Hilgerman Insurance Solutions Blog

Prescription Drug Coverage (Part D): What You Need to Know

by Deborah Hilgerman | Jul 1, 2024 | Medicare

Navigating Medicare can be complex, especially when it comes to Prescription Drug Coverage (Part D). This part of the Medicare program changes frequently, almost every year, so it’s crucial to have your plan reviewed to determine coverage and costs for the upcoming year.

What is Medicare Part D?

Medicare Part D is prescription drug coverage that helps cover the cost of your medications. It’s available to anyone with Medicare and is provided through private insurance companies approved by Medicare. Part D plans can vary in terms of costs, covered drugs (formulary), and pharmacy networks.

Why is Part D Important?

Medications can be a significant part of your healthcare needs, and having the right Part D plan ensures you have access to the drugs you need without breaking the bank. Here are the key aspects of Medicare Part D:

Formulary: A formulary is a list of drugs covered by a Part D plan. Each plan has its own formulary, which can change annually. It’s crucial to ensure that your medications are covered each year.
Costs: Costs associated with Part D include premiums, deductibles, copayments, and coinsurance. These costs can vary widely between plans and can change every year.
Pharmacy Network: Part D plans have a network of pharmacies where you can fill your prescriptions. Using an in-network pharmacy typically costs less than going out-of-network.
Coverage Gap (Donut Hole): The coverage gap, commonly known as the donut hole, is a temporary limit on what the drug plan will cover for drugs. After spending a certain amount on covered drugs, you enter the donut hole, where you may pay higher out-of-pocket costs until you reach the catastrophic coverage threshold. In 2025 the coverage gap will be capped at $2,000.

Staying Up-to-Date with Part D Changes

Because Part D plans and formularies can change every year, it’s essential to review your plan annually to ensure it still meets your needs. Changes in your health or medication needs, as well as changes in the plan’s formulary, can impact your out-of-pocket costs and coverage. Hilgerman Insurance Solutions spends many hours each year learning and researching all the changes with Part D. This makes it very easy for you to get the correct information and help finding the best plan for you.

How Hilgerman Insurance Solutions Can Help

At Hilgerman Insurance Solutions, staying current with Medicare Part D changes is one of our specialties. We understand that keeping up with these changes can be overwhelming. That’s why we take care of it for you. Each year, we research all the changes and available plans to make sure you’re getting the best coverage for your needs at the best cost.

By working with us, you can be confident that you won’t overpay for your medications or lose access to the drugs you need. I, Deborah Hilgerman, am dedicated to helping you navigate the complexities of Medicare Part D, ensuring you have peace of mind and the right coverage.

Get the Help You Need

Let us help you make the best choice for your prescription drug coverage. Visit our website https://hilgermanins.com/ to request assistance. Together, we can make sure you have the coverage you need at a price you can afford, without the stress of keeping up with constant changes.

Hilgerman Insurance Solutions of Camarillo is an independent insurance agency that specializes in the senior market, while offering health insurance solutions for small businesses and individuals. We are contracted with most of the top insurance providers to offer you plans that best suit your needs, all with personal hands-on service and support.

Our commitment is to provide expertise, friendly service along with a timely response. Please feel free to contact us today for a quote and/or no-cost consultation.

Hilgerman Insurance Solutions
(805) 279-5482
deb@hilgermanins.com
www.hilgermanins.com

Medicare Coverage for Hearing Aids 2024: What’s Covered?

by Deborah Hilgerman | Jun 24, 2024 | Medicare

Surprisingly, less than 15% of adults needing hearing aids actually use them, and it takes nearly nine years, on average, to purchase them after a diagnosis, according to a 2019 study. Kathleen Cameron from the National Council on Aging emphasizes that some older adults underestimate the impact of untreated hearing loss on overall health, viewing it as a normal part of aging.

Hearing exams and aids rank among the top five most postponed healthcare expenditures. A 2023 survey by the Senior Citizens League reveals that a quarter of respondents aged 65 and older delayed getting hearing exams and aids.

Medicare and Hearing Aids: Original Medicare (Parts A and B) doesn’t cover hearing aids or related exams. Medicare Part B covers diagnostic hearing and balance exams but not hearing aids.

Medicare Advantage plans (Part C) offer alternatives, with coverage varying by plan and state. Some plans cover hearing exams and aids, and from 2018 to 2020, the percentage of plans offering hearing benefits increased from 83% to 93%.

Medicaid and Hearing Aids: Dual-eligible individuals with both Medicare and Medicaid may have coverage for hearing aids, but specifics vary by state. Medicaid coverage details can be found in the Hearing Loss Association of America’s state-by-state guide.

Options for Hearing Aid Costs:

Private health insurance may cover hearing tests and aids.
Flexible spending accounts (FSAs) and health savings accounts (HSAs) can offset costs.
Some insurers like Aetna, Blue Cross Blue Shield, Cigna, Humana, and United Healthcare offer hearing aid benefits.
Veterans Administration (VA) benefits may provide free or low-cost hearing aids for eligible veterans.
Community-specific resources and charitable foundations, like the Miracle-Ear Foundation, offer assistance.

Alternative Options:

Over-the-counter (OTC) hearing aids, created in 2017, aim to be more accessible and affordable for mild to moderate hearing loss without a prescription.
Insurers may cover OTC options like Audien Atom Pro, Eargo, Go Hearing, MDHearing, and Otofonix.

When choosing hearing aids, consider factors like customer service, return policies, warranty coverage, and alternative options like OTC devices. Overall, addressing hearing loss promptly is crucial for overall health, even if Medicare doesn’t cover the cost of hearing aids.

