rx Pass only includes generic medications, which might not cover all the needs of Medicare beneficiaries, especially if you are prescribed any Brand-Name medications. YOU MUST BE AN AMAZON PRIME MEMBER :   The service is only available to Amazon Prime  members, which adds cost for those not already subscribed to Prime. AMAZON RX PASS IS PART OF YOUR AMAZON PRIME BENEFITS AMAZON RxPASS COST SAVINGS One of the most significant advantages of the Amazon Rx Pass for Medicare beneficiaries is the potential cost savings associated with using the program.With a minimal $5 Flat Fee, per month, members can access over 60 generic medications. Plus, there is no cap to the number of prescriptions you can fill using this program. Whether you fill 1 or 10 prescriptions, you are only required to pay the monthly membership fee. This can be particularly beneficial for individuals on multiple medications, as it simplifies budgeting for prescription costs.   Instead of paying multiple co-payments that usually cost $2 - $10 for each Prescription, which can average from $2-$10 per generic medication depending on the pharmacy you use and the Part D plan you are enrolled in. You could just pay one consistent flat fee of $5 per month. If you receive at least one medication through Rx Pass each year, it is projected that you could save up to $70 out-of-pocket.   That number increases the more medications you receive. It is intended to help reduce Medicare spending. If all Medicare enrollees began using Rx Pass for their eligible medications, Medicare spending would reduce by 1.5 - 2 billion dollars annually. This would allow for potentially lower Medicare costs and result in higher margins for the Medicare program.   MORE CONVENIENCE BROUGHT TO YOU BY AMAZON RxPass was designed around convenience. Not only are the prices low, but the medications are easy to obtain. The program provides the convenience of home delivery with free shipping, eliminating the need for trips to the pharmacy. In addition to easy medication delivery, members also have 24/7 access to a licensed pharmacist. This ensures you receive professional advice whenever and wherever needed.   Individuals who are bed-bound, have limited mobility, or wish to stay home to reduce the risk of falls or avoidable injuries may have opted out of Medication in the past due to their inability to go to the pharmacy or leave their home. Now, these individuals can have access to the medication they need and can benefit greatly from this program. HOW AMAZON AND THE RxPASS COULD SHAKE UP THE PRESCRIPTION DRUG LANDSCAPE IN AMERICA The introduction of Rx Pass places competitive pressure on traditional pharmacies and other prescription delivery services. This competition could lead to more affordable options and better services across the industry, benefiting all consumers, including Medicare beneficiaries.   This type of pressure is a step in the right direction for individuals who rely on prescription medications to maintain a healthy lifestyle. Additionally, if Amazon Rx Pass leads to better medication availability this could lead to better health outcomes, resulting in fewer hospitalizations and less medical interventions, leading to lower overall healthcare costs and keeping more money in your pocket each month.   Overall, Amazon Rx Pass represents a significant innovation in the delivery and cost of prescription medications. For Medicare beneficiaries, the potential cost savings, convenience, and improved medication availability are substantial benefits.   As the service evolves, it will be interesting to see how it impacts Medicare Beneficiaries, their wallets, and the overall impact it will have on the Prescription Medication systems we have in the United States.   WRAPPING THINGS UP We are excited to see how quickly the word spreads about the new Amazon RxPass. There is potential for savings and convenience for the Medicare Beneficiaries /Amazon Prime Members. I liken this approach to COSTCO and SAM's CLUB. They are not making money off of the prices at the locations, they are making money off of the Memberships. And, in the long run, this is a great way to keep a growing staff of Pharmacists and Pharmacy Techs busy while also adding value to your Amazon Prime membership.

Michael T. Braden, August 27, 2024 BRADEN MEDICARE INSURANCE What is a Medicare Broker? And how are Medicare Brokers different from Medicare Agents? MEDICARE BROKER VS MEDICARE AGENT There are two types of Agents. A Captive Agent is contracted with only one Insurance company, meaning they are not permitted to market or discuss any other Medicare plans from any other company. The second type of Agent is an Independent Agent, typically contracted with only 1-3 companies . While a Medicare Broker, who is still technically an Agent, can represent multiple Insurance companies. Most brokers work with 4-8 companies. At the same time, here at Braden Medicare, we are contracted with over 40 of the Top-Rated and most respected Medicare Insurance companies in the United States. This means we have access to more plans, and , beyond giving consumers more choices, it also gives you access to the lowest premiums. Because of the relationships we have created and nurtured over the years, we have the ability and obligation to help you find the best Medicare plan to meet your needs .  We do this by listening to you , then we research and prepare quotes based on the information and insights you provide .  Our interest is to put your interests and desires front and center. We hope to earn your confidence and your trust so that we will have the honor of serving you and your family today and for the rest of your tomorrows.   HOW DO BROKERS GET PAID? The good news is that Medicare brokers are paid by the insurance companies they represent, so there is never a cost for our help, advice, services, or expertise . You pay the same rate for your insurance if you use a Medicare Broker or if you contact any insurance company on your own.  Every company builds commissions into its premiums. There is no additional fee to enroll through a broker like us.  This means you pay nothing and receive all the benefits of our years of experience and the Training we must complete every year.  So, then everything I get from you at Braden Medicare is free? Yes, our service is completely free to you.      WHY IS CHOOSING BRADEN MEDICARE INSURANCE THE SMART CHOICE FOR YOUR MEDICARE INSURANCE NEEDS?  The benefit to you is enormous. Braden Medicare includes all of the back-end policy support that you cannot get directly from an insurance company, and the dedicated personal touch that our competition simply cannot or will not offer. We are here to assist you whenever you need help. Whether you are shopping for a new policy or looking for ways to reduce your premiums without losing any of your benefits, you have questions about billing or researching your Part D Prescription Drug Plans every year. We are dedicated to serving all of our clients as if they were members of our extended family. Family sticks together, and family looks out for each other's best interests.   We happily put you and your interests first, above all else; serving you and your family is what it is all about for us.  At Braden MSI Insurance and https://www.bradenmedicare.com , we are not just passionate about what we do; we love helping our clients however we can. Most Medicare Brokers can write a policy for you ; some give you information, but I know from experience that no one else can deliver as we do at Braden Medicare Insurance.  We will always do our best to break Medicare down to simple terms and will never try to dazzle you with BS! We take pride in providing you with Tips and Insights about Medicare that make it easy to understand.   At our core, we are teachers, mentors, and advisors. We are happy to take the time you need to understand Medicare and all its moving parts. You will also be able to help your friends and family with the knowledge and confidence you gain by working with Braden Medicare Insurance.    HOW DO I KNOW YOU AREN'T JUST RECOMMENDING COMPANIES WITH THE HIGHEST COMMISSIONS FOR YOUR OWN GAIN? This question is asked quite a bit; it is not only a great question, but also an honest one. I have found that a new broker is more likely to be swayed by writing a policy with a 1% higher commission than another policy, as they are trying to build a business and maximize their revenue.  However,  when you are working with an experienced broker like  www.BradenMedicare.com and Braden MSI Insurance, you will find out in short order that we are completely transparent in our approach.  We share quotes directly from the Insurance companies with you so you can see the rates for all companies .   We understand our role as your advisors, and our goal is always to ensure you are 110% satisfied with us.  I honestly could not tell you what the commission structures are for each company we are duly licensed and contracted with.  This is because of two primary factors: Medicare is a Government Program, so there needs to be complete transparency and It is a very competitive market and, as such, is highly similar; each company knows what the other companies are paying. It is a very level playing field. I can confirm that commissions for Medicare Advantage policies are roughly double those for Medicare Supplement plans.  I can further disclose that our business is about 70% Medicare Supplement/Medigap policies and 30% Medicare Advantage plans.  Our role is that of an advisor; we listen to your wants, needs, and goals regarding your Healthcare plan.  We present the full, unedited quotes, then continue answering your questions honestly and straightforwardly . We share our thoughts and ideas whenever you call upon us, but we have no hidden agendas. Because Medicare Supplement plans are standardized, each Plan offers the same benefits and coverage in every state.  We know from experience that price is the deciding factor for 90% of our clients, and we recognize that each private Insurance company sets prices in every state where it operates . No Broker in America can offer lower rates, as they are set by each state, not by us.   Please feel free to contact us anytime by phone at (480) 225-1393, by text message at (480) 225-1393, or by email at mike@bradenmedicare.com . At Braden Medicare , you can see for yourself what it means to work with a company that not only cares, but they honestly do whatever they can to save you money, while always being honest, answering all of your questions, and busting their butts off to earn trust.  We are a humble group. We listen first and ask questions, and you will never feel pressured to do anything. We believe Insurance, especially Health Insurance is a personal decision. We will never speak negatively about any other Agents or Brokers. We think we have put in the time, the work, and the ongoing study hours to be better prepared than anyone else for Medicare Insurance. BRADEN MEDICARE INSURANCE IS LICENSED IN 12 STATES We are based in Chandler, Arizona, the 4th-largest city in Arizona and a suburb of Phoenix. In addition to servicing our awesome clients across the state of Arizona, we are also licensed in the following states: Florida Indiana Iowa Nevada California Colorado Michigan Ohio Oregon New Mexico Pennsylvania Texas Wisconsin Braden Medicare Insurance Poster Describing the differences between Medicare Agents and Medicare Brokers. And, why working with a licensed independent Medicare Broker makes good common sense.

