Medicare Part D is an optional federal government program that helps subsidize the cost of prescription drugs for Medicare beneficiaries. All Part D plans are administered by private insurance companies who have been approved by Medicare.
Part D coverage is available two different ways. Those who have Original Medicare can purchase a standalone Prescription Drug Plan that will add prescription drug coverage to their Parts A and B coverage. Others receive their Prescription Part D coverage with their Medicare Advantage plan. Although Part D coverage is optional, there may be premium penalties for those who do not sign up when they first become eligible unless they have other creditable coverage.
All plans are not the same. The monthly premiums vary depending on the type of prescription drug plan you select. Also, some plans charge an annual deductible. Other plans do not.
In addition to the monthly premiums and any deductible, you can expect to pay a co-pay or co-insurance for most prescription. Again, your share of the cost will be determined by the policy you choose, the type of prescription drug you are purchasing and whether it is brand name drug or a generic drug. For example, you might have to pay $5 for a generic drug, $25 for a “preferred” brand name drug and $40 for a non-preferred brand name drug. Your share of the cost may also be higher or lower depending on whether you use the pharmacies in your plan’s network.
In 2019, once you and your insurance carrier pay $3,820 on covered drugs, you will enter the coverage gap also called the donut hole. For complete information on the out-of-pocket costs while you are in the coverage gap and information on catastrophic coverage, please visit www.Medicare.gov and search for costs-in-the-coverage-gap.
The time to make changes in your Medicare Part D coverage is coming soon. During Medicare’s Annual Open Enrollment (October 15 to December 7) you can join a new plan or switch to a different plan that works better for you. Changes you make in your coverage during Open Enrollment will begin on January 1, 2020.
To learn more or to make changes in your coverage, please contact Mutsko Insurance Services at 440-255-5700 or email me at [email protected] to set up an appointment during Open Enrollment to discuss your needs.
Now is a good time to consider whether a Medicare Advantage plan is a good choice for you. If you decide to switch, you can do so during Medicare’s Fall Open Enrollment which begins on October 15 and runs through December 7.
Here are some key differences between Original Medicare and Medicare Advantage plans:
Medicare Parts A and B are commonly referred to as Original Medicare. Original Medicare is managed by the federal government and provides eligible individuals with coverage for doctors, hospitals and other health care providers. You pay a monthly premium for Original Medicare.
Medicare Advantage plans (Medicare Part C) are an alternative way to get your Medicare benefits. Advantage Plans are administered by private insurance companies who are required to provide the same level of coverage offered by Original Medicare. Some Advantage plans are offered at zero monthly premiums while others charge a monthly premium in addition to what you pay for Medicare Part B.
Medicare Advantage plans usually require you to use their plan’s network of doctors, hospitals, and other providers. If you go to a provider who is not in your plan's network, your services may not be covered or your costs may be higher. With Original Medicare there are no networks or referrals needed. You can go to any doctor, supplier, hospital or facility that is a Medicare provider.
Advantage Plans cap your annual out-of-pocket costs for medical services. Once you reach this limit, you will pay nothing additional for covered services. With Original Medicare there is no annual cap.
Prescription coverage (Part D) must be purchased separately for those with Original Medicare. Prescription coverage is included with many Medicare Advantage plans.
Many Advantage plans provide additional benefits not offered by Original Medicare, including coverage for routine dental and vision care, hearing aids, podiatry care, gym memberships and allowances for non-prescription medicines to name a few.
There are other differences between Original Medicare and Medicare Advantage plans. If you would like to learn more or are ready to make a change, contact me at 440-255-5700 or email me at [email protected] and we can go over all your options.
Many people are surprised to learn that Medicare does not cover 100% of their health care expenses. In addition to co-pays, deductibles and co-insurance, there is a list of healthcare services that are not covered by Original Medicare Part A, Part B or Part D. Here are some of the gaps to watch out for:
Medicare covers glaucoma, cataracts and macular degeneration, but it does not cover the kind of vision care we most often need, namely routine vision exams, contact lenses and eyeglasses.
It is estimated that around half of seniors more than 75 years old experience hearing loss. Unfortunately, even though this is such a common disability, Original Medicare does not provide coverage for hearing aids or the exam to diagnose hearing loss.
Medicare does not cover preventive dental cleanings, x-rays, fillings or root canals. You can also expect to pay out of pocket for dentures or oral surgery needed to combat gum disease. As a side note, Original Medicare does cover treatments that are essential before someone can undergo another procedure that is covered. An example of this would be extracting a decaying tooth prior to having heart surgery.
