Roadmap Staff

The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.

Research, Compare, and Pick a Medicare Part D Plan with Confidence!

Medicare Open Enrollment is here, and the clock is ticking towards making your final prescription drug (Part D) plan selection. Enrollment and taking time to understand your options can be stressful. This is particularly true if you are new to Medicare because the choices you make now may have a financial impact on your Medicare costs down the road.

Starting your research early to gather the information you need, compare plans and weigh your options can reduce the stress. If you need help navigating the complicated Part D terrain, don’t be afraid to reach out to those around. Here are a few tips for getting your research under way so you can choose next year’s Medicare Part D plan with confidence!

  1. Find reliable online tools. Medicare.gov offers detailed information about Part D plans and a tool to compare how drugs are covered by each provider. Signing up for Roadmap for Medicare newsletters will give you free access to our Roadmap eBook where you’ll find helpful checklists and a step-by-step guide to Medicare Part D.
  2. Check state and local resources. Consider contacting your State Health Insurance Assistance Program (SHIP). This program, which is funded by the federal government, has trained counselors in each state that can help you understand your Medicare plan choices and answer questions about switching plans at no cost to you. Check online for the phone number of the SHIP in your state or, if you are currently enrolled in Part D, you can easily find that contact information in your Evidence of Coverage. Look for local organizations hosting community events where you can get helpful tips and even have some fun! You can also make an appointment with a licensed Medicare insurance broker if you need additional help.
  3. Recruit family and friends. Once you’ve done your research, turning to a spouse, friend or relative can be helpful. They can assist by talking through your concerns, sharing additional online resources or pointing to events happening in your community. Since Medicare Part D Open Enrollment ends December 7, the Thanksgiving holiday can be a great time to wrap up your decision and choose the plan that’s best for you.

To learn more about how to maximize your network of friends and family and make the best use of resources to research next year’s Medicare plans, please watch this video.

 

 

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The Do’s and Don’ts to Guide You Down the Path to
Part D Enrollment

As you journey down the road towards choosing a Medicare prescription drug plan, you’ll likely hit some bumps along the way. Below are some tips to help you navigate the roadblocks and enroll in a Part D plan that best meets your needs.

Keep these do’s and don’ts in mind while considering your Part D options:

Don’t delay. It takes time to research and find the plan that best meets your needs. Make sure to start that research early to make sure you have enough time to identify and consider your options. Be sure to enroll before December 7th to avoid paying late enrollment penalty fees.

Do check a plan’s formulary (the list of drugs the plan covers) to make sure that all the prescription medications you currently take are covered. Also talk to your doctor about drugs that you may be prescribed in the coming year, so you can make sure that those are also on the formulary.  While you can’t predict all your future prescription needs, it’s best to be well prepared for the ones that could be added to your treatment plan in the months ahead.

Don’t make your decision based solely on the plan’s monthly premium. The cost of the premium is only one factor to consider when determining the full cost of the plan. Deductibles and copayments also need to be considered, as well as the medications you take. If you regularly take only one or two prescription drugs, then a low premium plan may work well for you. However, if you take three or more medications, you may require more comprehensive coverage than a low premium plan offers. Remember to always evaluate the overall annual costs of the plan when making your selection.

Do opt for a plan with a preferred pharmacy network that includes your current retail pharmacy or another one that’s conveniently located. Preferred pharmacies offer lower copays for prescription drugs. If you’re on a medication that you take regularly for a chronic condition, you may be able to save even more money if there is a preferred mail delivery pharmacy option. It’s also easy and convenient to get your prescriptions delivered right to your home.

Don’t ignore Star Ratings. Plans are given between one and five stars by the Centers for Medicare & Medicaid Services (CMS) based on several factors including customer service and the quality of the care provided by the plan. Make sure to always check the plan’s Star Rating before you make your final decision.

Do seek out help in choosing a plan. Reading through each plan’s fine print and understanding what it all means is no easy task. Once you’ve done your research, take advantage of resources that are available to help guide you through the final decision-making process. Some of that help can be found right in your community. Your State Health Insurance Assistance Program (SHIP) provides a call line to answer Medicare questions. There are also Medicare insurance brokers that are available free of charge and can help you find the plan that meets your needs.

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Avoiding Medicare Enrollment Road Bumps

Tips for enrolling in a Medicare Part D plan

Key Dates for Medicare Part D Annual Enrollment Period


Plan Information Available:

October 1

Enrollment Begins:

October 15

Enrollment Ends:

December 7

Note: The late enrollment penalty is 1% of the national average premium for every month you were without Part D prescription drug coverage or other creditable prescription drug coverage following your initial enrollment period, or if you had a break in creditable prescription drug coverage of 63 or more consecutive days. Creditable prescription drug coverage (for example, from an employer or union) means that it is expected to pay, on average, as much as Medicare’s standard prescription drug coverage. You will pay this late enrollment penalty for as long as you have Part D coverage.

Enrolling in a Medicare Part D prescription drug plan (PDP) is an important process that requires time and research, but it shouldn’t be a difficult one if you’re prepared well in advance for any potential bumps in the road. Unfortunately, nine in 10 people wait until the last minute to select a plan. (more…)

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Seeking Value: Looking Beyond Medicare Part D Premiums

Four simple rules for choosing the right plan for you

When choosing a Medicare Part D prescription drug plan (PDP), you might assume that a low premium (the monthly amount you pay for the plan) equals a “good deal.” While it’s easy to compare premiums, there is much more to consider. To learn more about four simple rules of the road to keep in mind as you do your research, please watch this video. (more…)

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5 Tips for Meeting with your Medicare Broker

Medicare Part A, Part B, Medigap, Medicare Advantage Plans, Medicare Part D…it can be a bit mind- boggling when researching the choices you have and trying to understand the type of Medicare coverage that makes the most sense for your healthcare needs.

