Select the best Medicare Prescription Drug Plan (PDP)

We want to ensure that when we help our clients select the best Medicare Prescription Drug Plan (PDP) for their specific prescription needs. As the annual enrollment period begins our clients are provide through the U.S. Mail a large number of advertisements to select the particular carrier’s prescription drug plans. They have great advertising literature that say some great claims of saving 80% on your prescriptions.

I can see how this can be very overwhelming as a person looking to help save on their prescriptions. The truth is the claims may be true for certain prescriptions, but how will the carriers plan do with your set of prescriptions? You cannot believe the information provided without doing additional research on what your prescriptions will cost. In some cases, you may find that that prescription plan advertisement you got in the mail may be 80% more expensive than another plan.

There is a tool out there I use as an agent to remove emotion and help select the best prescription plan for my clients. This tool is provided on Medicare.gov. I never though the tool from the government can be so useful to objectively look at the coverage from all the various options available in your area. The tool will let you select your prescriptions, your pharmacy, and show you your prescription costs monthly throughout the year. The site will show you when you fall into the Coverage Gap and estimate when you will reach the catastrophic coverage. The tool can give you piece of mind that you are actually going to find the best plan for your particular set of medicines.

To check you set of prescriptions is very easy to do with the help of your insurance broker, but you can do this by yourself. The Medicare.gov system will be able to save your prescriptions and zip code to allow you to visit again. This is great especially if you have many prescriptions. Once you are on Medicare.gov, you can select “Find Health and Drug Plans”.

Once the new page opens you will enter your zip code.

Next you will answer the questions “How do you get your Medicare coverage?“And “Do you get help from Medicare or your state to pay your Medicare prescription drug costs?” then click the “Continue to Plan Results”.

The next step is to enter your prescription drugs. Be very specific on your prescriptions, dosage and number of times a day that you take them. They will even ask how often you refill your prescription (monthly, 90-day or other).

Once you enter your first prescription, you will be able to save a couple of numbers that will allow you to retrieve your drug list.

Drug List ID: 3484910016
Password Date: 10/3/2015 (change date)
Zip Code: 78732

As shown below in the screen shot from Medicare.gov. If you have these 3 numbers you can return to the list at a later date.

Once your drug list is complete, click “My Drug List is Complete”. You will then be able to select up to two pharmacies, your favorite one and one additional pharmacy.

When you are done here, you select “Continue to Plan Results” Then you will be able to select if you want to look at Medicare Health Plans with Prescription drug coverage (MAPD) or Prescription Drug Plans (with Original Medicare) – the top two options.

Next for this example I selected the Prescription Drug Plans. Original Medicare costs are always shown at the top of the list, but if you scroll down you will see the plans sorted by annual cost. The annual cost is the cost of your prescriptions at your first pharmacy and this includes the annual premium as well.

We can drill down even more on the plan by clicking the “SilveScript Choice (PDP) title and see further details on your cost.

Two things are very clear on this top part of the details – the plans Star Ratings, how well the plan is rated by a variety of factors, the plan monthly premium, and the annual drug deductible. As you move further down the page, you can see the annual costs for premium and drugs at each pharmacy option and through the mail order program included with the prescription drug plan.

In the above chart there is a lot of information to help you review the costs for this plan on your prescription drugs. They show you the Full Cost of the Drugs, this is the retail cost for each drug on the plan. The Initial Coverage Level, this is the cost for the prescriptions you would expect to pay at the pharmacy for each prescription (shown in Green on the bar graph). The cost you will expect in the Coverage Gap (Donut Hole), shown in brown in the bar graph. The cost of your drugs in the Catastrophic Coverage, shown in Blue on the bar graph.   The monthly premium is shown in grey on the bar graph. This graph can help you plan when you hit the Coverage Gap.

As you get close to the bottom of the plan details, they tell you what tier each medication is on the plans Formulary. They will as well tell you if your prescription is not covered on the Formulary.

When I help my clients we walk them through this level of detail to do the best job we can at estimating costs for them. We have found this Medicare.gov site is a great resource that can be very objective with the clients specific set of medicines.  This is a free tool and gives you the most comprehensive estimate of your RX costs and plan costs throughout the year.