It is a good idea to consider additional medical coverage if you plan to travel outside the U.S. In most cases, Original Medicare will not cover your medical costs for accidents, routine care, or medical evacuations when you are outside the U.S.
Original Medicare does not cover most chiropractic treatments, cosmetic surgery, routine podiatry care or alternative medicine.
Fortunately, you can get coverage for these services and more with many of today’s Medicare Part C Advantage Plans. I can show you Advantage Plans that provide generous allowances for over-the counter medications, transportation to health care appointments and free membership in fitness clubs. In addition, many plans offer coverage for dental, vision, hearing, podiatry care and much more. If you would like to learn more, give me a call at 440-255-5700 or email me at [email protected]. I look forward to helping you find the right plan for you.
When asked where they want to spend their retirement years, 9 out of 10 seniors prefer to stay in their own homes. Those who are most successful doing this, create a plan to age in place early on, while they are able to manage all aspects of living on their own. As they age, they already have a good idea of who and where to turn to for services and assistance to help them stay in their home, regardless of changes in their health, abilities and needs.
It is important not to wait to put together a plan. Start investigating companies or individuals who can take on some of the more physically challenging chores like window washing, yard maintenance and snow removal. Some seniors have a cleaning company come in once a month for an hour or two to tackle the tougher cleaning jobs. Your family is less likely to be concerned about you living alone if they see you are still able to manage your household.
The National Institute on Aging at www.nia.nih.gov is a good source for many other ideas. You can also do an online search for Aging in Place for a wealth of suggestions on meal preparation, transportation and medication management. Do an online search for Assistive Devices to find new products designed to make your everyday tasks easier to manage. You will find both high-tech and low-tech tools to do everything from remind you to take your pills to help putting on your socks. It’s amazing what is available.
As a part of your plan, be sure to look at the benefits provided by your health insurance plan. Some of today’s Medicare Advantage plans include optional services like transportation to and from health-related appointments, home helpers, assistive safety devices, prepared meals following a hospital stay and allowances for safety devices in your home. Having services like these available when you need them can go a long way in helping you maintain your independence.
If your Medicare Advantage Plan does not provide these services, I can help you find one that does. You can give me a call at 440-255-5700 or email me at [email protected]. I look forward to helping you find the right plan for you.
Drug interactions can be a real concern for anyone who regularly takes a number of prescription medications on a daily basis. But, you can take steps to reduce the risks.
Your pharmacists and doctors are your first line of defense. They are well-trained to review your medications and prevent drug interactions. Your first step should be to discuss your concerns with them and they will let you know if there is anything in particular you should watch for including potential side effects or adverse reactions. Be sure you know what each prescription is for.
For questions concerning health insurance, including Individual, Group, Medicare Advantage Plans or Medicare Supplements, please call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
Pneumococcal disease (often referred to as pneumonia) kills 18,000 adults 65+ each year. Older adults are at greater risk and face more severe side effects from pneumonia because immune systems weaken as we get older. The vaccines for pneumonia are especially important for those who have chronic diseases.
The pneumococcal vaccine is a cost-free benefit covered by Original Medicare Part B. The vaccine is a series of two shots typically given a year apart. Check with your doctor to see if you are up to date on this important element of your preventive health care plan.
According to the National Council on Aging, one in three adults contract shingles at some point in their life—the majority of whom are 60 years or older. Shingles is a very painful skin rash that is caused by the “reawakening” of the same virus responsible for chickenpox. If you ever had chickenpox, you are at risk for developing shingles.
Original Medicare, Part A and Part B, does not cover the shingles vaccination. To get this covered, you must be enrolled in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage plan that includes prescription drug coverage. Depending on your plan benefits, you may have to pay a copayment or coinsurance amount. I recommend you contact your plan and follow their guidelines in order to make sure you are covered for this vaccine.
It is interesting to note that many people do not think they had chicken pox as a child. However, the Center for Disease Control recommends people 60 years of age or older get the shingles vaccine whether or not they recall having had chickenpox. Studies show that more than 99% of Americans aged 40 and older have had chickenpox, even if they do not remember getting the disease.
You can find more information about coverage for these and other vaccines at 1-800-MEDICARE or visit www.Medicare.gov. If you have a Medicare Advantage Plan, please call your Medicare Advantage Plan provider for more information on these and other vaccines.
