Category: Medicare Part D

Schedule Your Annual Enrollment Appointment Today To Enroll!

Get ready for a game-changer in managing your healthcare costs! Starting January 1, 2025, Medicare Part D is rolling out an exciting new program under the Inflation Reduction Act. The Medicare Prescription Payment Plan will revolutionize how you pay for your prescription drugs by allowing you to spread out your out-of-pocket costs over the year.

Inflation Reduction Act 2025 Changes:

• $2,000 Yearly Cap: A new $2,000 yearly cap on Medicare prescription drug costs.
• Price Negotiations: Medicare can now negotiate drug prices directly.
• Improved Access and Cost Caps: Improved access to biosimilars and a $35/month cost-sharing cap on insulin in durable medical equipment pumps.

What’s in Store for You:

• Monthly Payment Magic: Say goodbye to unpredictable costs! All Medicare Part D plans will now offer capped monthly payments for prescription drugs, making it easier than ever to budget and manage your healthcare expenses.
• Who’s In?: If you’re enrolled in Medicare Part D, including those receiving Extra Help, you’re eligible to benefit from this groundbreaking payment plan. Those with higher cost-sharing, especially for brand-name or non-preferred drugs, will find this program particularly helpful.
• Opting In Is a Breeze: During the Annual Enrollment Period (AEP) starting in October 2024, you can opt into this program as you enroll or renew your Part D coverage. Already enrolled? No worries! You can jump on board at any time during the plan year by reaching out to your Part D sponsor.

Key Features to Remember:

• Applies to both standalone Medicare prescription drug plans and Medicare Advantage plans with drug coverage.
• This program doesn’t reduce your total prescription drug costs but makes them way more manageable.
• Your Part D sponsor is committed to processing your election requests promptly.
• If you’ve been hit hard with high cost-sharing early in the year, this program could be a game-changer for your budget.

As you prepare for the upcoming changes, it’s important to stay informed and make decisions that align with your healthcare needs and budget. Consider discussing this new payment plan with me during your AEP appointment to see how it fits into your overall healthcare strategy. With the Medicare Prescription Payment Plan, managing your prescription drug costs has never been easier.

REMINDER! Schedule Your Annual Enrollment Period (AEP) Appointment Today!

Don’t wait until the last minute! Schedule your AEP appointment now to get a full coverage review to ensure your 2025 health care needs are in place, and receive assistance in opting into this new prescription payment plan program.

Fill out the 2025 Insurance Updates Form prior to your appointment to streamline the process and make the most of your enrollment period.

To schedule your appointment please contact our office today. We look forward to assisting you with your 2025 healthcare needs!

Answers to Your Most Common Questions

Summer is the perfect time for seniors to embark on new adventures, whether exploring national parks across the U.S. or visiting exotic destinations abroad. As you plan your travels, understanding how your Medicare coverage works away from home is crucial. Here, we address the most frequently asked questions about Medicare and travel, ensuring you’re well-prepared for any health-related needs during your summer journeys.

Coverage Outside the U.S.: Does Medicare Cover Medical Care While I’m Traveling Abroad?

A: Original Medicare generally does not cover healthcare services outside the U.S., except in limited situations such as emergencies in Canada or when traveling through Canada on your way to Alaska from another U.S. state.

Medicare Advantage Plans: What About Travel Coverage?

A: Some Medicare Advantage plans offer travel benefits that extend beyond emergency and urgent care. These benefits can include coverage for routine health care services whether you are vacationing within the U.S. or abroad. It’s essential to consider that coverage details, rules, and limitations can vary significantly between plans. When selecting a Medicare Advantage plan, ensure it meets your travel needs by asking:

• What emergency or routine health care services are covered if I vacation in the U.S. or out of the country?
• Do I have to seek services with specific providers?
• How long can I be away from home and still receive coverage?
• Will this plan cover both domestic and international travel?

Prescription Drugs Abroad: Does Medicare Cover Them?

A: Medicare Part D does not cover drugs purchased outside the U.S., but certain travel-related vaccines might be covered.  Medicare Advantage plans do no cover prescription medicines or routine health care services overseas. This means you might be paying 100% of the costs of care.

Using Medigap Policies for Travel: What Do You Need to Know?