Michael T. Braden August 27, 2024 MEDICARE SUPPLEMENTS & MEDIGAP THIS IS HOW ORIGINAL MEDICARE COORDINATES WITH MEDICARE SUPPLEMENT/MEDIGAP PLANS A woman using her laptop in her kitchen to research how Medicare Supplement Plans work with Original Medicare. If you’re around 65, close to retiring, or already retired, chances are you’re researching Medicare. During your research, perhaps you’ve come to like what Original Medicare, or Medicare Part A and Part B, offers. But there’s a glaring problem you may have spotted: Medicare doesn’t cover some of the costs your employer-provided insurance likely used to cover. Luckily, with a Medicare Supplement plan, you can get coverage more like what you were used to. A Medicare Supplement plan is an excellent option for people who prefer the government-run Medicare program but want a few more of their costs covered. This article explains what a Medicare Supplement plan is, how it works, the benefits each plan offers , and more.   WHAT EXACTLY IS A MEDICARE SUPPLEMENT PLAN? A Medicare Supplement (also known as Medigap) plan is a supplemental insurance plan sold by a private company. This type of insurance helps cover costs that Original Medicare doesn’t, such as deductibles, copayments, and coinsurance.   EXPOSING THE GAPS IN ORIGINAL MEDICARE Original Medicare covers a wide range of illnesses, ailments, and preventative treatments. But under this insurance, you may still end up paying quite a bit more than you were expecting for services that you thought should be better covered. For example, hospital stays are covered under Medicare Part A, but only for up to 90 days. If you were to contract an illness requiring a more extended stay, you’d face steep medical bills. This situation is one of many “gaps” that people often wish were filled. Original Medicare is like a dam holding back a reservoir of medical costs you’ll never have to worry about. In many cases, these costs don’t affect you if Medicare covers you and you continue to pay your premiums. But in this same dam , there are a few leaks—costs that will be passed to you, especially if you’re a frequent user of your Medicare health insurance. This is where Medicare Supplement (Medigap) plans help. A Medicare Supplement plan is like a private insurance company plugging some of the leakier holes in the dam of Medicare coverage. But unfortunately, it’s not free. And the more leaks insurance companies fill, the more it will cost you in premiums (monthly payments). But in the long run, you can avoid spending a lot of money out of pocket later if you’re willing to pay a little more in premiums in the short term.   JUST HOW DO MEDICARE SUPPLEMENT PLANS WORK? Once you enroll in both Part A and Part B, you have the option to add a Medicare Supplement plan to give yourself additional coverage. Medicare Supplement plans work in addition to your existing Medicare coverage, so the benefits of the Medigap plan kick in once coverage from Part A or Part B ends. Additionally, the federal government regulates which benefits each plan provides. The plans themselves offer the same benefits no matter which company sells them. This means that no matter which company you purchase a Plan F (one of many Medigap policies) from, the benefits must all match the Plan F benefits set by law. It’s worth noting, however, that premiums for a plan can vary widely from one company to the next. For this reason, you may be able to find better deals if you get quotes from various companies. It’s pretty easy to get Medicare Supplement  plans  confused with Medicare  parts  because some of them share names. Keep in mind, they are not the same. Medicare Part A, Part B, Part C, and Part D are all sections of Medicare. Medicare Supplement Plans  A ,  B ,  C ,  D ,  F ,  G ,  K ,  L ,  M , and  N  are Medigap policies that supplement your Original Medicare coverage. The  plans  supplement coverage for the  parts.   EXPLANATION OF MEDICARE SUPPLEMENT PLAN BENEFITS? 1. MEDICARE PART A HOSPITAL COSTS & CO-INSURANCE Remember the example from the beginning, about the person who stayed in a hospital longer than 90 days? This benefit is especially valuable for worst-case-scenario hospital stays. Under Medicare Part A, a hospital stay past 60 days (until day 90) will cost you coinsurance payments. Days 90 and beyond are far more expensive. The Part A coinsurance and hospital benefit remedies these potentially high costs, kicking in for up to a full year, once your Original Medicare benefits are used up.   2. MEDICARE PART B CO-INSURANCE & CO-PAYMENTS This covers coinsurance or copayments that doctors and other providers typically charge you under Part B .   3. YOUR 1ST THREE PINTS OF BLOOD ARE FREE Under Original Medicare, you have to pay for every pint of blood you receive until you hit four pints in a calendar year. You’re covered for the first three pints you get in a year with this benefit.   4. HOSPICE CO-INSURANCE & CO-PAYMENTS Medicare Part A covers Hospice care, but there can be a few co-payments. For instance, with Original Medicare alone, you must pay $5 per prescription . And if your hospice facility needs to temporarily move you to another facility, like a nursing home, you’ll have to pay 5% of respite care costs. With Part A hospice care co-payment coverage, all these co-payments would be covered, so hospice would essentially be free.   5. CARE AT A SKILLED NURSING FACILITY OR SNF Suppose you receive care from skilled nursing or therapy staff. These facilities may be part of a nursing home or a hospital and are registered as SNFs with Medicare. Treatment in SNFs includes physical therapy, audiology, occupational therapy, and others. Although Original Medicare covers treatment in an SNF for up to 20 days, after day 20 you incur daily coinsurance (currently $185.50 per day in 2022).1 Those fees are completely covered if you purchase a plan with the SNF care coinsurance benefit.   6. PART A DEDUCTIBLE Part A of Medicare will cover your first 60 days in a hospital, but only after you meet your not-so-small deductible in your benefit period ($1,556 in 2022).2 A plan with this benefit covers your Part A deductible completely.   7. PART B DEDUCTIBLE This is a significant benefit that covers your deductible for any Medicare-approved Part B service. With this deductible covered, you can see a doctor without any out-of-pocket cost. The Part B deductible benefit is controversial, so much so that Congress will no longer allow plans that cover the Part B deductible (Plan F and Plan C) to be sold after January 1, 2020. Newly eligible beneficiaries after 2020 will not be able to buy Plan F or Plan C, but anyone who already had either of these plans before can keep them The 2023 Annual Part B Deductible is decreasing from $233 to $226.   8. PART B EXCESS CHARGES If you go to a doctor who doesn’t accept “assignment” (another way of saying the doctor agrees to the Medicare-approved amount for a service), they can legally overcharge you for the service. The Part B excess charge benefit covers these excess charges .   9. FOREIGN TRAVEL COVERAGE In general, Original Medicare doesn’t cover emergency services outside the U.S. There are a few rare exceptions, such as traveling from foreign countries to US territories (e.g., driving through Canada to reach Alaska). If you enjoy foreign travel, this is a great benefit to have in addition to, or instead of, other Travel Insurance.   10. OUT OF POCKET LIMIT A benefit many are typically used to with private insurance, the out-of-pocket limit applies only to Plans K and L. When you reach your Annual Part B deductible ( in 2021, the Medicare Annual Part B deductible was $203) and the out-of-pocket limit for your plan, your Medigap plan pays 100% of your covered services for the rest of the year.   ARE MEDICARE SUPPLEMENT PLANS EXPENSIVE? It depends! Generally, the more coverage a plan provides, the higher the cost. But prices also vary by insurance company, beneficiary location, and the number of other people on the plan in your area. Again, by law, every plan must cover the same benefits , so shopping around can save you money.   WHAT IS THE BEST TIME TO ENROLL IN A MEDICARE SUPPLEMENT PLAN You can enroll within six months of signing up for Medicare Part B, as long as you have your Medicare Number. Besides choosing a plan that best suits your needs, timing is critical when purchasing a Medigap plan. For anyone 65 and over, within a six-month window of signing up for Medicare Part B, federal law guarantees the following protections: You cannot be denied a Medicare Supplement policy offered in your area. You cannot be charged higher premiums based on pre-existing health conditions. Federal law assures these protections (called guaranteed issue rights) within that six-month window. But once that window closes, Medigap providers can deny you coverage, charge you more based on your health, or require you to wait longer for coverage to begin. If you are considering a Medigap plan, do your absolute best to obtain your policy during the period when you have guaranteed issue rights.  THE EIGHT THINGS YOU NEED TO UNDERSTAND ABOUT MEDICARE SUPPLEMENT AND MEDIGAP PLANS  You must have Medicare Part A and Medicare Part B. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one. Any standardized Medigap policy is guaranteed renewable, even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium. Some Medigap policies sold in the past covered prescription drugs. But, Medigap policies sold after January 1, 2006, aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan, also known as Medicare Part D.  It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.   ITEMS THAT ARE NOT COVERED BY MEDICARE SUPPLEMENT OR MEDIGAP PLANS It is important to remember that your Medicare Supplement Policy will mirror Original Medicare. There are some items not covered by Original Medicare. Some of these items are: Routine Dental Care Routine Eye Care (Glasses & Contacts) Routine Hearing Care Hearing Aids Long Term Care Short Term Care Private Nursing Care INSURANCE POLICIES THAT ARE NOT MEDIGAP Some types of insurance aren't Medigap plans; they include: Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan) Medicare Prescription Drug Plans Medicaid Employer or Union Health Plans, including the Federal Employees Health Benefits Program (FEHBP) TRICARE Veterans' benefits such as CHAMP Long-Term Care Insurance   Native American Indian Health Service, Tribal, and Urban Indian Health Plans

Michael T. Braden, August 27, 2024 BRADEN MEDICARE INSURANCE They say a journey of 1000 miles begins with 1 step. If you don't understand Medicare, start here. BEFORE STARTING MEDICARE, YOU NEED TO BE ENROLLED IN MEDICARE Getting older can be challenging.  The healthcare options available to you may seem confusing or unnecessary.  Your inexperience in this new chapter, coupled with ongoing health concerns, creates a recipe for disaster.  The best way to address these fears is to understand your options and the enrollment process .   With age comes wisdom , and knowing how to navigate the system will demonstrate it .  Getting the coverage and protection that you need is much easier than it seems.  Here are three essential parts of enrolling in Medicare that will help guide you through the process. TIMING The biggest mistake seniors make when enrolling in Medicare is timing.  There is a small window during which enrollment is open.  This window is limited to the three months leading up to your 65th birthday, the month of your birthday, and the three months following your birthday.  Failure to enroll within the specified timeframe may result in penalties.  To avoid those fees, being proactive with the enrollment is the best way to get started.  This time is called the “First Enrollment Period,” which is self-explanatory.  Getting ahead of the enrollment period gives you plenty of time to ensure you are comfortable with your coverage before using it . KNOWLEDGE Many seniors make mistakes because they feel vulnerable and don’t want to be taken advantage of.  The best way to address this is to educate yourself about your options.  There are two parts to the enrollment.  Part A covers long-term care, hospice, and hospital stays.  Part B covers specific doctors’ appointments, outpatient visits, and medical supplies.  The two parts work together to keep you covered across a wide range of situations.  Part C is an elective component that supplements A and B.  Think of Part C as the component that expands your options.  With Part A and Part B, you may be limited in the number of physicians who accept Medicare.  Part C is offered through a separate private company, which provides more options and a broader coverage portfolio.  Part B is paid coverage; you may elect not to have it, but doing so will result in a loss of benefits. Considering the benefits of additional coverage in the event of illness or accident is best achieved by consulting a reputable Medicare Part C affiliate. They can educate you on the benefits of extra protection that can help keep your out-of-pocket expenses minimal when the time comes. There’s more that can be done than just crossing your fingers and hoping for the best. Keeping in mind the value of having a small monthly premium to improve the quality and accessibility of care when needed will pay off later .    ENROLLMENT Enrollment options vary, but there’s one for everyone.  The easiest way is to attempt to enroll online.  If you have internet access on your phone, desktop, or laptop, you can enroll in care on the website .  On medicare.gov , the process is outlined, and the application can be filled out there.  The system on the government website is very user-friendly and allows guided question-and-answer completion.  You can check the status of your application after submission on the website.  This avenue helps prevent unnecessary trips to the Social Security office, and you can make corrections to your application online.  To ensure that it is completed, you can also track the status of your application for Medicare to verify what stage it is at and if there are any processing issues. This allows you to get ahead of potential problems that may require additional information or documentation from you.  If you do prefer to avoid the Social Security office but don’t feel confident about applying through their website, you can also apply by phone.  The Medicare Registration can be reached at 1-800-772-1213.  The office is open 7 am to 7 pm, and their service will walk you through the application process.  Of course, you can take the old-fashioned way and head to the Social Security office and wait in line.  These processes vary in time, but the fastest option is typically over the phone or via the website . Preparation is key.  Now that you have a good understanding of the options available, you will want to weigh your choices .  There are pros and cons to the coverage options, and realistically, you want to pick the one that best fits you.  However, it is worth noting that with age come additional health risks.  Rejecting valuable coverage can leave someone in financial ruin without insurance to pay the difference in cost.  By leveraging your understanding of your needs and being proactive, you will feel confident and empowered in your decisions.  Seeing your friends or family members impacted by a terminal condition or an ongoing health issue may have already led you to see this.  It is all the more critical for you to consider your options.  Another benefit of Medicare is that each year you can adjust the coverage from what you had selected the previous year.  Regardless of this opportunity, be careful to say, “Maybe next year I’ll add Part C,” as the year passes, emergencies can arise. At this critical juncture in your life, it is essential that you feel poised to handle your own Medicare benefits without the fear of being taken advantage of.  The more you know, the better you can protect yourself.  Knowledge is power, and with age comes wisdom, so you’re likely to make the right decision with all that you’ve learned.   GETTING STARTED WITH MEDICARE As you get started with Medicare, you have a choice in how you get your Medicare coverage. And there are some critical decisions for you to make. Follow these three steps to help you get started:   SIGN UP FOR MEDICARE THROUGH SOCIAL SECURITY Social Security enrolls you in Original Medicare (Part A and Part B). Medicare Part A (Hospital Insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care. Medicare Part B (Medical Insurance) helps pay for services from Doctors' Visits and other health care providers; laboratory costs; medical imaging (MRIs, CT scans & X-rays); outpatient care; home health care; durable medical equipment; and some preventive services, such as Screenings. OTHER PARTS OF MEDICARE ARE MANAGED BY PRIVATE INSURANCE COMPANIES THAT ARE OBLIGATED TO FOLLOW THE RULES AND GUIDELINES SET FORTH BY MEDICARE Supplemental (Medigap) policies help pay Medicare out-of-pocket copayments, coinsurance, and deductibles. Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Parts A and B—prescription drugs and additional benefits such as vision, hearing, and dental—bundled into one plan. Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Most people aged 65 or older are eligible for free medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare Medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read:   MEDICARE DOES HAVE RULES IN PLACE FOR HIGH-WAGE EARNERS IRMAA Stands for Income-Related Monthly Adjusted Amount. It acts as a Tax, but Medicare & Social Security prefer to refer to it as simply a monthly upcharge to the standard Medicare Part B and Medicare Part D Premiums. Many Professionals and Other high-wage earners are subject to this rule. The rule is not permanent. Typically, after you retire, within a year or two, when your Tax Filing shows you are no longer included, you can call your local SS Office and request a meeting to have the IRMAA removed. Please bring the records supporting your request. They will be happy to remove it. If there is any overpayment, they will refund it to you. SHOULD YOU SIGN UP FOR MEDICARE PART B? If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.  There are many factors to understand and consider when it's time to enroll in Medicare. For everyone, enrolling in Medicare Part A (Hospital Insurance) is a no-brainer.  It is free for 99% of those enrolling who have worked or have a spouse who has worked for at least 10 years.  Enrolling in Part B depends on your current Work situation and, believe it or not, the type of Health Insurance you currently have.  Why does that matter?  Medicare considers health coverage from a company with more than 20 employees to be "Credible" coverage.  All other Health Care coverage is considered non-credible by Medicare. Even if you have ACA/ Obamacare insurance, it is not considered "Credible" by Medicare. So, at age 65, unless you are insured under your or your spouse's Employer Health Plan, you need to enroll in Medicare Parts A & B at age 65 to avoid any penalties. If you choose not to enroll in Medicare Part B initially and later decide to enroll, your coverage may be delayed, and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a " Special Enrollment Period " (SEP). If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll.  If you have a Health Savings Account (HSA) or health insurance based on current employment, you may want to ask your personnel office or insurance company how signing up for Medicare will affect you.   SPECIAL ENROLLMENT PERIODS (SEP) If you have medical insurance coverage under a group health plan based on your or your spouse's  current employment , you may not need to apply for Medicare Part B at age 65. You may qualify for a " Special Enrollment Period " (SEP) that will let you sign up for Part B during: Any month you remain covered under the group health plan  and  you, or your spouse's, employment continues. The 8-month period begins on the first day of the month after your group health plan coverage or the employment it is based on ends, whichever occurs first.   HOW TO APPLY FOR JUST MEDICARE If you are within three months of age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouse's benefits later. It takes less than 10 minutes, with no forms to sign and usually no documentation required .   MEDICARE CARDS To help protect your identity, your Medicare card has a Medicare number that’s unique to you. If you did not receive your red, white, and blue Medicare card, there may be an issue that needs to be corrected, such as your mailing address. You can update your mailing address by signing in to or creating your personal  my  Social Security account. Learn more about  your Medicare card .   ARE YOU ALREADY ENROLLED IN MEDICARE? If you already have Medicare, you can get information and services online. Find out how to  manage your benefits . If you are already enrolled in Medicare Part A and you want to enroll in Part B, please complete form  CMS-40B , Application for Enrollment in Medicare – Part B (medical insurance). If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form  CMS-L564 , Request for Employment Information. You have three options to submit your enrollment request under the Special Enrollment Period. You can do one of the following: Go to “ Apply Online for Medicare Part B During a Special Enrollment Period ” and complete  CMS-40B  and  CMS-L564 . Then upload your evidence of a Group Health Plan or a Large Group Health Plan. Fax your  CMS-40B  and employer-signed  CMS-L564  to 1-833-914-2016. Mail your  CMS-40B  and employer-signed  CMS-L564  to your local Social Security office.   Note: When completing the  CMS-L564 State on the form “I want Part B coverage to begin (MM/YY)” in the remarks section of the  CMS-40B  form or online application. If possible, your employer should complete Section B. If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employer’s signature and submit one of the following forms of secondary evidence: An income tax form that shows health insurance premiums paid. W-2s reflecting pre-tax medical contributions. Pay stubs that reflect health insurance premium deductions. Health insurance cards with a policy effective date. explanations of benefits paid by the GHP or LGHP; or Statements or receipts that reflect payment of health Insurance premiums. You’ll have Original Medicare (Part A and Part B) unless you make another choice. You can decide to add a drug plan (Part D) or buy a Medigap policy to help pay for costs that Original Medicare doesn’t cover. You can choose to join a Medicare Advantage Plan (Part C) and get all your Medicare coverage (including drugs and extra benefits like vision, hearing, dental, and more) bundled together in one plan.  Some people with limited resources and income may also be eligible for  Extra Help to pay for Part D drug costs .   WHAT HAPPENS AFTER I APPLY? The Centers for Medicare & Medicaid Services CMS) manages Medicare. After you are enrolled, they will send you a  Welcome to Medicare  packet by mail, including your Medicare card. You will also receive the Medicare & You handbook, with important information about your Medicare coverage choices.  People get Medicare coverage in different ways. You'll get lots of information to help you decide how to get your Medicare coverage: An official "Welcome to Medicare" packet with important information about your coverage options. Your official "Medicare & You" handbook once you're enrolled and every year, each fall. Mail from private insurance companies, agents, and brokers, marketing the Medicare plans they offer.   THE TWO MAIN WAYS TO GET MEDICARE COVERAGE 1) ORIGINAL MEDICARE/TRADITIONAL MEDICARE Includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S. If you want drug coverage, you can join a separate Medicare Prescription Drug Plan (Part D). To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage like a Medicare Supplement Insurance Plan or Medigap policy.   If you don't get Part D or a Medigap policy when you're first eligible, you may have to pay more to get this coverage later. For Part D, this could mean a lifetime premium penalty. 2) MEDICARE ADVANTAGE (MEDICARE PART C) An "all-in-one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most plans offer additional benefits that Original Medicare doesn't cover, such as vision, hearing, dental, and more. Plans may have lower out-of-pocket costs than Original Medicare. In most cases, you'll need to use doctors who are in the plan's network. HOW MEDICARE WORKS WITH OTHER INSURANCE If you have Medicare and other health insurance or coverage, each coverage type is called a "payer." When there is more than one payer, "coordination of benefits" rules determine which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.   WHAT DOES IT MEAN IF MEDICARE IS THE PRIMARY OR SECONDARY PAYER? The insurance that pays first (primary payer) pays up to its coverage limits. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the uncovered costs. If your employer's insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay. If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to cover the bill and later recover any payments the primary payer should've made.   HOW DOES MEDICARE COORDINATE WITH OTHER HEALTH COVERAGE? If you have questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627). Tell your doctor and other health care providers about any changes in your insurance or coverage when you get care.   IS THERE A PENALTY IF I DO NOT ENROLL IN TIME FOR MEDICARE? Medicare is very strict about when you can and need to enroll in or change your Medicare Coverage.  If you have Employer Coverage, for example, you're fine as it is considered Credible Coverage. Unless you are enrolled in Medicare Part B during your IEP, you will most likely be subject to paying a late enrollment penalty. This can hurt because all late enrollment penalties continue as long as you have Medicare Coverage.  The Late Penalty is 10% for each year that you should have had Part B coverage but didn't. The standard premium for Part B is $148.50 in 2021, which means you’ll pay an extra $14.85 every month. This will increase if the standard Part B premium goes up next year, which it likely will. You’ll pay this penalty even if you ultimately choose to enroll in a Medicare Advantage Plan. You may need to continue without Part B for an extended period . If you fail to enroll in Medicare Part B during your IEP, you will not be able to enroll until the General Enrollment Period, or GEP. This means your coverage won’t start until July 1 that year. If you don’t have creditable Part D prescription drug coverage and miss your IEP, you’ll pay a penalty with your Part D premium—again, as long as you have the coverage. The penalty is 1% per consecutive month that you went without coverage for prescription drugs. The national base premium is currently about $36 per month, so if you go without coverage for a year, you’ll pay an extra $4.30 a month, and probably will even pay a little more if the Part D base premium increases. And this penalty will be in force as long as you have Part D coverage.   WHAT DOES IT MEAN TO HAVE CREDITABLE COVERAGE? Most Medicare beneficiaries who are still working have group coverage through an employer or an employer's union plan.  This allows you to delay enrollment in Part A and/or B without penalties.  When you retire, you can enroll in those Parts during a Special Enrollment Period (SEP). Medicare credits you for employer group coverage with any large employer (20+ employees). Later, when you retire, you will be eligible for a 63-day Special Enrollment period to sign up for Parts A and/or B with no late enrollment penalties. The Medicare Special Enrollment Period is an eight-month period that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.   WHEN IS THE MEDICARE GENERAL ENROLLMENT PERIOD? If , for some reason, you missed or forgot to enroll in your Initial Enrollment Period (IEP), you will have to wait to enroll in the General Enrollment Period (GEP). This runs from January 1 through March 31 each year. Even though you can enroll in Original Medicare during this time, you are still subject to the late enrollment penalties. However, in most cases , your new Medicare coverage will not take effect until July 1st, leaving you with an extended period without insurance . Keep in mind that the General Enrollment Period only applies to Original Medicare. If you want a Medicare Advantage plan or Medicare Part D coverage for prescription drugs, you’ll have to wait for the Annual Enrollment Period. From October 15 through December 7th each year. WHAT IS MEDIGAP INSURANCE? Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare covers much, but not all, of the cost of covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: Co-Payments Coinsurance Deductibles Some Medigap policies also cover services that Original Medicare doesn't , such as medical care when you travel outside the U.S . If you have Original Medicare. You buy a Medigap policy, here's what happens: Medicare will pay its share of the Medicare amount for covered health care costs. Then, your Medigap policy pays its share.   THE TOP 8 THINGS YOU NEED TO KNOW REGARDING MEDIGAP/MEDICARE SUPPLEMENTS You must have Medicare Part A and Medicare Part B. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one. Any standardized Medigap policy is guaranteed renewable, even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium. Some Medigap policies sold in the past covered prescription drugs. But, Medigap policies sold after January 1, 2006, aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Part D (Prescription Drug Plan). It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare. IS THERE ANYTHING A MEDIGAP POLICY WILL NOT COVER? Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.   INSURANCE THAT IS NOT MEDIGAP INSURANCE Some types of insurance aren't Medigap plans; they include: Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan) Medicare Prescription Drug Plans Medicaid Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP) Tri-Care Veterans' benefits Long-term care insurance policies Indian Health Service, Tribal, and Urban Indian Health plans   CANCELLING YOUR MEDIGAP COVERAGE You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage. If you choose to drop your entire Medigap policy, be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies: You drop your entire Medigap policy, and the drug coverage wasn't credible prescription drug coverage. You go 63 days or more in a row before your new Medicare drug coverage begins.   MEDICARE SUPPLEMENT & MEDIGAP COSTS Medicare doesn't cover any of the costs of obtaining a Medigap policy. You have to pay the premiums for a Medigap policy.   MEDIGAP HELPS COVER SOME OR ALL OF YOUR MEDICARE PART B COSTS In most Medigap policies, the Medigap insurance company will get your Part B claim information directly from Medicare. Then, they pay the doctor directly. Some Medigap insurance companies also provide this service for Part A claims. If your Medigap insurance company doesn't offer this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company must pay the doctor directly upon your request .   COMPARING THE COST OF MEDIGAP PLANS Insurance companies may charge different premiums for the same policy. As you shop for a policy, be sure you're comparing apples to apples. For example, compare Plan A from one company with Plan A from another company. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you purchase a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy. The Medicare Advantage Open Enrollment Period   MEDICARE ADVANTAGE PLANS Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Original Medicare doesn’t pay for your Medicare services . Below are the most common types of Medicare Advantage Plans.  Health Maintenance Organization or HMO Plans Preferred Maintenance Organizations or PPO Plans Private Fee for Service Plans or PFFS Plans Special Needs Plans or SNPs and Dual Special Needs Plans or DSNPs   MEDICARE PART D LATE ENROLLMENT PENALTY The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these: A Medicare Prescription Drug Plan (Part D) A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage Credible prescription drug coverage.   3 WAYS TO AVOID PART D PENALTIES 1. Join A Medicare Drug Plan When You're First Eligible. You won't have to pay a Part D late enrollment penalty, even if you've never had prescription drug coverage before. 2. Don't Go 63 days Or More In A Row Without Medicare Prescription Drug Coverage Or Other Creditable Drug Coverage. Credible prescription drug coverage  may include coverage from a current or former union employee, TRICARE, the Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or other health insurance . Your prescription drug plan must tell you each year if your drug coverage is creditable. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later and want to avoid the Part D late enrollment penalty. 3. Keep Records Showing When You Had Creditable Drug Coverage, And Tell Your Plan About It. When you join a Medicare drug plan, the plan will check whether you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn't, it will send you a letter with a form asking about any drug coverage you had. To avoid a Part D penalty, complete the form and return it to your drug plan by the deadline in the letter. If you don't report your creditable drug coverage to the plan, you may be subject to a Medicare Part D late enrollment penalty. Are there company policies that are particularly important to your business? Perhaps your unlimited paternity/maternity leave policy has endeared you to employees across the company. This is a good place to talk about that.