For questions concerning health insurance including Individual, Group, Medicare Advantage Plans or Medicare Supplements, please call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
The VA provides a Medical Benefits Package that is a standard enhanced health benefits plan available to all veterans who served with honor. This plan includes both preventive and primary care, and offers a full range of outpatient and inpatient services within the VA health care system. Those who are enrolled are eligible to receive treatment at more than 1700 medical centers and outpatient clinics across the U.S.
While all veterans may be eligible for health care benefits, eligibility and cost of care are based on many factors including:
If you have access to the internet, I suggest you begin your research by visiting www.va.gov/health-care for an overview of the benefits you may be entitled to receive. You can also find helpful information on Lake County’s V.A. website at www.lakecountyohio.gov/veterans/Benefits and the Cleveland Regional Office website at www.benefits.va.gov/Cleveland. These websites provide a wealth of information to help you become familiar with the system.
Veterans living in Lake County are encouraged to reach out to the County’s Veterans Service Officers (CVSO). Their staff members are trained and accredited by the National Association of County Veterans Service Offices and are veterans who are paid to help you at no cost to you. They will explain your available benefits, assist you in obtaining necessary documentation, help you complete forms and applications and act as your advocate throughout the entire process. You can reach them by calling (440) 350-2904.
The VA itself strongly recommends that all veterans with VA health care also enroll in Medicare Parts A and B as soon as they become eligible (unless they have group insurance from a current employer). Having both Medicare and VA benefits greatly widens your coverage.
If you have insurance questions concerning Individual, Group, Medicare Advantage Plans, Medicare Supplements, Vision, Dental or other Life or Health insurance call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
We are finding a growing number of our customers are relying on the internet paired with their smart phones, tablets and other mobile devices to search for insurance information. However, we all know that not everything you find on the internet can be trusted so it’s a good idea to be cautious of the sites you visit.
Here are a few reliable resources:
Medicare.gov is the official U.S. Government site for Medicare. It is a one stop site for official Medicare benefit information including coverage options, costs, preventive services, blogs and videos. It is also where you can sign up for MyMedicare.gov, a free and secure way for you to access your personal information online, cutting down on the amount of paperwork Medicare routinely sends to you.
The Center for Medicare and Medicaid Services (CMS) recently introduced an easy to use tool called the “What’s Covered” app to give you accurate cost and coverage information on your smartphone or mobile device. Their goal is to make it easier for you to find the information that is important to you. You can download the What’s Covered App for free from your Apple or Android app store.
You can also visit the Mutsko Insurance Services website at www.mutskoinsurance.com for news, resources and updates on insurance matters. We recently updated our website, adding new downloadable forms and interactive features you will find helpful, including:
For more updates and interesting facts on insurance matters, become a facebook friend of Mutsko Insurance Services at www.facebook.com/MutskoInsurance.
Be careful. Never share bank information, social security numbers or other personal information with anyone you do not know and trust. If someone asks you for information of this nature, tell them you will contact them after you have independently verified their information. Then contact your bank, Medicare at 1-800-Medicare or Social Security Office to verify that the caller is legitimate.
If you have questions concerning Health Insurance including Individual, Group, Medicare Advantage Plans or Medicare Supplements, call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
The National Hearing Test is a telephone-based screening test developed with funding from the National Institutes of Health. You can take this confidential hearing test over a telephone and the results can help you decide whether you should seek a more thorough evaluation of your hearing.
The National Hearing Test is quick and convenient. When you register to take the test, you will be given an access code. You then call from a landline phone (not a cell phone) and enter your access code to start the test. You will be instructed to listen to numbers spoken through electronic noise and enter the numbers you hear on your telephone key pad. If you are doing well, the test becomes more difficult, making it harder for you to hear the numbers. If you are not doing well, the test gets easier. The test takes approximately ten minutes to complete.
Once you have completed the test, you will receive individual results for both ears. You can then use this information to decide whether you should see an audiologist to receive a more complete examination.
Untreated hearing loss can lead to a serious decline in your quality of life, causing social isolation, problems on the job, and embarrassment. This screening is particularly effective at detecting the most common forms of hearing loss which are age-related and those that result from exposure to loud noises. Similar tests have been used successfully in Europe and Australia.
The National Hearing Test is a simple, affordable and scientifically validated. It is provided on a non-profit basis and costs $8.00. AARP members can take the test for free once a year. To learn more about The National Hearing Test, please visit their website at https://www.nationalhearingtest.org.
