Approaching 65 or retirement can be a time of celebration, but also a time of confusion and overwhelm when it comes the transition from health insurance to Medicare. There are Parts A and B original Medicare, then what’s referred to as Part C for Advantage Plans, but also Supplements and Part D Prescription Drug Plans. It’s a lot, right? Although it sounds like an alphabet soup puzzle, it doesn’t have to be over complicated. Let’s focus on the Part D Prescription Drug coverage for now. This is sold by private companies, in addition to the medical coverage on a Supplement, that goes with original Parts A and B.
How do I choose a Part D Plan?
- You can visit medicare.gov and select the tab titled “Drug Coverage (Part D)”. If you are going the route of an Advantage Plan, there will be Part D coverage built into that plan. But if you’re opting for a Supplement, such as the ever-so-popular Plan F with Florida Blue, you’ll need a separate Part D Plan.
- This Part D section of medicare.gov is a great tool to compare plans that are specifically offered in your zip code. You can also look up actual medications in their formulary to see what your cost would be, based on what plan and pharmacy you prefer.
- As you compare coverage, you may see things like copays and coinsurance that apply to certain drugs. There is also a coverage gap referred to as the “donut hole”. In 2019, the guideline is that once you and your drug plan have spent $3,820 on covered medications, you enter the “donut hole”. Once in that coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name drugs. In 2019, Medicare will pay 63% of generic drugs during this time as well.
When can I enroll?
- Time frames to consider: You can choose and enroll in a Part D plan within the same 7 month window as regular Medicare…. 3 months before your 65th birthday month until 3 months after. Outside of that period, the late enrollment penalty will apply. And if your health status or prescribed medications happen to change throughout the year, you can switch Part D Plans during open enrollment, which begins October 15th, 2019.
What if I don’t enroll on time or choose not to have a Part D Plan?
- It is advised that even if you don’t currently take any regular medications, still enroll in some sort of Part D coverage to avoid the late enrollment penalty. The current penalty fee in 2019 is 1% of the “national base beneficiary premium” of $33.19 times the number of full, uncovered months you didn’t have Part D or creditable coverage once becoming eligible. The monthly penalty is then rounded to the nearest $.10 and added to your monthly Part D premium…. Forever.
- Keep in mind that your health can change or decline quickly and the cost of prescription medications are at an all-time high. It’s more important than ever to have Part D coverage and it’s worth every penny to avoid astronomical out of pocket expenses and the forever-haunting penalty that comes from going without.
This can all seem very complicated so it’s really best and most accurate if you look up your specific medications and compare plans based on your actual needs. We are always happy to help guide you through this process and make recommendations or answer questions anytime.
Yes, it’s April 1st but don’t be fooled!
If you’ve ever heard “Be your own advocate!” when it comes to health care, or ever been in a situation where that would apply… you know how true it is. Things are happening in health care. Big things. And while some of them are huge innovations, strides with technology and more knowledge than medical professionals ever dreamed of… there’s still a bit of a dark side that the average consumer needs to be aware of. Billing. Womp womp.
Now before this gets misconstrued as a negative connotation of doctors, nurses, hospitals or anything else specific to the medical world, we are not by any means speaking generally or negatively about all things health-related. This is simply a warning to patients to pay attention.
Here are some quick stats from a healthline study to ensure that we are providing facts rather than opinions on this:
- Up to 80% of medical bills have errors
- Nearly 1/3 of Americans learn that their health insurance doesn’t pay what they expected
- 59% of the time Americans are contacted by debt collectors is for an outstanding medical bill
- 16% of Americans’ credit report includes medical debt totaling over $80 billion
Instead of pointing the finger at medical professionals or facilities for over charging, let’s discuss a few ways you can prevent being on the receiving end of those not so fun surprise charges:
- Speak up. If you don’t understand a procedure, diagnosis, treatment plan or medication, find your voice and use it. Ask questions. Make notes. Do some research. You know your phone is close by, look it up online and educate yourself. Yes, you should trust the licensed and very well educated professional that spent a lot of time in school to do this for a living but understand what they’re telling you and be sure you’re on board.
- Price shop. Find out if certain facilities perform procedures for less and why. This is common with teaching hospitals. This also applies heavily to prescription drugs. Don’t just use the pharmacy closest to your house because it’s convenient and they have a drive-thru. Look at goodrx.com or call around to others to see what their cost is. Now obviously, keep in mind that if you have health insurance, there may be certain pharmacies they work with or providers that are in or out of their network. But don’t just default to the most popular or most convenient. Your wallet will thank you.
- Request details. Ask for an itemized bill/Explanation of Benefits. Keep documentation for your records. Don’t just pay whatever you’re told without knowing what exactly it’s for.
- Channel that feisty preteen 7th grader in debate class that we know is still in you and fight for yourself. It might amaze you at how much health care providers are willing to negotiate if you can come to an agreement of either a payment plan, pay in full discount or overall reduction if it can be justified.