WHAT IS MEDICARE PART D? MEDICARE PRESCRIPTION DRUG PLANS You must be enrolled in Medicare Part A and/or Part B to be eligible to enroll in Part D. Medicare drug coverage is only available through private plans. If you have Medicare Part A and/or Part B and you do not have other drug coverage (creditable coverage), you should enroll in a Part D plan.   HELPFUL TERMS THAT INVOLVE MEDICARE PART D THAT EVERY MEDICARE BENEFICIARY NEEDS TO BE FAMILIAR WITH FORMULARY This is the Prescription Drug List of all medications covered by a Part D Drug plan. Each insurance company has its own formularies for each of its Medicare Part D Drug plans. Medicare requires that every plan include at least two drugs in each Drug Classification. This means that the Diabetes Medication you take may not be covered under this plan, but other plans may include the medication that works best for you.   DRUG TIERS Each prescription medication is assigned a Drug Tier based on the drug's cost . Every Medicare Part D Drug Plan uses the same Drug Tier system; the only thing that can change is which drugs are included in their formulary.   Tier 1   - Lowest Cost Generic Drugs Tier 2  - Preferred Generics Drugs Tier 3  - Preferred Name Brand Drugs  & High Cost Generics Tier 4  - Non-Preferred Brand Name Drugs  Tier 5  - Specialty Drugs   DEDUCTIBLE Most Medicare Part D Drug plans have a deductible. Some have deductibles for Tiers 2-5, some for Tiers 3-5, and some have no deductibles at all. Having a Deductible means you have to reach the Deductible before the plan starts to give you the drugs at their discounted price; until you get it, you are paying full price for that particular medication. There are no deductibles for Tier 1 medications.    CO-PAY With a co-payment, you pay a set amount (e.g., $2) for all drugs in Tier 2. You may pay a lower co-payment for generic drugs than brand-name drugs.   CO-INSURANCE With coinsurance, you pay a percentage of the cost of the drug (e.g., 25%). Note: The amount you pay for a covered prescription is usually for a one-month supply of a drug. However, you may request a supply of less than one month. You might do this if you’re trying a new medication or you want to synchronize refills for your medications. If you get less than a one-month supply, the amount you pay is reduced based on the amount you actually get.     YOU ONLY HAVE TWO OPTIONS TO GET PRESCRIPTION DRUG COVERAGE WITH MEDICARE    MEDICARE PART D STAND-ALONE PRESCRIPTION DRUG PLANS Stand-Alone Medicare Part D Plans are Prescription Drug Plans that you have to choose because they are not included in Medicare Part A or Medicare Part B. These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans (Most Medicare Advantage PPO Plans do not include Prescription Drug Plans, unlike Medicare Advantage HMO plans), some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.   MEDICARE ADVANTAGE PLANS THAT INCLUDE PRESCRIPTION DRUG COVERAGE (MA/PD PLANS) The Majority of Medicare Advantage Plans include a prescription drug plan , such as an HMO, PPO, or SNP, or another Medicare Health Plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes referred to as “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.    CONSIDER ALL OF YOUR DRUG CHOICES Before you make a decision, talk with your agent or broker and learn how prescription drug coverage works with any other drug coverage that you might have. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage with Medicare Part D coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options. If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.   BE CAREFUL WHEN LOOKING FOR A NEW MEDICARE PART D PRESCRIPTION DRUG PLAN Your Medicare Advantage Plan (Part C) will disenroll you, and you'll go back to Original Medicare if both of these apply: Your Medicare Advantage Plan includes prescription drug coverage. You join a Medicare Prescription Drug Plan (Part D).   ARE THERE PREMIUMS FOR MEDICARE PART D? Most Medicare Prescription Drug Plans charge a monthly fee that varies by plan. You pay this in addition to the Medicare Part B premium. If you join a Medicare Advantage Plan (Medicare Part C) or Medicare Cost Plan that includes Medicare prescription drug coverage, the plan's monthly premium may include an amount for drug coverage. Note: The same insurance company may offer Medigap policies and Medicare Part D prescription drug plans. If you join a Medigap policy and a Medicare drug plan offered by the same company, you may need to make two separate premium payments for your coverage. Contact your insurance company for more details.   HOW CAN I PAY FOR MY PART D PREMIUMS? Contact your drug plan (not Social Security) if you want your premium deducted from your monthly Social Security payment. Your first deduction will typically begin after 3 months, and 3 months of premiums will likely be deducted at once. After that, only one premium will be deducted each month. You may also experience a delay in premium withholding if you switch plans. If you want to stop premium deductions and get billed directly, contact your drug plan.   HOW MUCH DO MEDICARE PART D DRUG PLANS COST? Medicare PDP Plans run from $0.00 to well over $150 per month, depending on where you live. That is why there are so many choices for people to make. The average price for 2024 is between $27 - $42 per month. However, if you have only a few “Generic” medications, your monthly premium should be between $0.00 and $21.00 . NOTE: The cost of medications is not included in premiums.     IRMAA & PART D   Most Medicare beneficiaries only need to pay their Part D premium. If you don't enroll in Part D when you're first eligible (within 63 Days of your Medicare Part B Effective Date), you may incur a Medicare Part D late enrollment penalty. If your modified adjusted gross income is above a certain amount, you may pay a Part D income-related monthly adjustment amount (Part D IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS). You'll pay the Part D IRMAA amount in addition to your monthly plan premium, and this extra amount is paid directly to Medicare, not to your plan. The chart below lists the additional cost amounts by income. Social Security will contact you if you are required to pay Part D IRMAA based on your income. The amount you pay can change each year. If you have to pay a higher amount for your Part D premium and you disagree (for example, if your income goes down).  If you have questions about your Medicare prescription drug coverage, contact your plan. Note:  The extra amount you have to pay isn’t part of your plan premium. You don’t pay the additional amount to your plan. Most people have the additional amount taken from their Social Security check. If the amount isn’t taken from your check, you’ll get a bill from Medicare or the Railroad Retirement Board. You must pay this amount to keep your Part D coverage. You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. If Social Security notifies you about paying a higher amount for your Part D coverage, you’re required by law to pay the Part D-Income Related Monthly Adjustment Amount (Part D IRMAA).  If you don’t pay the Part D IRMAA, you’ll lose your Part D coverage. REMEMBER THAT YOU ARE OBLIGATED TO PAY ANY PART D PENALTY TO MEDICARE, NOT YOUR EMPLOYER. You’re required to pay the Part D IRMAA, even if your employer or a third party (like a teacher’s union or a retirement system) pays for your Part D plan premiums. If you don’t pay the Part D IRMAA and get disenrolled, you may also lose your retirement coverage, and you may not be able to get it back.   IMPORTANT TIP Pay your Part D IRMAA bill to Medicare as soon as you get it.  Keep your address current with Social Security, even if you don’t get a Social Security Check.   MEDICARE PART D LATE ENROLLMENT PENALTY The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these. A Medicare Prescription Drug Plan (Part D) A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage Creditable Prescription Drug Coverage.   WHAT IS THE COST ASSOCIATED WITH A MEDICARE PART D PENALTY? The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.43 in 2022) by the number of full, uncovered months during which you lacked Part D or creditable coverage. The monthly premium is rounded to the nearest $ 0.10 and added to your monthly Part D premium.   The national base beneficiary premium may change each year, so your penalty amount may also vary. EXAMPLE OF A TRUE PART D PENALTY CASE: John Baker is currently eligible for Medicare ; his Initial Enrollment Period ended on May 31, 2017. He doesn't have prescription drug coverage from any other source. Because John didn't join a Medicare Part D Prescription Drug Plan by May 31, 217, and instead joined during the Open Enrollment Period that ended December 7, 2020. His drug coverage was effective January 1, 2021. Since John was without creditable prescription drug coverage from June 2017 to December 2020, his Part D penalty was calculated by figuring (1% for each of the National Part D Premium Average, which was $35.44). So, 31 months multiplied by $0.33544 per month = $10.55. Because the monthly penalty is always rounded to the nearest $0.10, Mr. Baker paid $10.60 each month in addition to his plan's monthly premium, and his penalty will never be eliminated .   Because of his late enrollment in Medicare Part D, John will pay his monthly premium plus an additional $10.60 per month. After you join a Medicare drug plan, Medicare will inform you if you owe a penalty and what your premium will be. In general, you'll have to pay this penalty for as long as you have a Medicare drug plan.   DO I HAVE ANY RECOURSE IF I DISAGREE WITH THE LATE ENROLLMENT PENALTY? You may be able to ask for a "reconsideration." Your drug plan will send information about how to request a reconsideration. Complete the form and return it to the address or fax number listed on the form.  You must do this within 60 days of the date on the letter notifying you of a late enrollment penalty. Also, send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.   WHAT IF YOU DO NOT AGREE TO THE PENALTY? IS THERE ANYTHING ELSE YOU CAN DO ABOUT IT? By law, the late enrollment penalty is part of the premium, so you must pay the penalty with the premium. You must also pay the penalty even if you requested reconsideration. Medicare drug plans can disenroll members who don't pay their premiums, including the late enrollment penalty portion of the premium.   HOW LONG DOES IT USUALLY TAKE TO RECEIVE A DECISION? In general, Medicare’s contractor makes reconsideration decisions within 90 days. The contractor will try to decide as quickly as possible. However, you may request an extension. Or, for good cause, Medicare’s contractor may take an additional 14 days to resolve your case.   WHAT HAPPENS IF YOU WIN AND THE PENALTY IS INCORRECT? If Medicare’s contractor decides that all or part of your late enrollment penalty is wrong, the Medicare contractor will send you and your drug plan a letter explaining its decision. Your Medicare drug plan will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you'll get a refund.   WHAT HAPPENS IF THE PENALTY IS UPHELD? If Medicare’s contractor decides that your late enrollment penalty is correct, the Medicare contractor will send you a letter explaining the decision, and you must pay the penalty.     WHEN CAN YOU CHANGE YOUR MEDICARE PART D PLAN? You can switch to a new Medicare drug plan by joining another drug plan whenever you are eligible.  The Annual Enrollment Period (AEP) runs every Fall from October 15th to December 7th. This is the time you can change your Prescription Drug Coverage for the upcoming year.  There may be other times when you could qualify for a Special Election Period (SEP) if you move out of the plan's network.  You should contact your agent or call 1-800-Medicare if you have any questions.  Note: You don't need to cancel your old Medicare drug plan. Your current Medicare drug plan coverage will end when your new drug plan begins. If you want to join a plan or switch plans, do so as soon as possible so that you’ll have your membership card when your coverage begins, and you can get your prescriptions filled without delay.   WHAT IF YOU ARE NOT TAKING ANY PRESCRIPTION MEDICATIONS CURRENTLY? You do not have to enroll in Part D at any time. But it is a safe bet that it will save you money in the long run, even if you do not currently have any prescribed medications. If this is you, I would enroll in the lowest-priced plan available so you will never have to incur the penalty in the future . I know that sounds silly, but it is the government we are talking about. I agree ; it is unreasonable, but it is not changing, and we all need to accept a couple of the flaws as best we can.

