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Archive for the ‘Medicare’ Category

Getting familiar with your State Pharmaceutical Assistance Program is a great way, not only to help your Medicare beneficiary clients, but also to unlock special elections to enroll in Medicare PDP or Medicare advantage plans with Part D.  Medicare beneficiaries who are enrolled in an SPAP get one Special Election Period per year to change their Prescription Drug plan (whether stand alone or integrated into Medicare advantage).

Depending on the state, the Medicare beneficiary may qualify for a reduced (or eliminated) deductible, premium savings, enhanced formulary, reduced copays and the elimination of the doughnut hole.  These programs can save your clients hundreds and perhaps thousands of dollars each year, depending on the state and the individual circumstances.

Additionally, enrolling in a state pharmaceutical program for the first time opens an immediate SEP for an enrollment into a Medicare plan which includes prescription drugs.

Here is a link to the Medicare website which has information and links to each of the state’s Pharmaceutical Assistance Programs.  This is a handy resource to keep bookmarked!

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The AHIP certification will become available for 2014 on June 24th, 2013.  The 2013 certification will be closing on Friday, June 21st, 2013.  The certification website can be found at www.medicareonlinetraining.com

We are recommending that agents wait to begin their 2014 AHIP coursework until AFTER their top Medicare advantage carriers open their certification for 2014.  If you do the certification through an insurance company’s website, often times you can get the certification at a discounted rate (generally, $100), however, if you do the AHIP certification directly, you will pay $150.

Regardless of whether you complete the AHIP directly or through a carriers website, the certificate works the same way and can be used with any company that accepts or requires the AHIP training.  For example, if you complete the AHIP with Aetna, you can use the AHIP for United Healthcare, Humana, etc.

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On Friday, February 15th, 2013, CMS released the 2014 Medicare Part D deductibles and co-insurance limits for 2014.  This was a part of their “2014 Advance Call Letter” which gives Medicare advantage plans and Medicare Part D plans advance notice of funding for calendar year 2014 so that they can start formulating their bids for the following year.  The final notice will be published by CMS on April 1st, 2013.

In a very unusual situation, the Medicare Part D deductibles and co-insurance limits actually declined in 2014 versus 2013.  The Medicare Part D deductible will fall from $325 to $310.  The Initial Coverage Limit will decline from $2,970 in 2013 to $2,830 in 2014.  The Initial Coverage Limit is the total negotiated value of prescription drug costs (both the insurance company portion and the Medicare beneficiary’s cost share) before the Medicare beneficiary reaches the “Doughnut Hole” or Coverage Gap.

The “Out of Pocket Threshold” decreased from $4,750 in 2013 to $4,550 in 2014.  The “Out of Pocket Threshold” is the amount of cost sharing borne by the Medicare beneficiary before they leave the Coverage Gap and enters the “Catastrophic Coverage” portion of the Medicare Part D benefit.  The “Out of Pocket Threshold” includes the following costs:  (1) the deductible; (2) cost sharing while in the Initial Coverage Limit; and (3) cost sharing while in the Coverage Gap.  Additionally, the portion of prescription drug cost borne by the Pharmaceutical companies for brand name prescription drugs in the Coverage Gap (this is sometimes called the Part D Rebate) is also included in the “Out of Pocket Threshold”.

Due to the provisions of the Affordable Care Act (ACA), Medicare beneficiaries will continue to pay lesser and lesser amounts for both their brand name and generic prescription drugs.  Ultimately, by 2020, the entire “Coverage Gap” will be eliminated; however, this is being phased in during the period from 2010 through 2019.  For example, in 2013, Medicare beneficiaries will pay 47.5% of brand name drugs and 79% of the cost of generic drugs.  The “rebate” is 50% of the cost of brand name drugs, so the insurance company actually pays 2.5% of brand name drugs and 21% of generics in the coverage gap.  In 2014, Medicare beneficiaries will continue to pay 47.5% for brand name drugs (50% covered by rebate and 2.5% by the insurance company), but the cost sharing for generic drugs will drop from 79% to 72%.