If you are interested in learning more about insurance plans that provide coverage for hearing screenings, hearing aids or other services not covered by Original Medicare, call me at 440-255-5700 or email me at [email protected]. I look forward to helping you find the plan that’s right for you.
You are permitted to enroll in or make changes to your Medicare Supplement at any time throughout the year.
To be clear, a Medicare Supplement, sometimes referred to as Medigap Insurance, is not the same as a Medicare Advantage plan. Both are sold by private insurance companies. However an Advantage plan covers your Medicare benefits through a private insurer. While a Medicare Supplement works in conjunction with Original Medicare paying some of the health care costs not covered by Original Medicare such as copayments, coinsurance and deductibles. Some Medicare Supplements may also cover emergency treatment when traveling outside the United States. Medicare Supplements do not normally cover long-term care, vision care, dental care, hearing aids, eyeglasses, or private-duty nursing.
You should expect to pay a separate premium for a Medicare Supplement in addition to your Original Medicare premium. You will also need to purchase a separate Prescription Part D plan as this coverage is not usually included.
The best time to buy a Medicare Supplement is during your 6-month Medicare Supplement open enrollment period. During this time you cannot be turned down or charged more because of any health conditions. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B (Medical Insurance). Once this open enrollment period ends, you may be subject to medical underwriting restrictions and your acceptance into a plan is not guaranteed.
You cannot have both a Medicare Advantage Plan and a Medicare Supplement. It is illegal for anyone to sell you a Medicare Supplement unless you have Original Medicare.
Falls are the leading cause of injury among older adults. A number of factors including physical changes as we age, health conditions and medications used to treat health conditions make falls more likely among older adults.
While a lift chair can be helpful in certain circumstances, you need to be aware of Medicare’s requirements before you purchase a chair at your local furniture store and try to send the bill to Medicare.
Medicare will cover a portion of the cost of a lift chair, but only the cost of the seat lift mechanism. They will only provide coverage when this type of assistive device is prescribed by an individual’s physician as durable medical equipment (DME). The lift chair will need to be purchased through a Medicare Approved DME supplier who accepts assignments. In addition, when you purchase the chair through an approved supplier, you can expect to pay 20% of the Medicare-approved amount for the seat lift mechanism and the additional cost of the chair. The Part B deductible applies.
Medicare will cover the cost of the lift mechanism only for individuals who have trouble standing because of severe arthritis in the hip or knees or other debilitating conditions. Lift chairs can be helpful for patients who would otherwise be unable to stand up or sit down from a chair without help. The individual must be able to walk once they are standing.
Your doctor may recommend a number of other assistive devices to help prevent falls. For example:
For other ideas, ask your doctor for a referral to an occupational therapist. He or she can help you come up with other fall-prevention strategies.
Medicare covers some of the above items as Durable Medical Equipment. For a complete list, go to www.Medicare.gov and search for Durable Medical Equipment. Some Medicare Advantage Plans now provide flexible coverage for items not covered by Original Medicare. Please check with your insurance
If you need to replace your Medicare card because you believe someone else is using your number, it is best to report this immediately to Medicare at 1-800-MEDICARE where they will help facilitate your request.
However, if you are requesting a replacement card because yours was lost or damaged, you have a number of options, depending on how quickly you need your new card and how comfortable you are with using online resources.
Option #1: MyMedicare.gov
The quickest way for you to get a replacement card is to log into your MyMedicare.gov account. Click on the My Medicare Card box on the upper right side of the page. It will allow you to view and print an official copy of your Medicare card. If you do not have a MyMedicare.gov account, you can create an account and then use this option to print out your replacement card.
Option #2: Contact Social Security
You can request a replacement Medicare card by calling Social Security at 1-800-772-1213, Monday through Friday, between the hours of 7 a.m. to 7 p.m. You can also visit your local Social Security office to request a new card.
If you have an online my Social Security account at www.ssa.gov, you can log into your account and select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.” Your Medicare card will be mailed to the address you have on file with Social Security and will arrive in about 30 days.
Guard your Medicare Card
Only give your Medicare number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on your behalf. If you forget your card, you, your doctor or other health care provider may be able to look up your Medicare number online.
Remember that Medicare will never call you uninvited and ask you to provide personal or private information. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call us at 1-800-MEDICARE (1-800-633-4227).