Michael T. Braden August 27, 2024 MEDICARE SUPPLEMENTS & MEDIGAP Did You Know That Medigap plans and Medicare Supplement Plans Are The Same Thing? MEDICARE SUPPLEMENTS & MEDIGAP PLANS Why would anyone choose a limited Medicare Advantage plan with local networks and limited choices for Physician's and Healthcare Facilities when you have less exposure and better coverage with a Medicare Supplement Plan G? And, not just that but once you are approved and enroll in a Medicare Supplement, your pla, can never cancel your policy, as long as your premiums are paid. That is true peace of mind for you and your family. Medicare Supplement Plans became available in 1990 , and they are standardized and must follow Medicare guidelines .  Medigap Plans are lettered , and although the coverage is the same across insurance companies, prices will vary.  These are Plans A, B, C, D, F, G, K, L, M, and N. The most common plans sold are Plans C, F, G, and N; however, only Plan G and N are available for those new to Medicare after January 1st, 2020. Medicare Supplement Plan G or Medigap Plan G is the best and the most comprehensive Medicare Supplement available to new Medicare Beneficiaries as of 1/1/2020.  Plan F was once considered the Best Medigap plan available. It is still popular; however, annual premiums for Plan F are usually $400- $1,200 higher than for Plan G. The only difference between the plans (aside from price) is that Plan F automatically pays your Annual Part B Deductible . Medicare sends you a bill for your Part B Deductible. With Plans F and G , you will never have a bill from Medicare for any Medicare-approved /Medically Necessary procedure, aside from your Annual Part B Deductible, which everyone has to pay, regardless of what Plan they enroll in.   With a Plan G Medicare Supplement plan, Medicare pays its 80% share, your Plan G policy covers the remaining 20% (your share), and you pay nothing!  Medicare will pay its share, and your Medicare Plan G Supplement will cover the rest.  Honestly, this is the best deal in Healthcare in the US. The best way to look at this is that your Maximum Out-Of-Pocket Expense is your monthly premium.   The majority of Plan G beneficiaries pay well under $2,000 a year in premiums , and when you realize that the lowest MOOP (Maximum Out-of-Pocket Expense) you can find with a limited no-cost Medicare Advantage plan is $5,700, based on the 2022 nationwide average. Comparison.  Perhaps the most significant benefit is choice and portability. A Medicare Supplement or Medigap plan allows you to choose  ANY  Doctor, go to  ANY  Hospital  ANYWHERE in the United States, and you are covered, as long as the Doctor and Hospital both accept Medicare's Assignment/Fee Structure. Why would anyone choose a limited Medicare Advantage plan with local networks and limited choices for physicians and Healthcare Facilities when you have less exposure and better coverage with a Medicare Supplement Plan G? And, not just that, but once you are approved and enroll in a Medicare Supplement, your plan can never cancel your policy, as long as your premiums are paid. That is true peace of mind for you and your family.  You must continue to pay your Medicare Part B premium even if you are enrolled in a Medigap Plan.     Items not covered by Original Medicare include:   Routine Dental, Vision, and Hearing exams Hearing Aids Eyeglasses or Contact Lenses Long Term Care or Custodial Care Retail Prescription Drugs Medicare does cover Cataract Surgery, Macular Degeneration, and a limited amount of Chiropractic and Acupuncture therapies. For the sake of Medicare, it is easiest to remember that Medicare covers services at an Ophthalmologist's office but not at an Optometrist's office. Did you know that Medicare standardizes all Medicare Supplement Plans (also known as Medigap Plans) ? This means that every Medicare Supplement Plan available in the US is the same from coast to coast. What differs is each insurance company's premium rates in a specific market (State). You can rest assured that a Medicare Supplement Plan G from ACE Healthcare offers the same benefits as the plan from Blue Cross.  Many companies that offer Medicare Supplements offer additional services and benefits, such as health club memberships and discounts on dental and vision services . If these are important to you, please ask your Broker. Medicare Supplement Plans F, G , and N will also pay the $1,600.00 Medicare Part A Deductible for you, and Plans F and G will also cover any Excess Medicare Part B charges for you. Lastly, many Medicare Supplement insurers charge a $20- $25 Application/Policy Fee when applying for one of their plans.  Although this is quite common, it is not necessary.  Many other reputable companies do not charge these unnecessary fees.

What is the Medicare Advantage Poster showing a Senior Female Raising Her Hand To Ask A Question About Medicare Advantage Plans? DID YOU KNOW THAT MEDICARE ADVANTAGE IS ALSO REFERRED TO AS MEDICARE PART C   THIS ARTICLE IS WRITTEN TO HELP THE PUBLIC UNDERSTAND NOT JUST WHAT MEDICARE ADVANTAGE PLANS ARE, BUT HOW THEY WORK WHEN IT COMES TO HEALTHCARE. What is Medicare Advantage? Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Original Medicare doesn’t pay for your Medicare services . Below are the most common types of Medicare Advantage Plans.  Health Maintenance Organization (HMO) Plans Preferred Provider Organizations (PPO) Plans Private Fee for Service Plans (PFFS) Plans Special Needs Plans (SNPs)   HOW MEDICARE ADVANTAGE PLANS WORK? Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all-in-one” alternative to Original Medicare. Private companies approved by Medicare offer them .  If you join a Medicare Advantage Plan, you still have Medicare.  These "bundled" plans include Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and usually Medicare Prescription Drug Plan (Part D). WHAT ARE MEDICARE ADVANTAGE PLANS, AND DO MEDICARE ADVANTAGE PLANS COVER PRESCRIPTION MEDICATIONS? What are Medicare Advantage Plans? Medicare Advantage Plans cover all Medicare services.  Some Medicare Advantage Plans also offer extra coverage, such as vision, hearing,, and dental coverage.    ARE THE RULES DIFFERENT FOR MEDICARE ADVANTAGE THAN THEY ARE FOR ORIGINAL MEDICARE? Medicare pays a fixed amount to the companies offering Medicare Advantage Plans each month for your care . These companies must follow rules set by Medicare. Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like: Whether you need a referral from your Primary Care Physician to see a specialist. If you have to go to doctors, facilities, or suppliers that are part of the plan for non-emergency or non-urgent care. These rules can change each year.   WHAT ARE MEDICARE ADVANTAGE PLANS & HOW MUCH DO THEY COST? What you pay in a Medicare Advantage Plan depends on several factors. Like the type of plan, the size of the network, and what ancillary products are included. Also, plans are generally priced by county so that prices can vary quite a bit from city to city and state to state.   ARE PRESCRIPTION MEDICATIONS COVERED UNDER MEDICARE ADVANTAGE PLANS? The Medicare Advantage Plans include Prescription Drug Coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that: Can’t offer drug coverage (like Medicare Medical Savings Account plans) Choose not to offer drug coverage (like some Private Fee-for-Service plans) Note: You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply: You’re in a Medicare Advantage HMO or PPO. You join a separate Medicare Prescription Drug Plan.   DO MEDICARE ADVANTAGE PLANS WORK WITH MEDICARE SUPPLEMENT PLANS? Medigap policies can't work with Medicare Advantage Plans. CAN ANYONE JOIN A MEDICARE ADVANTAGE PLAN? MOST EVERYONE CAN ENROLL IN ONE OF THESE MA/MAPD PLANS Health Maintenance Organization (HMO) Plans Preferred Provider Organizations (PPO) Plans Private Fee for Service Plans (PFFS) Plans Special Needs Plans (SNPs) What are MEDICARE ADVANTAGE PLANS? YOU ARE ELIGIBLE FOR MEDICARE ADVANTAGE AS LONG AS THESE APPLY TO YOU: You live in the service area of the plan you want to join. The plan can give you more information about its service area. If you live in another state for part of the year, ask if the plan will cover you there. You have Medicare Part A and Part B. You  don't  have End Stage Renal Disease (ESRD). HOW TO JOIN, SWITCH, CHANGE, OR DROP A MEDICARE ADVANTAGE PLAN HOW TO SWITCH OR CHANGE MEDICARE ADVANTAGE PLANS What are Medicare Advantage Plans? When is the time to change or switch your Medicare Advantage plan? If you're already in a Medicare Advantage Plan and want to switch, follow these steps: To switch to a new Medicare Advantage Plan,  join the plan you choose during one of the enrollment periods. You'll be disenrolled automatically from your old plan when your new plan's coverage begins. To switch to Original Medicare, contact your current plan or call us at 1-800-MEDICARE. Unless you have other drug coverage, you should carefully consider a Medicare Prescription Drug Plan (Part D). You may also want to consider a Medicare Supplement Policy or a Medigap Plan. Remember, you may only be able to switch plans at certain times of the year.   WHAT ARE MEDICARE ADVANTAGE PLANS IF YOU HAVE OTHER HEALTH INSURANCE Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose employer or union coverage. If you lose coverage for yourself, you may also lose coverage for your spouse and dependents. In other cases, you may still be able to use your employer or union coverage along with the Medicare Advantage plan you join. Note: Remember, if you drop your employer or union coverage, you may not be able to get it back.   WHAT HAPPENS IF YOUR PLAN IS EVER DISCONTINUED? At the end of the year, plans can decide to leave the Medicare Program. If your plan leaves, you'll get a letter explaining your options. Generally, you'll be automatically returned to Original Medicare if you don't choose to join another Medicare Advantage Plan. You will also have the right to buy a Medigap policy. No matter what you choose, you're still in the Medicare Program and will get all Medicare-covered services. If you choose to return to Original Medicare, you need to decide whether you want drug coverage. If so, you need to join a Medicare Prescription Drug Plan (Part D). WHAT IF I RECEIVE HEALTH INSURANCE FROM YOUR EMPLOYER It’s essential to understand how your current coverage works with Medicare. If you have questions about your current insurance, the best source of information is your benefits administrator, insurer, or plan provider.   IF YOU NEED TO APPLY FOR MEDICARE PART A AND/OR MEDICARE PART B Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically , and other people have to sign up for them . In most cases, it depends on whether you’re getting Social Security benefits.  Note: Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans. WHAT IS A MEDICARE HEALTH PLAN? MEDICARE HEALTH PLANS ARE USUALLY ONE OF THE FOLLOWING HEALTH PLANS A private insurance company offers it. Contracts with Medicare to provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits. Provides these benefits to people with Medicare who enroll in the plan. MEDICARE HEALTH PLANS INCLUDE Medicare Advantage Plans (Medicare Part C) Other Medicare Health Plans Medicare Supplement Plans or Medigap Demonstrations/Pilot Programs Programs of All-inclusive Care for the Elderly (PACE)   WHAT IS A MEDICARE ADVANTAGE NETWORK? Medicare Advantage Plans offer lower premiums but require you to use their own networks of Doctors and Hospitals, which enables them to lower their costs. A Medicare HMO (Health Maintenance Organization) usually requires you to see only network providers, except in emergencies. You'll need to select a primary care physician. That physician will authorize and coordinate a referral if you need to see a specialist. Medicare HMO plans are the most significant type of Medicare Advantage networks. HMOs make up over 70% of the Medicare Advantage marketplace. Medicare PPO (Preferred Provider Organization) networks allow you to see doctors outside the network, but you will expect to pay much higher out-of-pocket costs to do so. In limited counties, there are Medicare Private-Fee-for-Service plans. These plans may or may not include Part D. How you access care is also different. While this plan type was once prevalent, it has been gradually phased out in most areas.  