Questions to ask your doctor.

My thoughts on some of the six excellent questions Elizabeth Rosenthal, author of “An American Sickness,” suggests you should ask at every doctor’s appointment to make sure your medical bills are what you expect.

Question #1. How much will this cost?  Your provider’s office staff will know the fee a procedure, or series of procedures are billed at. And they will be able to tell you if your health plan has negotiated a different fee schedule including your flat copay or co-insurance percentage. To be forewarned is forearmed.

Question #4: Are there cheaper alternatives that are equally good, or nearly so? One example I see is a medication that is a combination of two, or more, off-patent generics. Check your health plan’s drug formulary and compare the co-pays. If the new combination pill is high priced ask your prescribing doctor why the one pill is recommended over taking two; sometimes the only benefit is convenience.

Question #5. Where will this procedure take place and how does that selection affect my cost?  Your health plan may have a preferred pricing arrangement (called “in network”, “participating” or “contracted”) with other facilities. Ask your doctor about performing the procedure at one of those.

One more suggestion. Contact your health plan agent or member services representative when planning an appointment with a new provider or facility.  Your plan may have preferred providers, usage limitations and pre authorization requirements. 

http://www.pbs.org/newshour/making-sense/column-6-questions-to-ask-at-every-doctors-appointment/?utm_source=facebook&utm_medium=pbsofficial&utm_campaign=newshour

3 Questions and Answers About 2017 Medicare Part A

Medicare-Card

When you’re first eligible for Medicare, usually when you turn 65, you have an Initial Enrollment Period to sign up for Part A.   You usually don’t pay a monthly premium for Medicare Part A (Hospital Coverage) if you or your spouse paid Medicare taxes for 40 quarters, or ten years, while working. This is sometimes called “premium-free Part A.” Most people get premium-free Part A.

In general Medicare Part A covers

  • Hospital care
  • Skilled Nursing Facility Care
  • Hospice
  • Home Health Services
  • Nursing Home Care (as long as custodial long-term-care isn’t the only care.)

If you are admitted as an inpatient in a hospital or Skilled Nursing Facility Medicare Part A pays for your stay after a $1,316 deductible that must be met for each hospital benefit period.

Q1: So what’s a hospital benefit period?  

A: This period begins the day you’re admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 consecutive days. For example, you were admitted and released from a hospital on days 1 and 4.  After 60 consecutive days of NOT being in the hospital, that would be day 64, the benefit period ended.  If you were admitted to the hospital of SNF on day 65 a new benefit period would start and, yes, a new $1,316 deductible would apply.

Q2: After the $1,316 deductible, is there a daily copay?

A: The $1,316 deductible covers the first 60 days of hospital confinement cost or 20 days of skilled nursing facility eligible expenses.  After these periods, in patient hospital and skilled nursing facility co-pays apply to hospital stay days 61-150 and skilled nursing facility stay days 21-100. (See below)

2017-A-Chart

Q3: Is there a health plan to help cover those hospital and skilled nursing deductible and daily co-pays?

A:  Yes. A Medicare Supplemental Insurance plan, often known as “MediGap,” can help with the Medicare Part A deductible and daily co-pay expenses.  As a reminder, Medigap policies generally don’t cover long-term care, vision vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

 In New York State, the Department of Financial Services posts the current monthly premiums for Medicare Supplement plans by zip code. Click here or call me at 518-346-2115 for assistance.

Switching Medicare Supplement (Medigap) policies

Reasons Why New Yorkers Switch Their Medigap Policies:

As a reminder, Medicare Supplement, also known as Medigap, are policies designed primarily to supplement (or fill the gap) Medicare benefits. You simply present your red, white and blue Medicare card to the provider or facility along with the Supplement / Medigap card to help with out-of-pocket costs; such as deductible and co-insurance amounts with Original Medicare Part A  and Part B.

Currently, there are 10 standardized Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; there’s also a high-deductible version of Plan F). These plans are available in most states.  While premiums will vary from state to state the standardized benefits of each lettered plan remain the same despite the insurance company or location. For example, Plan F benefits are the same in Florida as they are in New York.

Q: Is there an Annual / Open Enrollment Period?

Most people buy their Medicare Supplement / Medigap policy during the six month period after they first enroll in Medicare.   After that, in many states,  Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

Q: So How Do New York State Residents Have More Protection?