The following graph illustrates the changes in Plan and Member Cost Share from 2010 through 2020 with 2014 highlighted.

partdgraph

Finally, once the Medicare beneficiary reaches the “Out of Pocket Threshold” and into the catastrophic coverage, they will see the minimum copay decline as well.  The minimum copay for generics will decline from $2.65 copay to $2.55 copay in 2014.  For brand name drugs, the minimum copay will decline from $6.60 copay to $6.35 copay in 2014.  The Medicare beneficiary will pay either 5% of the negotiated cost of the drug or the minimum copays listed above, whichever is greatest.

On April 1st, 2014 CMS will finalize these dollar amounts; however, it is unlikely that they will not deviate by very much.

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Here is a link to information about the bill from Senator Kerry’s webpage.  Current Federal Medigap protections only cover those 65 or older.  Individual states can expand these protections to those under 65 and some do and some do not.  This bill would expand the Federal Medigap protections to all Medicare beneficiaries so that all states would have the same protections for under 65 Medicare beneficiaries.  Also, the bill would allow those with End State Renal to qualify for Medicare advantage.

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Do you need insurance product training? RitterIm.com has an up-to-date posting of all the top carriers’ trainings on our event calendar. Registration is “one click” away at Ritter Insurance’s “Events’ Calendar”! (You must be logged in to register!)

  • Monday, April 30 - There are no scheduled trainings at this time
  • Tuesday, May 1 - Baltimore Life Silver Guard INSpeed Call Center Process Training and Baltimore Life Asset Transfer Product Training webinars are both open to all agents.
  • Wednesday, May 2 - Humana Certification 2-Day Class will be hosted in Reno, NV.
  • Thursday, May 3 - Humana Certification 2-Day Class will be hosted in Reno, NV.
  • Friday, May 4 - There are no scheduled trainings at this time
  • Monday, May 7 - Care Improvement Plus Study Hall Event is being hosted in Little Rock, AR.

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Here is a link to an interview by Fox Business of Joe Baker of the Medicare Rights Center, a non-profit counseling and advocacy organization in New York.

I think he may be understating the impact of the cuts to Medicare Advantage somewhat.  He talks about the reduction from 110% to 113% of original Medicare costs being lowered to 100% in the next few years.  Current estimates for Medicare Advantage reimbursements are estimated at 107% in 2012, so there is still a bit of cutting left to do.  While it is true that these cuts don’t impact those on original Medicare, they will impact Medicare beneficiaries who currently have (or will in the future have) Medicare Advantage plans.

It’s quite true, however, that Medicare Advantage has not seen a reduction in it’s overall membership.  Frankly, this has been a bit surprising to me and could be explained by the fact that Medicare beneficiaries are satisfied with the plans in spite of the fact that the extra benefits are not as rich as they once were.

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Do you need insurance product training? RitterIm.com has an up-to-date posting of all the top carriers’ trainings on our event calendar. Registration is “one click” away at Ritter Insurance’s “Events’ Calendar”! (You must be logged in to register!)
  • Monday, December 5, 2011; IBC Sales Training webinar is open to all licensed IBC agents. Florida NDP Broker CCP Product Training is being held in Hollywood, FL.
  • Tuesday, December 6, 2011; Baltimore Life Tele-sales Training for Silver Guard Products Using INSpeed webinar is open to all Baltimore Life licensed agents. Aetna Senior Supplemental Product Training seminar is being held in Hattiesburg, MS. Coventry Medicare Basic Training seminar is being held in Stuart, FL.
  • Wednesday, December 7, 2011; Aetna Senior Supplemental Product Training seminar is being held in Pearl, MS.
  • Thursday, December 8, 2011; Aetna Senior Supplemental Product Training seminar is being held in Tupelo, MS. Care Improvement Plus Understanding Your SEP Opportunity webinar is open to all agents.
  • Friday, December 9, 2011; No scheduled training at this time.
  • Monday, December 12, 2011; Florida NDP Broker CCP Product Training seminar is being held in Miami, FL.

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