If you do have questions visit with a local broker to help you through the process. There is no extra cost for having someone help you find the best options. Don’t miss your change to make a change of plans if there may be a better option out there for you. The Annual Enrollment Period is October 15^th through December 7^th each year.  Plan evaluation is an important part of your annual review of your coverage.

Loosing Group Coverage – COBRA or Individual Health Plan

The Affordable Care Act and changes for COBRA that you need to be aware of before you take the easy route and make your first COBRA payment.  The laws have changes some with respect to COBRA.  If you do make your first months COBRA payment, then they expect you to stay on that plan until you exhaust COBRA or hit an annual enrollment period.  A loss of group coverage does give you a “Qualifying Life Event” that will allow you to enroll in an individual plan.   My advice to my customers is to compare your COBRA options to the Individual Plan options either on the Healthcare.gov website or just direct from the carriers.  There is no reason to enroll through Healthcare.gov unless you have a need for subsidized plan or you are getting additional benefits from them for being a Native American.

We would suggest working with a broker who will be able to advise you and help you compare coverages.  Depending on your needs in a health plan and cost I have advised some of my customers that COBRA may be the best option.  Other customers who have less needs can find ways to save on premiums with other individual options.  Brokers will be able to guide you to find the best options for your health plan and RX needs.

Just know that if you pay one payment to COBRA you are stuck with it until the next open enrollment period.  This is much different than it was in the past as we could drop COBRA at any time and enroll in an individual plan.  So if you in the situation of looking at COBRA it is a good thing to compare your options before the commitment.  The Affordable Care Act has added some twists to how health insurance works.  Let a broker help you find the best solution for your particular needs.

We are now able to make changes to our individual health insurance plans under Obamacare open enrollment period begins on November 15th.  We help people with updating and purchasing their individual health insurance on the marketplace (www.healthcare.gov) when you are looking to get a subsidy to help pay for the health insurance coverage for you and your family.

You can enroll with an licensed agent that will be your advocate to assist you with selecting a plan, and supporting you for any issues you have with your policy.  Enrollment period for 2014 is from November 15 to February 15th.  If you want to have a January 1st effective date, you must submit your application by December 15th.

Do you think you are eligible for a subsidy, below is a table to help you determine if you should look at going through the healthcare.gov with the help of an agent.  Below is simplified table to assist you in determining your particular situation.  Remember you are estimating your 2015 income.

My suggestion for health insurance subsidies is that you should be cautious on your income levels, if anything estimate on the high side as you may have to pay back subsidies if you underestimate your earning for 2015.  If you estimate too low and your income comes in much higher, you may need to pay back thousands of dollars on your 2015 taxes.

We definitely help our clients find the best plan for their situation if they are enrolling with Healthcare.gov or if they are enrolling direct with the carriers.  If you are looking at enrolling and you are eligible for subsidies, you can select the Silver Plans first.  If you subsidy is enough you end up in the cost sharing band.   When you are in this band, you will received lower deductible and max out of pocket with the premium subsidies.   You could end up with a Silver plan with a $500 deductible with $750 annual max out of pocket.  I did run into some people who did enroll with the plan Bronze plan, because they did not notice the plan deductible savings on the Silver plans.  I did talk with them as they were disappointed in the choice that had made when they did it by them self.

The bottom line is that you should work with an agent who can best advise you for coverage either on or off of the Healthcare.gov site.  There is no charge for the help and you would have an agent that will assist you with any questions or problems you may have.  Don’t miss the enrollment window for Obamacare as to have a January 1st effective date you must submit an application by December 15th.  For 2014 the Open Enrollment Period is from November 15th to February 15th 2015.  If you do not make changes during this time, you can not purchase health insurance unless you have a valid qualifying event.

Starting on November 15th, the 2015 Open Enrollment Period Health Insurance begins for changes for all individual insurance plans.  We expect all carriers to release their rates just before the 15th of November for the 2015.  This is for both on the Healthcare.gov or through the various insurance providers.  The Open Enrollment period for 2015 is from November 15, 2014 – February 15, 2014.  To get coverage for January 1, 2015, you must have your application submitted by December 15, 2014.  If you apply by the 15th of the month you can get coverage the first of the following month through the Open Enrollment Period.