New York State laws and regulations continue this open enrollment period. A person enrolled in Medicare Parts A and B may purchase a Medigap policy at any time. Insurers may not consider an applicant’s health status, claims experience, or age.  Laws in New York also prohibit insurers from basing Medigap premiums on age and charging a higher premium as they grow older.  Also,

Q: But What About Pre-Existing Conditions; Are They Covered?

Medigap insurers may impose up to a six-month waiting period to be covered for any preexisting conditions a person may have. Federal law and New York State regulation define a preexisting condition as any condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon whether an individual has had previous health insurance coverage. Medigap insurers are required to reduce the preexisting condition waiting period by the number of days an individual was covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days.   Translation: If you are switching from a “creditable” plan that you have held consecutively for six months, New York regulation requires the new Medicare Supplement / Medigap plan to reduce or waive the six month pre-existing condition waiting period.

Questions about Switching a MediGap Policy?

Please call me at (518) 346-2115 or send a quick note with your contact information and question.

Please visit and follow via Facebook Page. Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states.  Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.

Tips: Prepare For A Trip To The Doctor

doctor-visit

Sometimes face to face time with our doctor seems rushed.
So to get the most out of this short time, and perhaps even a healthier outcome, I have summarized below several tips that doctors recommend from an article I read in the Wall Street Journal titled Get The Most Out Of A Trip To The Doctor and written by Sumathi Reddy.

 

1. Ask Questions. Doctors suggest writing out a list of questions before your visit to ensure that you remember them. Write the questions in order of importance in case you can’t get to everything.

2. Mind the time. Stay focused on why you’re in the office. We all like a little chit-chat and doctors like to know what’s going on in our lives but if you only get 10 minutes then minimize the small talk. Call ahead if you’re running a few minutes late and minimize your waiting time by booking appointments first thing in the morning.

3. Bring your Meds. That includes herbal and over-the-counter medications, and prescriptions you might have got from another doctor. Bring the actual bottles with the original label so you can double-check the dosing and make sure there hasn’t been an error.

4. Take Notes. Writing down what the doctor says could help your memory, jog your memory later after the visit.

5. Tell the Truth. Even uncomfortable topics such as poor eating habits, or medication adherence, or risky practices might cause you to avoid or sugar-coat a subject, but don’t leave things out. If you’re not being truthful the doctor can’t do their best job in taking care of you.

6. Bring a Friend. Going to an appointment accompanied by a spouse, and adult child, or a friend is particularly important if you’re expecting important test results. You may have trouble understanding or remembering things, and having someone else there can help with that.

7. Be Realistic. Having a hard time getting more exercise like the doctor told you to, or having trouble changing your diet? Don’t feel embarrassed to ask a question if you don’t understand something, and keep the instructions realistic.

8. Bring Things Up First. When you’re having a health concern that provokes some anxiety, you may need to work up the nerve to ask about it, but don’t save it to the end of the visit. Then you’ll have the least time to discuss it. Having a prioritized list of what you want to discuss with the doctor can help with this.

Please visit and follow via Facebook Page. Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states.  Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.

When what we do helps someone… February 2017

…. it’s great to hear results.    Read more of this post

“What’s The Donut Hole?”

hero_donuthole_320_dd

On January 1, 2006, the US federal government introduced a program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.  You must enroll in a Part C (Medicare Advantage with Drug) or Part D (Stand Alone Prescription Drug) plan to participate in this federal-government-subsidized drug program.

Here’s a summary on how these plans work.

In 2017, Part C and Part D plans often require you to first pay a defined deductible, then use tiered drug co-payments from you up to an initial coverage limit of $3700 – which is the full retail cost of prescriptions. Once this $3700 initial coverage limit is reached, you will have to pay a larger cost share of your prescription drugs up until your total out-of-pocket expenses (deductible and copay expense excluding) reaches $4,950 infamously referred to as the “Donut Hole”.

donut-hole

Let’s review the Four Stages:

screen-shot-12-07-16-at-06-37-pm

Stage 1: Deductible, if applicable

Similar to many auto and home insurance plans, some Part C (Medicare Advantage with Drug) or Part D (Stand Alone Prescription Drug) plans include an annual deductible where you pay the total cost of drugs until you reach the deductible amount.   Some plans set the deductible only for brand name drugs; check for your plan specifics. (Deductible payments are included in the amount counted toward the $4950 Maximum Out of Pocket level for 2017.)