A: Medigap (Medicare Supplement Insurance) policies provide emergency health coverage for the first 60 days of your trip outside the U.S. During this period, the policy typically covers 80% of the costs for medically necessary emergency care, as defined by Medicare. It’s important to note that Medigap plans are not designed to cover non-emergency medical services or surgeries abroad. Instead, they aim to stabilize your condition for transport back to the U.S.

Can I Use Telehealth Services While Traveling?

A: Some Medicare Advantage plans offer telehealth services that allow you to consult with healthcare providers remotely. Check with your plan to see if telehealth services are available while you’re traveling within the U.S. or abroad.

What Should I Do If I Need Medical Care While Traveling Abroad?

A: If you need medical care outside the U.S., you generally need to pay for the services upfront. Foreign hospitals are not required to file Medicare claims for your travel medical costs. You’ll need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services if you’re admitted to a foreign hospital under specific circumstances and the hospital does not file Medicare claims for you.

Travel Insurance Options: Should You Consider Additional Coverage?

A: Due to limited Medicare travel coverage, many seniors opt for supplemental travel insurance. Review policy terms carefully.

Cruise Ship Coverage: What’s Covered by Medicare?

A: Original Medicare (Parts A and B) and Medicare Advantage Plans may cover medically necessary health care services on a cruise ship if the ship is in U.S. territorial waters or within six hours of a U.S. port when the services are received. 

Does Medicare Cover Emergency Air Transportation Back to the U.S.?

A: Medicare generally does not cover emergency air transportation (medical evacuation) from a foreign country to the U.S., except in very limited circumstances where the transportation is considered medically necessary and is provided as part of an inpatient hospital stay that Medicare covers.

Planning Ahead for Emergencies: What Should I Include in My Medical Travel Kit?

A: When traveling, it’s essential to pack a medical travel kit with essentials like medications, copies of insurance cards, emergency contacts, and a list of allergies. Being prepared can help ensure you’re ready for any unexpected health situations that may arise during your trip.

As you plan your travels, it’s important to keep in mind how your Medicare coverage works outside of your home area. Always check with your plan beforehand to understand what’s covered and consider additional travel insurance for added peace of mind. Being prepared ensures you can focus on enjoying your trip without worrying about unexpected medical costs.

If you’d like to review your plan before your next travel, please contact our office today at (631) 738-6760 and we would be happy to assist you in ensuring you fully understand your coverage before you set sail onto your next adventure!

Bon Voyage!

Get ready for a game-changer in managing your healthcare costs! Starting January 1, 2025, Medicare Part D is rolling out an exciting new program under the Inflation Reduction Act. The Medicare Prescription Payment Plan will revolutionize how you pay for your prescription drugs by allowing you to spread out your out-of-pocket costs over the year.

What’s in Store for You:

1. Monthly Payment Magic: Say goodbye to unpredictable costs! All Medicare Part D plans will now offer capped monthly payments for prescription drugs, making it easier than ever to budget and manage your healthcare expenses.
2. Who’s In?: If you’re enrolled in Medicare Part D, including those receiving Extra Help, you’re eligible to benefit from this groundbreaking payment plan. Those with higher cost-sharing, especially for brand-name or non-preferred drugs, will find this program particularly helpful.
3. Opting In Is a Breeze: During the Annual Enrollment Period (AEP) starting in October 2024, you can opt into this program as you enroll or renew your Part D coverage. Already enrolled? No worries! You can jump on board at any time during the plan year by reaching out to your Part D sponsor.

Key Features to Remember:

• This program doesn’t reduce your total prescription drug costs but makes them way more manageable.
• Your Part D sponsor is committed to processing your election requests promptly.
• If you’ve been hit hard with high cost-sharing early in the year, this program could be a game-changer for your budget.

As you prepare for the upcoming changes, it’s important to stay informed and make decisions that align with your healthcare needs and budget. Consider discussing this new payment plan with your Medicare Broker to see how it fits into your overall healthcare strategy. With the Medicare Prescription Payment Plan, managing your prescription drug costs has never been easier.
To learn more, or get assistance in enrolling to this new program, contact our customer support services today.
To learn more, or get enrollment assistance, please contact our office today at (631) 476-4015.