Last year we saw many issues with the Healthcare.gov site, this year should be smoother.  We have seen many clients who tried to enroll on the Healthcare.gov to help get subsidies that did not know that a local insurance agent can assist with the enrollment process.  An agent has a strong understanding of the plans on the market and know how to guide you to find the best plan for your specific situation.  The agent can be your advocate should their be any issues with your coverage either on or off the Healthcare.gov site.

We did see people who did make mistakes when they enrolled without assistance purchasing a Platinum, Gold, Silver or Bronze plan.  If you are getting a subsidy, it makes sense to check out the Silver plans because they do offer cost sharing for some who are eligible for a subsidy.  Cost sharing does lower your deductible and out of pocket costs automatically.  When you work with an agent we can help you see the savings on those plans to ensure you maximize your benefits.

If you are not receiving a subsidy, there is no reason to enroll through HealthCare.gov unless you are looking for a multi-state coverage.  You can purchase these plans without HealthCare.gov.  Your local agent can help you enroll.

There are three advantages for you to work with a local independent broker to help you sign up for your health plan on or off healthcare.gov.  First is a personal advice and guidance to find the best plan for your needs, an advocate to assist you with issues once your policy is issued, and lastly helping others in your community by supporting their local business.  If you buy direct, the insurance company will take the commissions that the agent would have made, and the money does not stay in your community.

Don’t Procrastinate Get Life Insurance Austin, TX

There are a number of reasons you don’t procrastinate, get Life Insurance in Austin, TX.  The first reason is that you never know when your life can change and effect the members that depend on you.  Life insurance does not mean much to you when you do not need it, but it can be invaluable to you when you are facing some health issues.  Not all health issues can cause trouble for your life, but it can cause trouble in qualifying for life insurance.

We have heard many clients go through drastic lifestyle changes due to not have life insurance in place for the mother and father in the family.  Today many families have both parents working to keep the house running financially.  The salaries are counted on to make ends meet and if at sometime in the future one of them has an unexpected accident or fatal illness, this leave the family in a bad financial state.  We never know when we may have a life change in our family, so we suggest planning before you are faced with the unexpected.  Life Insurance should be part of your family plan and in your budget.  Event if you can only afford a little, you can always purchase additional coverage if your financial situation improves.

We have heard many stories of just not making life insurance high on the priority list, but what you can see what happens to a family without it, you would be an advocate for getting it as early as you can.  To keep the premiums low and ensure you get it when you are healthy to protect your future insure-ability just in case you become ill or have a condition that would be problematic.  Some customers think having large insurance coverage through your employer is a good way to go because of its low cost, and I believe you should take advantage of that, but be sure to have some coverage outside of you work.  Today people are changing jobs frequently or may be laid off for extended periods of time, if you only had corporate sponsored insurance, then during this time you have NO Life Insurance, exposing your family.

Key Things to Know about Life Insurance

1. Your Family may count on your income from your job, if you are not there, then your family will need to change their lifestyle.  Life Insurance can protect them and their future.
2. Life Insurance is underwritten, and your rates will go up for age and your health, if you have some health issues you may not be able to obtain life insurance at a reasonable cost.
3. You should have life insurance outside of your employer, if you loose your job you do not have life insurance, or you may not qualify for a life when you want to purchase it.
4. If you are facing a severe illness, you want to get life insurance you will not be able to get it in most situations.
5. Don’t procrastinate to get life insurance, you never know when your family will need to have that protection.  Get it when you do not need it.

We have seen many stories where the family does not properly plan and without the life insurance in their plan, they are forced to change how they live their life.  This can be a problem caused by high medical bills and funeral expenses for their departed family member.  We have seen this happening more and more.  Don’t procrastinate get Life Insurance Austin TX when you do not need it from a Broker.  There is no added cost to working with a broker, and they can help guide you to the best policy and face value for your specific needs.

The process is not hard once you decide on the type and insurance face value you are looking for.  You will fill out an application for the life insurance company, decide if you want to have some temporary insurance while the policy is being underwriting, and getting scheduled to have a paramedical exam to take your vitals,blood, urine and other required items based on the policies face value and the carrier.  The entire process usually takes about a month from application to policy is placed in force.  This time spent planning for your families future will be much appreciated by them.  Do not procrastinate get life insurance Austin TX today.