Stage 2: Initial Coverage Up to $3,700 in Total Cost

In this stage you share cost with your Part C (Medicare Advantage with Drug) or Part D (Stand Alone Prescription Drug) plan, usually as fixed amount copays or percentage co-insurance.  The plan pays for the rest until the Total Drug Costs paid by the plan and you (including the Stage 1 Deductible) reach $3,700.

img_20151208_095456.jpg

In this example, the copay was $3.00 and the plan paid $374.31. Added together, the total $377.31 would count toward the $3,700.  After ten refills, the total $3,773.10 combined paid by the plan and member would exceed the $3,700 Stage 2 Initial Coverage.  The beneficiary member would then have exhausted the plan’s Initial Coverage and incur higher cost sharing in Stage 3, the Coverage Gap or “Donut Hole”

Stage 3: Coverage Gap or “Donut Hole” 

This is when my phone rings.  The conversation goes like this:

Client: “Dan, my prescription refill usually costs $X and today I was told the copay was double or triple that amount.”

Me: “Have you been receiving reports from the plan showing how the total cost of your prescriptions, what you and the plan paid together, has been creeping closer to that $3,700 threshold?”

Client:  “Yes.  But this is a shock.”

Yes, having exhausted the $3,700 in Stage 2 Initial Coverage, you now incur greater cost sharing.  In 2017, when you reach this stage you will be responsible for 40% of the cost of brand name drugs, 51% of generic drugs.  Then, once your year-to-date deductible, copay and coinsurance costs (Stages 1-3) reach $4,950 you then move to Stage 4.

Stage 4: Catastrophic Coverage after your out of pocket reaches $4,950

After the Stage 1, Stage 2 and Stage 3 combined Out of Pocket deductible, copay and coinsurance costs reach $4,950, you pay very little and your Part C (Medicare Advantage with Drug) or Part D (Stand Alone Prescription Drug) plan pays about 95% of the cost until the end of the year.   Then, on January 1, new plan begins again in Stage 1.

suggestions

Below are a few suggestions on how to delay the day by which you enter the “Donut Hole” Coverage Gap and stretch your copay dollars all year long.

  1. Preferred Pharmacy.  If you are in a Part C (Medicare Advantage with Drug) or Part D (Stand Alone Prescription Drug) make sure you fill your prescriptions at a preferred pharmacy where you can save on total costs compared with other drug-stores in your network.  Call your health plan for preferred stores near you.
  2. Generics.  According to AARP, the FDA will approve around 500 new generics next year.  Each will have the same active ingredient, quality, safety and strength as its branded original. Ask your doctor or pharmacist if the brand name drug you’re taking may have a generic option.
  3. Discounts.  Many larger retailers and supermarkets offer deep discount prices for popular generics.  Ask for copies of the chain’s discount list of generics to show to your doctor before he or she writes your prescriptions.  .
    • Example> Hannaford Price Chopper Walgreens
    • Check out GoodRx, a drug-price comparison web site.
    • (Also ask if the chain will fulfill the order independent of your Medicare Part D plan so the cost of the drug isn’t counted toward the $3,700 Initial Coverage.)
  4. Manufacturer.  If you need an expensive specialty drug and the Medicare plan doesn’t cover it, call the drugmaker. Many have customer assitance teams ready to assist families with household incomes up to $100,000.
  5. State Pharmacy Assistance Programs
  6. Social Security Extra Help offers subsidizes Prescription Drug Plan Costs to beneficiaries with limited income and limited resources.  [brochure]

helpNeed Help?  Please call me at (518) 346-2115 or send a quick note with your contact information and question.

 

When what we do helps someone…

…. it’s great to hear results.

Just before Thanksgiving I met with a recently widowed woman.  Still in mourning, she was reeling from her loss and struggling to make sense of her health plan costs and her dramatically reduced monthly income.

When she disclosed her assets and monthly income, I explained to her some programs she was likely eligible for and provided assistance with the enrollment process.

For starters, the easy one. I enrolled this client in the New York State Elderly Pharmaceutical Insurance Coverage (EPIC) program. EPIC helps with Medicare Part D premiums, prescriptions co-pays and the Part D “donut hole.”

Then, we confirmed she was eligible for Social Security Extra Help – available to Medicare participants with limited resources.

Third, New York State offers Part B premium assistance to Medicare participants with limited income and resources.

I love what I do.

When I received this note with the closing “Thank you again for giving me my life back” it reminds me of why we serve – to add some value to another’s life.  This is fulfilling and rewarding in its own way.

2016 0215 Thank you note

http://www.myuhcagent.com/daniel.alcorn
(518) 346-2115