Some people may feel that the rules restrict or limit them in ways they find disagreeable. However, others are willing to abide by the rules if they see a plan with an attractive low premium. It’s a personal choice. If you are deciding between Medicare Advantage and Original Medicare with a Medicare Supplement plan, you’ll want to consider some of the rules before you enroll. HERE ARE SOME BASIC MEDICARE ADVANTAGE RULES You have to be enrolled in both Medicare Part A & B and live in the service area of the Plan. Some Medicare beneficiaries believe they can drop Part B if they enroll in Medicare Advantage. That is not true; if you drop Part B while enrolled, you will immediately be kicked out of your Medicare Advantage plan. The only health-related question on the Medicare Advantage enrollment application is...out-of-pocket . Have you been diagnosed with End-Stage Renal Disease (kidney failure)? Use network doctors and hospitals for the lowest out of pocket costs. Plans may have HMO or PPO networks. Most Medicare HMO plans do not cover out-of-network care except in emergencies. In PPO networks, seeing a provider outside the network will result in substantially higher spending. It is your responsibility to gain prior authorization for specific procedures, especially in Medicare Advantage HMO plans. You must obtain a referral from your primary care physician before seeing a specialist on many HMO plans.   WHEN CAN YOU ENROLL IN A MEDICARE ADVANTAGE PLAN? Medicare Advantage plans have lock-in periods. You can enroll in one during the Initial Enrollment Period when you first turn 65. After that, you may enroll or dis-enroll only during certain times of the year. Once you enroll in Medicare Advantage, you must stay enrolled in the plan for the rest of the calendar year. You can only opt out of an Advantage plan during specific times of the year. The Annual Election Period in the fall is the most common time to change your Medicare Advantage plan. This period runs from October 15th to December 7th each fall. Changes made to your enrollment will take effect January 1. If you decide to leave a Medicare Advantage plan and return to Original Medicare, you must notify your Medicare Advantage plan carrier. Otherwise, Medicare will continue to show that you are enrolled in the Advantage plan instead of Medicare. WHAT IS THE MEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD (OEP? DID YOU KNOW THAT ONCE YOU CHOOSE A MEDICARE ADVANTAGE PLAN, YOU WILL MOST LIKELY NEED TO STAY IN THAT PLAN FOR THE ENTIRE CALENDAR YEAR? Some people don’t realize this and enroll in Medicare Advantage plans without an agent's help . Therefore, they don’t know about all of these rules. Sometimes they find themselves enrolled in a plan that their doctor doesn’t accept or that doesn’t include one of their medications. This happens most often in January after a person has used the Annual Election Period to join a Medicare Advantage plan. The Medicare Open Enrollment Period runs from January 1st to March 31st each year. During this time, you can disenroll from any Medicare Advantage plan and return to Original Medicare. You may add a standalone Part D Prescription Drug Plan. During the Medicare Advantage Open Enrollment Period, you can also change from your current Medicare Advantage plan to a different Medicare Advantage plan. Please be aware that you can only use this period once per calendar year.   IS ORIGINAL MEDICARE THAT MUCH different from MEDICARE ADVANTAGE PLANS? The intent of our lawmakers in creating these plans was to give you options in accessing your Medicare benefits. Listed below are some of the reasons why people might choose a Medicare Advantage plan: Many plans have low monthly premiums (although you must continue to pay your Medicare Part B Premium) You pay for medical services as you use them through co-pays and coinsurance. Unlike Original Medicare, Medicare Advantage plans have an out-of-pocket maximum to protect you against catastrophic spending. The convenience of having your medical and Part D Prescription Drug benefits rolled into one plan. Some plans may include benefits for things like limited vision coverage. Limitations, co-payments, and restrictions may apply.     RE-CAPPING YOUR MEDICARE OPTIONS You can either opt for Original Medicare (Medicare Parts A & B) and supplement it with a Medigap plan or a Medigap plan and/or a Medicare Prescription Drug plan (Part D), or you can choose a Medicare Advantage plan (Medicare Part C). A Medicare Supplement or Medigap plan will pick up the tab for all or part of your deductibles and coinsurance under Original Medicare (the level of coverage you get depends on the Medigap plan you choose). A Part D plan will provide prescription coverage. A Medicare Advantage plan wraps everything in one policy: It includes all of the benefits of Original Medicare, has a cap on annual out-of-pocket costs, and most Medicare Advantage plans also include prescription coverage.  I personally understand that many people are easily "seduced" and "swayed" by the content of Medicare Advantage Advertisements.  The truth is, however, that all Medicare Advantage plans are limited to specific geographic areas, meaning not all plans or Plan Benefits are available everywhere.   With MOOP expenses ranging from $3,000 to $12,000 annually, the vast majority of Medicare Advantage plans cannot compare to Medigap plans in terms of having a consistent cost for your healthcare.   When times are good, you can end up spending very little for your healthcare needs.  However, if you have a bad year here and there, you can expect to pay up to your Maximum-Out-Of-Pocket (MOOP) Expense, which can be devastating to many Medicare beneficiaries. When comparing plans , I encourage anyone leaning toward a Medicare Advantage plan to consider Medigap Premiums as their MOOP.  Because Medicare Supplements C, D, F, G, N will pay all of your costs (meaning your 20% share from Original Medicare) and if you are new to Medicare your annual premiums are only around $1,500 a year when you are first eligible, you never have to worry about not being accepted later in the event you have a serious illness or condition. You have the freedom and flexibility to see any Doctor or go to any Hospital in the country that accepts Medicare.

Some of you may remember the Article we wrote last year after it was announced that Medicare would start negotiating Prescription Drug Prices in 2024. Medicare will deal directly with drug manufacturers and pharmaceutical companies. Initially, they would select the 10 most-prescribed (Non-Generic) Medications for 2024. Then they would continue to negotiate 10 per year. Although the new pricing will not go into effect until January 1, 2026, I wanted to  show you their progress. THE INFLATION REDUCTION ACT OF 2022 I still have to suppress a laugh whenever I hear the Inflation Reduction Act mentioned in public because it has had no direct effect on lowering inflation. That was just politics at its finest to get lawmakers too lazy to read the bill to vote for it. At 800 billion dollars, the goal was to help mitigate climate change, enhance energy security, and lower the cost of medications for seniors. However, in one man's humble opinion, this will not affect reducing costs as long as they continue to add layers to the Federal Government. However, they are fulfilling their commitment to assist seniors with the ongoing increase in medication costs. Given the number of lobbyists in Washington, DC, who pharmaceutical companies generously compensate, it will remain challenging. The best thing our United States government can and should do is open its own FDA-manufacturing plants to produce medications in the US and eliminate all intermediaries. HOW THE INFLATION REDUCTION ACT WILL IMPACT MEDICARE PART D STARTING ON JANUARY 1, 2025 Let's start with the good news. The Medicare Donut Hole, the Catastrophic Coverage Phase of Medicare Part D Prescription Drug Plans, has been eliminated. The government has capped Part D medications at $ 2,000, meaning no Medicare Beneficiary will pay more than $2,000 annually for prescription medications. This is excellent news for many seniors burdened with expensive medicines. However, collateral damage is inevitable as a result of these moves. Now, let's look at the bad news. We are based in Arizona, and Arizona had 27 Stand-Alone Medicare Part D plans in 2023. However, in 2025, we will have only 10 plans available to the public. Worse yet, the costs of lowering out-of-pocket drug costs for Medicare Beneficiaries are forcing Insurance companies to increase the Part D Deductible and premiums for their Drug Plans. THE INFLATION REDUCTION ACT OF 2022 AND ITS IMPACT ON MEDICARE PART D DRUG PRICES THE MEDICARE PART D DEDUCTIBLE Beginning on January 1, 2025, the Medicare Part D Deductible will increase by $45, from $545 to $590. Of course, different plans can have lower thresholds, but the maximum deductible will be $590. THE MEDICARE PART D DRUG PLAN PREMIUMS There  may be only two Drug Plans with Premiums under $35 per month. Most companies seem to have settled on a suggested Premium range of $48 per month, which is excessive. On the bright side, the "Premium" Drug Plans that have previously had premiums over $100 are  lowering their premiums significantly. It is simply too early to forecast what will happen in 2026; insurance companies will take a hard look at Data from the first six months of 2025 when they begin discussing their strategy  for 2026 and beyond. Some companies may reenter the Market, some may lose plan availability, and others may exit the prescription  Drug Market altogether. However, because many of these companies receive substantial government payments for their Medicare Advantage plans, I do not expect many more to drop out; only  time will tell. VACCINATIONS COVERED UNDER MEDICARE PART D A few years ago, Medicare began covering annual vaccinations for Medicare beneficiaries. As of 2024, you need only go to any "preferred Pharmacy" for your plan, and they would administer the shots at the pharmacy, and Medicare would pay for them . But they are made more accessible. Starting on January 1, 2025, you can receive these vaccinations/ Inoculations at any licensed pharmacy; it does  not have to be a pharmacy associated with your particular plan. MEDICARE PART B DRUGS Drugs you may receive in a doctor's office, such as Prolia, Evenity, Leqvio, and other medicines that must be administered only by a doctor, are not included in any of the changes. These changes affect only Medicare  Part D. RESULTS FROM MEDICARE'S DRUG NEGOTIATIONS THIS PAST YEAR   Until this year, Medicare was not permitted to negotiate drug prices directly with manufacturers. Medicare (the government) had to accept the prices set by pharmaceutical companies . HERE ARE THE DRUGS THEY TARGETED FOR 2024 Eliquis Enbrel Entresto Fiasp Farxiga Imbruvica Januvia Jardiance Stelara Xarelto RESULTS OF MEDICARE'S PRESCRIPTION DRUG COST COMPARISONS Drug Name Negotiated Price (Per 1 month Supply) Change in Cost Januvia $113 -79% Fiasp, Fiasp Flex Touch, Fiasp Pen Fill, NovoLog, LovoLog Flex-Pen, NovoLog Pen Fill $119 -76% Farxiga $178.50 -68% Enbrel $2,355 -67% Jardiance $197 -66% Stelara $4,695 -66% Xarelto $197 -62% Eliquis $23 -56% Entresto $628 -53% Imbruvica $9,319 -38% HOW WILL THESE NEGOTIATIONS IMPACT SENIORS THE MOST For Medicare beneficiaries, these negotiations may substantially affect their quality of life by reducing out-of-pocket costs . The Administration has indicated that it anticipates savings of more than 6 Billion Dollars in 2026 when these new prices take effect. These costs are also expected to decrease by more than 25 billion dollars by year ten. MEDICARE BEING ABLE TO NEGOTIATE ITS OWN DRUG PRICES WILL HELP SHAPE THE FUTURE OF MEDICARE While this is a huge step forward for Medicare Part D beneficiaries, it is a work in progress. We all need to be patient. The newly negotiated prices shown in the chart earlier in this article will be implemented effective January 1st, 2026. At least ten additional re-negotiated medications will be added over the next decade. Of course, not everyone’s thrilled about these changes. Most Pharmaceutical companies are very concerned about the long-term impact of these changes. But please do not shed a tear for them. I hope that when they need to cut some of the "fat" from their budgets, they start with the ungodly amount of money they budget for lobbyists and follow that up with changing their philosophy to develop medicines that help people but that do  not send them to the poor house. My hope , against hope, is that it will prompt many of these players to re-evaluate natural remedies wherever possible and when effective . WRAPPING THINGS UP We hope you found this article informative and easy to understand . Please feel free to contact me anytime and let me know your comments at mike@bradenmedicare.com