What you need to know when faced with deciding between COBRA versus Individual Health Insurance Affordable Care Act.

There are a few rule changes that you should consider if you are facing deciding between COBRA versus Individual Health Insurance Affordable Care Act.  The Affordable Care Act did make major changes to when you can enroll in individual insurance plans.  These enrollment periods are during the Annual Enrollment Period (AEP) during October 1st and December 15th.  For 2015 the AEP was modified to be November 15th to February 15th.  The other time you are eligible to enroll is with a Special Enrollment Period (SEP).  SEP does give you the opportunity to enroll in an individual insurance plan (either direct from the insurance company or through the Marketplace with no added cost for using an agent).  Items that give you and your family a SEP here are some of the Qualifying Events:

• Marriage or divorce
• Having a baby, adopting a child, or placing a child for adoption or foster care
• Moving your residence, gaining citizenship, leaving incarceration
• Losing other health coverage – IMPORTANT: Voluntarily ending coverage doesn’t qualify you for a Special Enrollment Period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.

If you have one of these happen to you, you have an opportunity to enroll in an individual health insurance plan.  Most special enrollment periods last 60 days from the date of the qualifying life event.

The particular Qualifying Life Event I will discuss the losing of other health coverage – such as loosing group coverage through a downsizing at your company.  You will usually be offered COBRA, which continues the same coverage that you had when you were part of the group.  You will be offered to pay the full premium plus 2% administrative charge.

One of the changes that went into effect on July 1st, is that if you pay the first month premium for COBRA, you will not be able to switch to an individual plans until an AEP.  If you are considering putting off looking for an individual plan and go the easy route and just take COBRA, you can be stuck with it until the next calendar year AEP.  This is a big change in how the individual insurance market used to be before ACA where you could change insurance plans every month.  ACA you are limited to these enrollment periods.

Don’t procrastinate in deciding which way you want to go either COBRA or an Individual Health Insurance plan.  The other item you should know is that to get coverage for the next month, you need to apply for coverage by the 15th of the month with an individual carrier.  If you enroll on Marketplace with or without subsidies, you can get coverage by enrolling by the last day of the month for the first of next month.  I do not understand why the government site allows you to make the late enrollment enrollment exception for SEP, but I have seen it work with many customers.

If you are confused on the plan options, COBRA vs Individual plan, please get assistance from a local insurance agent/broker.  I have seen many customer sign up with out assistance and find themselves with a plan they did not understand.  The agents can help you find the best solution for your family even if it is to take the COBRA coverage.

Have you gone to inquire for health insurance and subsidies on the Marketplace (healthcare.gov)?  I have been enrolling my customers through the system over the past 4 months.  I can tell you it has not been a smooth process for the most part.  I have entered with a customer their information in the systems more times than I like to admit.  It is a timely process to get approved for a subsidy.  We have seen some subsidies covering nearly all of a customers premium – so they end up with a Silver plan that costs them $0.07/mo premium.  This makes the customers very happy to get this premium.

When I first meet with a customer we work together to see if they can qualify for a subsidy.  This process using the HealthCare.gov site is very simple and does not ask any personal/financial date to determine if you can qualify.  You would go to the “See Plans Before I Apply”.  They will ask what you are looking for and if you are interested to see if you qualify for assistance paying for your health insurance. If you do not qualify for a Subsidy, I usually suggest to clients to not go through the Marketplace, mostly because the process is easier on the client.

This assistance can as well include Cost Sharing, which basically means that they will lower your deductible and out of pocket limits on the Silver plan you select.  I believe many people who are not using an agent are not aware they should look at Silver plans to get the maximum benefit with a subsidized plan.  An agent can really guide you to find and understand your coverage.  I as well believe people are buying without agents help may end up with a plan that they will be very dissatisfied with if they did not understand what they are buying.

The application process usually takes around 1 hour to complete, I have been able to get it down to 45-minutes if everything works properly.  Selecting a user name has been difficult as I have had some difficulty having it work for the client.  They make you enter a few pages of information before they tell you they did not like the username.  Then you need to do it again and again until it works.

