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 email@example.com.
The IRS has an early holiday gift for employers, on November 29, 2018, the IRS released an extension for large employers to file the 2018 Form 1095-C or 1095-B under the Affordable Care Act requirements. The agency has pushed back a critical Affordable Care Act (ACA) deadline for the fourth year in a row. The forms, which outline employer-provided medical benefits, must be submitted annually by businesses with 50 or more full-time workers. The IRS uses these reports to track employer compliance.
-The deadline for furnishing 2018 Form 1095-C, or Form 1095-B, if applicable, to employees and individuals is March 4, 2019 (extended from January 31, 2019).
-The deadline for filing copies of the 2018 Forms 1095-C, along with transmittal Form 1094-C (or copies of Forms 1095-B with transmittal Form 1094-B), if applicable, remains unchanged:
-If filing by paper, February 28, 2019.
-If filing electronically, April 1, 2019.
The extended due date applies automatically so employers do not need to make individual requests for the extension.
The time for 2019 coverage selection is now! It’s open enrollment, the short time frame that is infamous for all decisions to be made regarding upcoming health insurance coverage. McGriff-Williams can assist in plan changes or confirmation of renewal if you stay on the same plan that you currently have. Our agents are knowledgeable and ready to help guide you through this process. And if you don’t have a plan already in place, now’s also the time to purchase new coverage! Here are some important dates to keep in mind:
October 1 – Open enrollment begins for off-marketplace (ACA but non-subsidized) plans
November 1 – Open enrollment begins for marketplace (subsidized) plans
December 15 – Deadline for all new coverage and plan changes, which will be effective January 1, 2019