Your health is not a game and you can’t put a price on a medical necessity… so you should by all means get the best care possible. However, a little awareness and self-advocacy can go a long way and may even help facilitate a more proactive approach to good health… now that you’ll be able to afford it.
Another year’s gone by and it’s time to file your taxes again. But what do these 1095 forms mean? What we said in our tax form blog last year still stands true. To refresh your memory, visit our site here for some good information on the various 1095 forms: https://mcgriffwilliams.com/blog/1095-tax-forms/ or even another one we did prior to that: https://mcgriffwilliams.com/blog/health-insurance-tax-forms/.
Good stuff, right? That was all pertaining to individual under 65 health plans. When it comes to Medicare, there are so many glorious things that happen when you’re finally eligible to switch over. Yes, you’re another year older but these days, many people look forward to that birthday in particular. Your health insurance rates typically go down when you transition from an individual plan and the coverage may even get better. It’s a great system that seems to run very smoothly.
There is one thing that you may not know though… you’ll still get those aforementioned tax forms in the mail. If you’re on Medicare, whether it be an Advantage plan or a supplement, you may still receive a 1095 form. The only difference now is that you aren’t required to submit it when you file your taxes. Hold on to this form for future reference if needed, it’s really just for your records.
Things are ever-changing in the health insurance and income tax world so if you ever have questions or concerns, we are happy to help. Give us a ring at (352)371-7977 or email firstname.lastname@example.org.
Ever pay attention to where people park at the office? It might say more about their personality than you’d expect. Authority, promotions, benefit packages and overall leadership often times come with a preferred or privileged parking spot. May seem silly to analyze where someone parks but what message would that leader be sending to their employees?
A leader that believes they deserve a front spot over their staff might as well also demand to sit at the head of the table during meetings or even stand to literally look down upon their team. What if that leader gave up their spot to park with the rest of the team? How would that change the dynamic? They may even catch a good conversation or get to know eachother a little better on their longer walk in. It also eliminates the impression that the leader thinks their own time and energy are more valuable than anyone else’s.
In one instance, a corporation with over 1,200 employees had a walking contest and noticed for the first time that directors, supervisors and administrators were parking in the very back spots in order to get more steps on the walk. Sure, this example shows that the people in those positions were competitive and aggressive go-getters. But what if they did that more with the intention of being ONE with their team rather than trying to say they WON? What if it was out of a humble, grateful, equal approach that could unify them to accomplish more than they ever would if they remained divided?
Forget the power trip. Pretend you’re wearing a pedometer. Use it as a tool to reward and spotlight a team member. However you justify it, think about how something as minor as where you park can identify you. It can be one small step (no pun intended) in the direction of combining forces with your team and gaining some respect, or even a friend.
Ever walk out to the parking lot and not recognize your car because it’s not the same color you remember? Covered from top to bottom in a lovely shade of yellow? No one likes pollen. It causes terrible allergies and constantly dusts our homes and vehicles.
It’s spring in our area (which often times happens the very next day after a winter freeze) and that’s typically a season most would welcome with open arms… and a box of tissues. It’s when all the pretty flowers bloom and the grass turns green again. But it also means all the plants and trees are releasing their tiny little pollen grains in an effort to fertilize others, causing some drug store visits and lots of cleaning for everyone. Here are some tips on how to combat this pollen apocalypse:
- Try to rinse your car off every other day, even just with water if you don’t have time to fully wash it. The longer pollen stays on the vehicle, especially with the hot and sunny days we’re having, the worse it bakes into the paint and can cause long term, irreversible damage. Just kicking that dust off daily or every few days can be a big help to prevent the acidity in pollen causing some bad oxidation and staining.
- Next time you wash your car, use a different sponge for the paint surfaces and the non-paint surfaces such as wheels, chrome and glass.
- Adding a coat of good wax to serve as a barrier to protect the paint is also a good idea. The only thing to be sure of here is that you wipe it dry right before applying the wax so there is no pollen residue at all that would get worked into the paint.
- If your allergies are really bad, an interior cleaning or replacing the cabin filters can help with what makes its way inside.
- Mix up a spray bottle with warm water & a few squirts of dishwashing liquid. These and an old rag can be used for columns, porches, patio furniture, grills/outdoor kitchens, toys, etc.
- For the actual house itself, you may want to use a pressure washer (even with just water) to knock off the yellow coating.
- If you’re noticing pollen making its way inside, try to convince the family (again) to leave their shoes at the door and not keep windows or doors open without a screen.
- If allergies are too much to handle, you can go as far as to empty your vacuum cleaner outside and wear a mask when you dust. May sound crazy but this stuff is no joke!
- It’s been found that if you don’t like the idea of allergy medication or it doesn’t seem to work, you may find relief in home remedies such as apple cider vinegar, honey, saline rinses, nasal sprays, acupuncture or Vitamin C.
As of this day in late February, the pollen count in Gainesville, Florida is a whopping 10.5 out of 12 and has maintained that unfortunate score for the past few days in a row. It’s expected to be a way of life for the next four months until we shift from spring to the summer heat. Try not to let it hinder your time outdoors and use these tips to reduce your exposure.