Source: https://health.usnews.com/medicare/articles/does-medicare-cover-hearing-aids#expert-sources

Traveling with Medicare Prescription Drug Plan

by Deborah Hilgerman | Jun 24, 2024 | Medicare

Question: Can I use my Medicare Part D prescription drug coverage when traveling outside of my home state?

Yes. You can use your Medicare Part D prescription drug plan at any one of your plan’s network pharmacies across the country, and most Medicare prescription drug plans include 50,000 to 65,000 (or more) pharmacies in their network. Here are a few additional reminders about using a network pharmacy as you travel within the United States:

(1) You may pay more for your formulary drugs at a standard network pharmacy.

Please remember that your Medicare Part D plan may charge higher copayments at standard network pharmacies as compared to “preferred network” pharmacies.

(2) You may pay more (or less) for your formulary drugs as you travel since retail drug prices can vary between network pharmacies.

Please remember that retail drug prices can vary from pharmacy-to-pharmacy. So if your drug coverage is based on coinsurance (you pay a percentage of the retail cost – such as 25% of retail) – or you are in the Donut Hole – or in the
2023 Catastrophic Coverage phase you may find that you pay different prices at different pharmacies – although the pharmacies are still part of your Medicare Part D plan’s pharmacy network (or preferred pharmacy network).

Keep in mind that 2023 is the last year that Medicare Part D beneficiaries will pay cost-sharing in the Catastrophic Coverage phase. For plan year 2024 and beyond, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase, so plan members will not have any out-of-pocket costs for formulary drugs after reaching the plan’s 2024 $8,000 total out-of-pocket threshold (TrOOP); therefore, TrOOP becomes the RxMOOP in 2024.

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Question: How do we find a network pharmacy when we are in an unfamiliar area?

If your travels take you to a remote or unfamiliar area of the country, and you are having trouble finding a network pharmacy or preferred network pharmacy, you can always telephone your Medicare Part D plan’s Member Services department and ask them to help you find the nearest pharmacy. The toll-free number for Member Services is located on your Member ID card and most of your plan’s printed information.

If you cannot find your Member ID card or your Medicare plan’s contact information, you can telephone Medicare at 1-800-633-4227 and ask a Medicare representative to help find your plan’s contact information.

If you prefer to search for pharmacies and/or providers online, you can use our pharmacy and provider search tool articles for instructions and links to the online tools for a few of the more popular Medicare plans.

When all else fails: Asking for reimbursement when no network pharmacy is available

If, in the unlikely event that you find no network pharmacy in some area of the country, you should be able to purchase medications at a non-network pharmacy and submit the receipts to your Medicare plan for reimbursement. (You can also telephone your plan’s Member Services department to learn about the reimbursement process – the telephone number is on your Member ID card.)

Traveling when you have drug coverage through your Medicare Advantage plan

If you receive your Medicare Part D prescription drug coverage through a Medicare Advantage plan that includes prescription drug coverage (also called an MAPD), you will find that your MAPD has the same generous number of network pharmacies across the country (50,000 to 65,000 pharmacies) and you should be able to find a network pharmacy as you travel.

As a note, depending on your Medicare Advantage plan, you may pay higher out-of- network copayments for other healthcare needs (like doctor or hospital visits) as you travel away from home and outside of your Medicare Advantage plan’s established healthcare network or service area.

Medicare Eligibility and Enrollment: A Simple Guide

by Deborah Hilgerman | Jun 1, 2024 | Medicare

Understanding Medicare eligibility and enrollment doesn’t have to be complicated. Let’s break it down in a friendly, easy-to-understand way so you know what to expect and when to start preparing.

When Should You Start Researching Medicare?

You should start researching Medicare a few months before your 65th birthday. This gives you plenty of time to understand your options and make informed decisions about your healthcare coverage. It’s never too early to learn about Medicare and what it can do for you. You can request help from Helgerman Insurance Solutions at this time, we will provide you with all the information you need to get started and explain everything to you.

Who is Eligible for Medicare?

Most people become eligible for Medicare when they turn 65. You are eligible for Medicare if:

You are 65 or older.
You are under 65 and have a qualifying disability.
You have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).
You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period (IEP) is a seven-month window that begins three months before the month you turn 65, includes your birthday month, and ends three months after. For example, if your birthday is in July, your IEP runs from April 1st to October 31st. This is the best time to enroll in Medicare to avoid any late enrollment penalties. Don’t worry, Helgerman Insurance Solutions is here to guide you and help you enroll.

How to Enroll in Medicare

1. Automatic Enrollment:

If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B when you turn 65. You will receive your Medicare card in the mail three months before your 65th birthday.

Manual Enrollment:

If you are not receiving Social Security benefits, you will need to sign up for Medicare. You can do this online at the Social Security Administration’s website, by phone, or by visiting your local Social Security office.

General Enrollment Period (GEP)

If you miss your IEP, you can enroll during the General Enrollment Period (GEP) from January 1st to March 31st each year. However, you may have to pay a late enrollment penalty, and your coverage will start on July 1st of that year.

Special Enrollment Period (SEP)

You may qualify for a Special Enrollment Period (SEP) if you have a qualifying life event, such as losing your employer-sponsored health insurance. This allows you to enroll in Medicare without facing a late enrollment penalty.

Getting Help with Medicare Enrollment

Navigating Medicare enrollment can feel overwhelming, but you don’t have to do it alone. Hilgerman Insurance Solutions, is here to help you understand all the moving parts of Medicare. Deborah Hilgerman will provide you with all the information and help you find the best plan for your needs. At Hilgerman Insurance Solutions, we do all the work researching the plans, so you can choose the right one without overspending or being underinsured.

Visit our website https://hilgermanins.com/ to request assistance. Let’s make Medicare simple and stress-free together!