Some people turn to Medicare insurance brokers to help sort through the fine print and choose the right Medicare plan. These professionals are experts at navigating through Medicare plan details and can narrow down options that suit your particular health and financial circumstances. They can also help you through the enrollment process. You will need to do some initial leg work to find the right broker and ensure you get the most out of the broker’s services, which are all free of charge.

If you choose to meet with a broker, here are five tips to help you find the right one and prepare for the meeting.

  1. Look for a specialist: Make sure you meet with a licensed broker who specializes in Medicare and has an American Health Insurance Plans (AHIP) certification. The broker should be licensed in the state where you have residency since Medicare plan options vary by state.
  2. The more information you share the better: Gather the following information that will help the broker direct you toward the best Medicare coverage for your health and financial needs.
    • Medical status and history: Your current and past health conditions.
    • Medications: Those you currently take as well as drugs you might need to take in the coming year. It’s best to have a discussion with your physician to assess what drugs you may need in the near future.
    • Finances: Be prepared to have a frank conversation about your finances so the broker can determine which plans are within your budget. It’s important to share information about your yearly income, if you’re on a fixed income, your living expenses, and the amount of money you currently spend on healthcare.
  1. The lowdown on prescription drug coverage: Each Part D plan has its own formulary, or list of covered drugs, so the broker will need to know your current prescriptions to make certain that not only the medications but the dosages you take are covered. You should ask the broker to check if the Part D plan has a preferred network of pharmacies that offers lower drug costs and if your own pharmacy or those in your area are included on that list.
  2. Know the lingo: Medicare has a lot of terminology, policies and processes that can be difficult to navigate and understand. The Medicare plan types are:
    • Original Medicare: The government-run benefit that includes Medicare Parts A and B
    • Medicare Part A: Covers inpatient care in hospitals, skilled nursing facilities, hospice care and some home healthcare. For most beneficiaries, there is no charge for Part A.
    • Medicare Part B: Covers physician services, outpatient services, laboratory tests, mental health services and other medical services not covered under Part A. Those enrolled in Part B will pay a monthly premium.
    • Medicare Part C also known as Medicare Advantage Plans: These are plans offered by private insurers as alternatives to Parts A and B. They usually provide additional benefits and may also include prescription drug coverage. The benefits and costs of these plans can vary widely.
    • Medicare Part D also known as a Prescription Drug Plan (PDP): These plans are offered by private insurers and provide prescription drug coverage which in most cases is not covered under Parts A or B. The formularies (drugs covered under the plan), clinical services and costs can vary widely.
    • Medicare supplemental insurance also known as Medigap plans: These plans are sold by private insurers and provide supplemental coverage to Original Medicare coverage. Unlike Medicare Advantage Plans, they are not meant to replace Parts A and B coverage but to provide additional benefits.

A full glossary of Medicare terminology is available at https://www.medicare.gov/glossary/a.html

  1. Make it habit to review yearly: Since your health status may change over time and plan benefits and costs often change from year to year, it’s important to review your Medicare coverage during the appropriate annual enrollment periods to ensure you have the right plan that will meet your health and budgetary needs in the coming year.

Healthcare coverage decisions can have serious consequences on your health and financial well-being, and a licensed insurance broker may be the resource that helps you find the Medicare insurance plan that is right for you at the price you can afford.

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New Medicare Cards Fight Fraud

The Centers for Medicare & Medicaid Services (CMS) is replacing the current Medicare cards with new cards. CMS is issuing the new cards in response to recommendations from the General Accountability Office, Medicare beneficiaries and advocacy groups. The new cards don’t use or display a beneficiary’s Social Security number. This protects beneficiaries who in the past have been unnecessarily exposed to fraud by the sharing of their personal information. The newly issued cards are also intended to protect taxpayer dollars because it will make it harder to bill Medicare for services that were never performed.

In place of the Social Security number, the new cards will use a Medicare Beneficiary Identifier (MBI) number that will be uniquely generated for each person. The MBI will use a random combination of numbers and capital letters. To avoid confusion between capital letters and numbers, the letters S, L, O, I, B and Z are not being used.

With more than 59 million beneficiary cards to replace, the new cards are being distributed over the course of a year.

What do beneficiaries need to do?

The new cards will be automatically sent on a rolling basis between April 2018 and April of 2019. You will not receive any calls or requests from Medicare for information. If Medicare has your current address, you don’t need to do anything. However, it’s important to call Medicare if you need to update your address so that you will receive your card promptly. You can contact Medicare at 1.800.633.4227 (TTY users, call 1.877.486.2048), 24 hours a day, 7 days a week. You can also sign up to receive an email notification about when to expect your card in the mail by visiting Medicare.gov/NewCard.

Once your new card arrives, you will need to dispose of your old one by cutting it up so that your Social Security number is destroyed. Your Medicare coverage and benefits will remain the same and there are no extra steps required by you to activate your card.

A transition period will be in effect through December 31, 2019, during which healthcare providers will accept both Medicare cards – the older plastic one, which includes your Social Security number, and the new paper version that includes your new MBI number.

Protect yourself from scammers and identity theft

A Medicare representative will never contact you by phone unless you have left a message requesting a callback. The representative will never ask you to provide personal information.

If someone calls you or sends an email asking for information or money they say is required for you to obtain your new Medicare card, you should immediately hang up and call Medicare at the numbers provided above.  You can also report it to the Federal Trade Commission (FTC) by calling 1.877.438.4338 (TTY users, call 1.866.653.4261).

At the end of the day it’s all about your protection. So be on the lookout for your new card and don’t respond to anyone asking for your information or trying to sell you what they say is the new Medicare card. Be informed. Be alert. Be protected.

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