After you get through that it is a straight forward form with some questions that are redundant between modules and some are very silly.  They ask if a 3-year old girl is pregnant, smoke, earns money, and some question drive me crazy as an agent.  Once you get through all the questions on the personal and financial side, then they spit out a subsidy eligibility.  From there you decide if you want to use all of it to pay for your health insurance.  I usually recommend using it all.

Then we go look at plans.  I usually start by looking at the Silver coverage.  Once you decide on the plan, you are good to go to select and apply for the coverage.  Just a few more questions and then you are enrolled.  The only thing that you need to do after that is wait about 5 days to allow for the insurance company to receive your information then you can pay the first months premium and recurring premium payment setup.  I would be sure to do this before your policy begins, to ensure that your coverage is fully paid an active.  They have begun to be more strict on having paid up premiums before benefits are paid out.  I think January was a month where the insurance company paid thousands in benefits without receiving any premium from the client.

Need help, do hesitate to ask a local agent.  You will not be charged any fees or the premiums will not be any higher.  You will have someone that can advise you and support you with any questions.  Subsidies are available, use an expert to ensure you get the maximum benefit from your subsidies and health plan.  Open enrollment ends on the Health Insurance Marketplace and off of the marketplace on March 31st 2014.  Don’t delay or you will not be able to get any health insurance until January 2015.

 

I have been involved with some of the Obamacare (Affordable Care Act (ACA)) On Marketplace and Off Marketplace enrollments during the Open Enrollment Period.  This year the enrollment period goes through March 31st for 2014.  I have seen a few issues with the Healthcare.gov website that have caused clients not to be able to finish the enrollment process.  There are a few items that are frustrating in the processing of applications on the Healthcare.gov.

When should you try to obtain health coverage through Healthcare.gov?  The most important reason is to take advantage of a government subsidy and cost sharing.  The subsidy is available based on your families income.  I have run across a few clients that have been able to get enough subsidy to purchase a Silver plan with a $0.07/mo premium.  The silver plans will offer cost sharing and this will reduce your deductible and out of pocket maximums in some cases.  You should always take a look at the Silver plans to see if they are offering you a better deal than the Gold or Platinum plan.   I have found the government “See Plans” has a calculator that works very well without entering any personal data to review plans and estimate your subsidy.

One additional thing to really look at is the network of  doctors on the plans you are considering.  Some carriers have made some changes to their network (PPO or HMO) that you may find that your doctor is not in network.  This is a good thing to check with your agent before you sign up.  The challenge is if you do not check you may be surprised to have a plan without your doctor for the rest of the calendar year.

If you do not need a policy that can pass state to state, you can buy insurance off of the exchange just like individuals have done in the past, before the Affordable Care Act (Obamacare).  The plan off of the exchange can offer different products and different doctors networks for some carriers.  If you do not get a subsidy then, you are an ideal candidate for an off of the exchange plan.  The process is simpler in the respect of you can sign up direct through the carrier with the help of an independent agent.   This take the Healthcare.gov out of the equation and issues that happen on the government site.

The one thing to know is that there are many options available on the Marketplace and they can be confusing to understand as you can be overwhelmed with details.  The one thing to note is you can use an Agent or Broker to help you enroll and ask questions about the options and know what your are signing up for on or off the Marketplace/Exchange.  This is plan you will have for the balance of the year.  There is no cost to work with an agent of broker, they will be your point of contact for questions or issues you may have on the plans.

If you need help understanding your ACA Individual Health Insurance plan if you can get a subsidy, differences in PPO, HMO, or POS plans we have some information to help you better understand your options.

We have seen that both on the Marketplace or Exchange and off of the Marketplace plans are much different that what we had in the past.  One thing for sure is you need to understand what you are buying for your coverage.  We do have HMO, PPO, and POS plans in Texas and you really need to check that the networks you are considering of enrolling in especially if you have particular doctors as a requirement.  If you do not understand the difference in network types you should before you sign up.

HMO – Health Maintenance Organization, these plans offer lower cost for the premiums, but they do require a selection for a Primary Care Physician (PCP) and you can ONLY use doctors in the network – NO COVERAGE for using doctors or services out of network.  This is the PCP you are requred to go to first for all your basic healthcare services.  They will evaluate your issue and could refer you to a specialist if needed.  The good thing about the HMO network is it keeps the cost down and your PCP will know you and your health history very well.  They call him the gate keeper to referrals to specialists only when needed.  Some clients do not like the loss of flexibility with this type of plan that they need to get referrals and that they can only use doctors in network.