I wrote my first blog post about Amazon Pharmacy shortly after Amazon acquired PillPack. I think for individuals who take multiple medications, and in particular, medicines at different times of the day, this is a game-changer and a lifesaver for many Medicare Beneficiaries across the country. Today, I am excited to share with you another excellent service for all Medicare Beneficiaries, courtesy of Amazon Pharmacy and RxPass.   _________________________________________________________________________   Last Month, Amazon announced the expansion of eligibility for its RxPass prescription medication program. This new program is the Amazon RxPass Prescription Plan. This program allows Medicare beneficiaries to receive unlimited popular, generic (Tier 1 & Tier 2) prescription medications for just a $5.00 Subscription Fee Per Month.   OVER 50 GENERIC MEDICATIONS FOR $5 PER MONTH, NOT $5 FOR EACH PRESCRIPTION, JUST $5 PERIOD! * Amazon Prime members, get all of your eligible medications in one monthly subscription RX PASS POSTER Showing Amazon's RX Pass for Braden Medicare.com . Just $5.00 A Month For Your Generic Medications, delivered to you by Amazon Prime! AMAZON'S RxPASS HAS YOU COVERED While other savings programs charge for each medication, Rx Pass is always $5 a month—no matter how many generic prescription medications you take.   AMAZON RxPASS HAS A LOW FLAT FEE ON 50 GENERIC MEDICATIONS FOR SENIORS. Every Amazon Prime Member who is a current Medicare Beneficiary can join RxPass and take advantage of these significant savings. SUBSCRIBE FOR JUST $5 PER MONTH Just one monthly price for all of your   eligible medications . EASILY SEARCH FOR YOUR MEDICATIONS ON AMAZON When you search on Amazon, we’ll show you whether a medication is included with RxPass. AMAZON WILL DELIVER YOUR MEDICATIONS DIRECTLY TO YOU Your medication is securely and discreetly packed, with status updates. REMEMBER.........YOU HAVE TO BE AN AMAZON PRIME MEMBER TO JOIN RxPASS RxPass is exclusive to Amazon Prime members. You’ll need to sign up for Amazon Prime before you can subscribe to RxPass. Plus, you’ll get all the other great benefits of being an Amazon Prime member—including free 2-day delivery, exclusive deals, and prescription savings.   RxPASS IS AN EASIER AND SIMPLER WAY TO GET YOUR RxPASS IS A BETTER WAY TO RECEIVE YOUR PRESCRIPTION MEDICATIONS   DID YOU KNOW THAT THE AVERAGE AMAZON PRIME MEMBER SAVES 47% BY USING RxPASS? COMPARE THE AMAZON PHARMACY GENERIC PRICING FOR GENERIC MEDICATIONS TO YOUR PRICE AND GoodRx. SEE IF THE AMAZON Rx PASS CAN SAVE YOU MONEY? INCLUDES MORE THAN 50 OF THE MOST COMMON PRESCRIBED GENERIC MEDICATIONS FAST, FREE DELIVERY TO YOUR DOOR      MORE WAYS TO SAVE BY USING AMAZON PHARMACY   DID YOU KNOW THAT AMAZON HAS A FULL-SERVICE PHARMACY? THE AMAZON PHARMACY MAY BE USED AS YOUR PREFERRED PHARMACY BY MOST MEDICARE PART D PRESCRIPTION DRUG PLANS. IF YOU TAKE MULTIPLE MEDICATIONS, ESPECIALLY IF YOU TAKE THEM MULTIPLE TIMES PER DAY, YOU SHOULD ASK ABOUT AMAZON PILLPACK. WITH AMAZON PILLPACK, EACH OF YOUR MEDICATIONS COMES SEPARATED AND DATED IN ITS CONVENIENT, EASY-TO-OPEN PACKET. YOU MAY BE WONDERING.......... . IS RxPASS A GOOD OPTION FOR YOU? If you’re a Prime member and you are paying more than $5 a month for all of your generic medications, RxPass could help you save. RxPass isn’t insurance, but it can help those without insurance or when insurance doesn’t cover certain medications. Many people with diabetes, high blood pressure, and anxiety will find their medications eligible with RxPass.     HOW DOES THE RxPASS WORK? RxPass is a Prime member benefit that provides access to the most common generic medications for a flat monthly fee of $5 . Subscribers can get all their prescribed generic medicines on the RxPass list, filled as often as needed, for one flat monthly fee. RxPass offers auto-refill so that you get all your eligible prescriptions automatically for $5 a month. Which medications are included with RxPass? YOUR RxPASS SUBSCRIPTION INCLUDES MORE THAN 50 GENERIC MEDICATIONS, COVERING MANY COMMON AILMENTS. Not everyone is eligible to subscribe to RxPass. Why? RxPass does restrict eligibility based on insurance and the state where medications will be shipped. People with state-funded insurance, such as Medicaid and CHIP, are not eligible to enroll in RxPass at this time. Additionally, RxPass is not currently available for shipping medications to California, Minnesota, Texas, or Washington. However, the Amazon Pharmacy  is still available in all of those states. DO YOU HAVE TO BE AN AMAZON PRIME MEMBER TO USE RxPASS? Yes, RxPass is exclusively an Amazon Prime member benefit. If you’re not a Prime member, you must join Prime before subscribing to RxPass. HOW OFTEN WILL YOU BE CHARGED? The RxPass subscription fee will be charged to your selected payment method on the first of each month. When you subscribe, you’ll be charged a prorated amount for your first month and charged on the first day of the following month. What if I decide to cancel? You can cancel RxPass anytime. You will still be able to use RxPass for the rest of the month you’ve paid for, and you will not be charged again.  You can still   CURRENT AMAZON Rx PASS MEDICATIONS Allopurinol Amlodipine Amlodipine Amoxicillin Atorvastatin Azelastine   Benztropine Bupropion Er Bupropion Cephalexin Cyanocobalamin Cyclobenzaprine Cyproheptadine Donepezil Doxazosin Doxepin Doxycycline Doxycycline Monohydrate Dutasteride Escitalopram Estradiol Ezetimibe - Simvastatin Finasteride Fluticasone Furosemide Glipizide Glyburide - Metformin Glyburide Micronized Hyoscyamine Disintegrating Tablets Hyoscyamine Sublingual Tablets Lamotrigine Lisinopril Losartan Methimazole Mometasone Multivitamin With Fluoride Naproxen Nystatin - Triamcinolone Ointment Nystatin Cream Omeprazole Ondansetron Disintegrating Tab Ondansetron Tab Oxybutynin Phenytoin Piroxicam Pramipexole Quetiapine Ramipril   Renal Caps Soft gel Risperidone Rizatriptan Ropinirole Rosuvastatin Sertraline Sildenafil Sotalol Subvenite Tamoxifen Terazosin Tizanidine Triphrocaps Venlafaxine THIS MIGHT BE A BIG HELP TO MANY MEDICARE BENEFICIARIES   While Rx Pass is available for Medicare enrollees, that does not mean you should disenroll from your Medicare Part D plan. Because the RxPass is limited, it is not considered "Credible" by CMS. So, this should be viewed as an addition to your current Stand-Alone Part D plan or your Medicare Advantage Prescription Coverage.   Rx Pass has been designed to work seamlessly with your current Part D Prescription Drug plan. RxPass is particularly beneficial for Medicare beneficiaries who take multiple generic medications. Instead of paying several small copays or coinsurance amounts for each medication, they can receive all of their Generic Medications (Provided they are specified on the list above) for just $5 per month, regardless of how many they take.    These medications are safely delivered to your door free of charge every month. If Amazon Rx Pass does not cover your medication , you should continue to use your Medicare Part D Prescription Drug plan, just like you always have at your favorite "Preferred Pharmacy"  for your particular plan. There are several benefits for both the Medicare program and enrollees when using Rx Pass. However, the most notable benefits include cost savings and convenience. DID YOU KNOW THAT THE AMAZON PHARMACY HAS BEEN AROUND FOR YEARS? AND THEY ARE AN APPROVED VENDOR FOR MOST MEDICARE PART D PRESCRIPTION DRUG PLANS? THEY ALSO OFFER CUTTING-EDGE TECHNOLOGY, LIKE THEIR INDIVIDUALLY WRAPPED AND LABELED PILL PACKS.   However, on the other hand, while Rx Pass offers many benefits, there are some potential challenges and considerations to keep in mind: LIMITED LIST OF GENERIC MEDICATION AS OF JULY 2024:   At present, Rx Pass only includes generic medications, which might not cover all the needs of Medicare beneficiaries, mainly if you are prescribed any Brand-Name medications. YOU MUST BE AN AMAZON PRIME MEMBER :   The service is only available to Amazon Prime  members, which adds cost for those not already subscribed to Prime. AMAZON RX PASS IS PART OF YOUR AMAZON PRIME BENEFITS AMAZON RxPASS COST SAVINGS One of the most significant advantages of the Amazon Rx Pass for Medicare beneficiaries is the potential cost savings it offers. With a minimal $5 monthly flat fee, members can access over 60 generic medications. Plus, there is no limit on the number of prescriptions you can fill with this program. Whether you fill 1 or 10 prescriptions, you are only required to pay the monthly membership fee. This can be particularly beneficial for individuals on multiple medications, as it simplifies budgeting for prescription costs.   Instead of paying multiple co-payments that usually cost $2 - $10 for each Prescription, which can average from $2-$10 per generic medication, depending on the pharmacy you use and the Part D plan you are enrolled in. You could pay a flat monthly fee of $5. If you receive at least one medication through Rx Pass each year, it is projected that you could save up to $70 out-of-pocket.   That number increases the more medications you receive.  It  is intended to help reduce Medicare spending. If all Medicare enrollees used Rx Pass for their eligible medications, Medicare spending would decrease by $ 1.5- $2 2 annually . This would allow for potentially lower Medicare costs and result in higher margins for the Medicare program.   MORE CONVENIENCE BROUGHT TO YOU BY AMAZON RxPass was designed around convenience. Not only are the prices low, but the medications are easy to obtain. The program offers home delivery with free shipping, eliminating the need to visit the pharmacy. In addition to easy medication delivery, members also have 24/7 access to a licensed pharmacist. This ensures you receive professional advice whenever and wherever you need it.   Individuals who are bed-bound, have limited mobility, or wish to stay home to reduce the risk of falls or avoidable injuries may have opted out of Medication in the past due to their inability to go to the pharmacy or leave their home. Now, these individuals can access the medication they need and benefit greatly from this program. HOW AMAZON AND THE RxPASS COULD SHAKE UP THE PRESCRIPTION DRUG LANDSCAPE IN AMERICA The introduction of Rx Pass places competitive pressure on traditional pharmacies and other prescription delivery services. This competition could lead to more affordable options and better services across the industry, benefiting all consumers, including Medicare beneficiaries.   This type of pressure is a step in the right direction for individuals who rely on prescription medications to maintain a healthy lifestyle. Additionally, if Amazon Rx Pass improves medication availability, it could improve health outcomes, resulting in fewer hospitalizations and fewer medical interventions, lower overall healthcare costs, and more money in your pocket each month.   Overall, Amazon Rx Pass represents a significant innovation in the delivery and cost of prescription medications. For Medicare beneficiaries, the potential cost savings, convenience, and improved medication availability are substantial benefits.   As the service evolves, it will be interesting to see how it affects Medicare Beneficiaries, their wallets, and the overall impact on prescription medication systems in the United States.   WRAPPING THINGS UP We are excited to see how quickly the word spreads about the new Amazon RxPass. There is potential to deliver savings and convenience for Medicare beneficiaries and Amazon Prime Members. I liken this approach to COSTCO and SAM'S CLUB. They are not making money from the prices at the locations; they are making money from the Memberships. And, in the long run, this is a great way to keep a growing staff of Pharmacists and Pharmacy Techs busy while also adding value to your Amazon Prime membership.