PPO – Preferred Provider Network, this is a network of physicians that have agreed to the carriers terms for being in the network.  PPO plans you do not need to select a PCP (Primary Care Physician).  If you use in network providers, you are offered copays and the costs apply toward your in network deductible.  In network providers offer lower costs, if you go out of network for a provider, usually they will cost more.  With a PPO plan you are able to self refer to a specialist, without needing a referral from a PCP.

POS – Point Of Service – this is basically a combination of a HMO and PPO plans.  This plan does allow going in and out of network like PPO, and you may be asked to select a Primary Care Physician.  You can be referred by your PCP to a specialist and you can self refer as well.

No matter which type of plan you are considering HMO, PPO or POS it is important to check that your doctors are part of the network to keep you costs down.  We have seen as we have been enrolling people that some people find out that they plan they felt best, did not have their doctors participate in.  It is worth checking before you get locked into a plan that you cannot go to see your favorite doctor.

If you are struggling with what to do, reach out to a local agent to help you narrow down your choices and have a dialog about your specific requirements.  There is no additional cost to working with an agent/broker, and you will have a personal advocate of you have any trouble.  They can help you enroll on or off of the Marketplace.  We do many enrollments and review the plans so we can help you to navigate the available plans.  Give us a call should you like some personalized help if finding the best options for you and your family.

As we approach the end of February, we have been helping people figure out the best ACA individual health insurance plan for their specific situation.  We still have time to enroll during the open enrollment period through March 31st, then the window will close until 2015.  If you have not figured out what plan is best for you, there is still time for enrollment either with a subsidy on the Marketplace or off the exchange.   Take your time when you are selecting the plan for you.

As January 1st is fast approaching the first ACA compliant policies are going into force some that have have been purchased through the Healthcare.gov and some that have been purchased through agents and direct with carriers.  The first part of the story is now people can get covered with no fear of being denied for any health conditions such as diabetes, BMI (Body Mass Index), Cancer, Mental Illness, Pregnancy, children alone and other conditions that may have in the past been deniable conditions by the insurance company.

The new law makes things easier for those who may need health insurance.  For others we have created some issues for them in the Medicaid Gap created between 100% of the poverty level and 138% of the poverty level in states where they did not adjust the medicaid level to match the lower range of subsidies to pay for the health insurance premiums.  The other aspect of the Affordable Care Act for those who do not qualify for a subsidy or if they do not want to try to obtain a subsidy, the premiums on these plans have caused some major increases in premium to allow everyone to be able to get insurance with or without subsidy.  I have seen the premiums go up about 45% in my case if I moved to an ACA compliant policy.

The premiums are not where they used to be and everything has changed on the policies available on the market.  We want to ensure everyone finds the best solution for their family.  I am helping clients enroll in Marketplace plans and off the marketplace depending on what they would like to do.  There is no added cost to working with agents and you will have a personal advocate in the event of any issues.

The new health care law does allow you to change your policy annually between October 1st and December 15th.  In 2014, they have a open enrollment period that will end on March 31st.  The policy will be effective if you enroll by the 15th the first of the following month.  If you enroll after the 15th of the month, it will be effective the 1st of the following month.  They way the enrollments work is different than they do today.  Outside of the enrollment period, they will not be able to make any changes, you can only make changes if you have a life event or move out of the service area.  If you miss the open enrollment, there is no opportunity for enrollment.  This is a big change.

If you are struggling with figuring out what to do or if you can qualify for a subsidy, work with a local agent.  Give us a call and we can walk you through the process to get you signed up and give you advice to find the best solution for you.  There is no added costs to work with an agent.  We can work on and off the federal Marketplace.  We do not limit your selections or ability to obtain a subsidy.  Let us help you today – there is still time to enroll.  Enroll by January 15th and have coverage February 1st.  We have found some people can qualify to have their subsidy make their monthly premium $0.08/month for a silver plan with some cost sharing benefits to reduce your out of pocket.   Don’t delay and we can help you get enrolled.