WellCare Medicare Part D Prescription Drug Plans IMPORTANT ANNOUNCEMENT REGARDING WELLCARE'S MEDICARE PART D PRESCRIPTION DRUG PLANS Some significant changes are coming to Medicare for the 2025 Plan year, primarily to Medicare Part D.We thought it was essential to send this article to all our  clients, subscribers, prospective clients, and visitors. With congressional approval of the Biden Administration's Inflation Reduction Act, significant changes are coming to Medicare. Most of these changes are fantastic and long overdue for many Medicare Beneficiaries. However, these rapid changes have a cause-and-effect relationship that needs to be explained. FIRST, LET'S LOOK AT THE CHANGES FOR 2025 The "Catastrophic Phase," also known as the "Donut Hole" in Medicare Prescription Drug plans, will be eliminated effective January 1, 2025. Due to uncertainty about how much these changes will negatively affect Insurance Companies, many have decided not to participate in Part D Plans in 2025. A few of the more prominent names that will not offer Stand-Alone Medicare Prescription Drug Plans in 2025 include BCBS Franchisees, Mutual of Omaha, and Banner Health. There will be far fewer plans for Medicare Beneficiaries to choose from in 2025. BCBS of Arizona and Mutual of Omaha are not offering any Stand-Alone Prescription Drug Plans in 2025. Humana and Aetna will offer only 1 Plan each, down from 3 previously. The Medicare Part D deductible is increasing to $590.00. It appears that several companies will not offer reduced-deductible plans for the 2025 Plan Year . WellCare and Cigna will both offer one low-premium plan. However, the average cost of all Medicare Part D plans nationwide will be around $37 per month, with most plans $44. For Medicare Beneficiaries who take Brand-Name Medications and have typically enrolled in plans with higher premiums, premiums have been reduced compared with the past few years. WellCare (CENTENE Corporation) has decided to deal with this Brave New World  by no longer paying Commissions to Agents and Brokers, not just for any "New" Medicare Part D Plans for 2025 but also on renewals of all current WellCare Stand-Alone Medicare Part D Drug Plans, including their very popular WellCare Value Script PDP plan. WellCare Logo OUR ASSESSMENT OF THESE DECISIONS We applaud Congress and CMS for taking positive steps to save Medicare Beneficiaries Millions of Dollars by finally putting a "Cap" on prescription drug Plan costs. We absolutely and unequivocally disagree with WellCare's shortsighted, quick-trigger approach to a situation that has not yet been officially implemented. As such, we have determined that it is in our company's best interest not to offer WellCare Prescription Drug Plans for at least the 2025 Medicare plan year and not to make them available as an option to any of our clients in 2025. Based on common-sense business logic, this will significantly harm WellCare. We believe WellCare has chosen a severely myopic approach to the new rule changes, and we refuse to be complicit in any of their actions. We estimate the minimum time required for agents and brokers to market and enroll clients and new Medicare beneficiaries in any Medicare Part D Prescription Drug Plan. Most of you already know that we take great pride in the detail and research we put into our plans. If any company seeks to discount and diminish the role and importance of licensed, independent agents and brokers, we will not sell, market, or enroll anyone in their plans. MOVING FORWARD, BEGINNING WITH THE MEDICARE AEP (ANNUAL ENROLLMENT PERIOD), WHICH RUNS FROM OCTOBER 15th THROUGH DECEMBER 7th We will not include WellCare Prescription Drug Plans in that. Still, we have Medicare Part D Drug Comparisons. All current and prospective clients are welcome to contact WellCare directly to enroll in one of their Medicare Part D Drug Plans, if that is their preference. Still, we can no longer assist them if they partner with WellCare and Centene Corporation for their Medicare Part D Prescription Drug plans. WRAPPING THINGS UP With all of these changes, we believe it is vital that every Medicare Beneficiary get a review of their Prescription Drug Plan before the 2025 Plan Year. There are too many changes to risk not comparing your plan with other available plans. One thing about AEP is that it starts the new Plan Year. However, we cannot unveil or market the latest plans to anyone before October 15, 2024. We cannot discuss any plan specifics until then. For this reason, we cannot list any other Drug Plans that will be available in the 2025 Plan Year. We wish we could, but we are not legally permitted to do that. We genuinely appreciate your understanding.

YOU WERE JUST INFORMED THAT YOUR MEDICARE SUPPLEMENT/MEDIGAP PLAN IS INCREASING YOUR PREMIUM Braden Medicare Insurance's Poster "What Do I Do When My Medigap Plan Has A Rate Increase" Insurance premiums increase and rarely decrease. This fact can be frustrating and concerning. However, it's important to remember that you have options. In this article, we will explore these options, assess their practicality, and outline steps you can take to manage your healthcare costs in retirement. UNDERSTANDING MEDICARE INSURANCE Health insurance helps manage risk. You pay an insurance company to help protect against catastrophic losses. When it comes to retirement healthcare, individuals face crucial decisions upon leaving Employer Group Health Plans. The options available include: Enrolling in Original Medicare Pairing Original Medicare with a Medigap plan Choosing a Medicare Advantage plan Exploring ACA/Obamacare options Considering a Ministry "Share" plan ORIGINAL MEDICARE Original Medicare covers 80% of approved healthcare services but does not provide routine coverage for dental, vision, or hearing care. This program allows you to visit any doctor or hospital that accepts Medicare in the U.S. However, the 20% you are responsible for can add up, especially in the case of serious health issues. For example, surgeries or treatments can drive costs above $100,000, prompting most beneficiaries to purchase a Medigap policy to reduce their financial exposure. MEDIGAP OR MEDICARE SUPPLEMENT PLANS A variety of Medicare Supplement plans exist—eleven to be exact. While many are similar, they vary in coverage levels. Medigap Plan F was once the most popular, but has now become the third most chosen plan since the changes that took effect on January 1, 2020. Those born before this date can purchase Plan F. Today, Plan G, Plan N, and the High Deductible Plan G are among the most favored options. All three cover the items that Medicare doesn't after you meet the annual deductible for Medicare Part B, which is set at $257. After you pay the deductible, all your healthcare costs in the U.S. will be covered. MEDICARE ADVANTAGE PLANS Medicare Advantage, also known as Medicare Part C, is another option available through private insurance companies rather than the government. Two primary types are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans. HMOs generally provide lower out-of-pocket maximums, while PPOs offer more flexibility but at a higher cost. IMPORTANT FACTS ABOUT MEDICARE ADVANTAGE Here are several factors to consider about Medicare Advantage plans: High co-pays and co-insurance apply. Coverage usually only extends within your resident county. Skilled nursing care is limited, typically to 20 days. Emergency and urgent care are available outside your network. Expect costs of approximately $375 per day for a hospital stay of up to seven days. Chemotherapy and radiation typically carry a 20% coinsurance. Plans often require several second opinions for covered procedures. Many renowned hospitals, such as the Mayo Clinic, may not be covered by Medicare Advantage. ACA/OBAMACARE PLANS ACA/Obamacare plans can be accessed through state marketplaces. While occasionally an option for those considering Medicare, they often come with high premiums and unfavorable deductibles. MINISTRY SHARE PLANS Various Share Ministries offer plans for members aged 65 and older. However, most people prefer more comprehensive coverage from Original Medicare or Medicare Advantage. FACTORS CONTRIBUTING TO MEDIGAP RATE INCREASES Several factors drive Medigap rate increases. Insurers must account for overall healthcare costs, inflation, and even market forces. By law, they cannot raise premiums based on an individual's claims, but can increase rates for everyone under the same plan across the state. ADDITIONAL FACTORS INFLUENCING MEDIGAP PREMIUMS Many beneficiaries are unaware that some companies offer declining discounts. Initially, when you enroll in a Medigap plan at age 65, you may receive a significant discount. However, this discount typically decreases by 1-2% annually. By year ten, many find their rates have increased without these discounts. Additionally, many couples fail to explore different rates when one spouse becomes eligible for Medicare. It’s important to compare options at least every two years. KEEPING YOUR MEDIGAP PREMIUMS LOW Your premium serves as the baseline for potential future rate increases. To mitigate these increases, compare rates every 2-3 years with an independent broker. A significant 80% of beneficiaries can pass underwriting, making it easier to switch plans if necessary. DO YOU NEED TO CHOOSE A SPECIFIC INSURANCE COMPANY? It may not matter as much as you think. Here are some key considerations: All carriers must pay their share for any claim that Medicare covers. Choose the company with the lowest price to save money over time. If a Medigap company were to go out of business, Medicare would intervene, allowing you six months to find a new plan without answering any medical questions. Limited gym membership options might affect your choice of company. EVALUATING MEDIGAP INSURANCE COMPANIES When comparing companies, consider: Their longevity in the market Historical rate increases Available discounts Loss ratios Whether they have declining discounts like AARP and CIGNA MY TOP TEN MEDIGAP COMPANIES TO CONSIDER Medico/Wellabe Mutual of Omaha Cigna ACE Medicare Supplement Medical Mutual Protect (Medical Mutual Of Ohio) Humana AARP/UHC Anthem Aetna 10. BCBS In summary, it’s essential to understand your options when your Medigap plan has a rate increase. Stay informed about your plans and always be willing to shop around. This proactive approach can help you save significantly on your healthcare costs. --- For additional information, visit Medicare.gov .