Once again, your referrals continue to make Faye and I two of the top producing agents in Bridlewood. Thank you from the bottom of our hearts! We are truly blessed to have clients like you and we pledge to do everything we can to honor those referrals by providing the best counsel and service that we possibly can. Please keep them coming.

New Requirements for Medicare Brokers

Due to the incredibly high number of complaints brought about by the Medicare “TV Pitchmen”, CMS has instituted several new requirements. Two of them will impact Faye and I directly and we want to make you aware of them. First, we are now required to record all our phone calls with you if the call is to discuss any specific plans, benefits, or costs. If you do not wish the call to be recorded, we are required to terminate the call. Secondly, we must use the following statement as a disclosure on all marketing materials as well as in the first 1 minute of phone conversations: “We do not offer every plan available in your area. Currently, we represent (#) organizations which offer (#) products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”

What organizations do we represent?

We research these plans every year and believe we only offer “the cream of the crop.” We currently represent the following Insurance carriers: United Healthcare, Devoted Health Plans, Humana, AETNA, Denver Health, and Wellcare. In 2024 we will add Kaiser. If other plans look like they have something “compelling” to offer, we will consider adding those plans as well.

Beware of the Medicare TV Ads

The Centers for Medicare and Medicaid Services (or CMS, the governmental agency that runs Medicare) has enacted several new rules that all Medicare salespeople must follow. We were hopeful that these new rules would force the TV advertisers to present Medicare in a more forthright way. They have made an impact, but the TV people are still being very creative in getting people to call them. Here are a few things you should know. If you call any of the “800” numbers to get information, they will do whatever they can to get you to change your plan. Why? Because that is the ONLY way for them to make money. Believe me when I say that your best interest will not be served here. Also, if you do change your plan, Faye and I can no longer be your agent. In effect, you will have no agent. Your “agent” will be someone different every time you call the 800 number. The newest series of ads strongly promote “Part C of Medicare” as if this is something new. Part C of Medicare is simply another name for Medicare Advantage Plans and most of our clients are already in a Medicare Advantage Plan. Don’t be duped! If you want to explore other plans, CALL US! We will be happy to review your current plan and help compare other plans that are available.

Important changes to Medicare – this year and beyond

Changes in 2023

Vaccines: Starting in January of this year, all vaccines that are recommended by the “Advisory Committee on Immunization Practices” will no longer require a co-pay. As an example, the shingles vaccine had copays in 2022 of about $150. This year those copays have been eliminated.

Insulin: Insulin costs have historically been about $150 for a typical 30-day supply. Now Medicare beneficiaries get their insulin for no more than $35 per month per insulin. However, if your insulin is delivered via an insulin pump you have not had this price advantage. Here is the good news for you folks. If you meet all the criteria, then starting in July 2023, insulin delivered with an insulin pump in conjunction with a CGM (Continuous Glucose Monitor) and defined as “durable medical equipment” will also be capped at $35 per insulin per month. CGM brands that may qualify for this are Freestyle Libre, Dexcom, and Medtronic. Another “bonus” for all insulin users is that the costs for insulin will not contribute to the coverage gap. More information can be found at this link: https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf

Changes coming in 2024

Extra Help:  The Extra Help program is a program for folks whose income is no more than 135% of the federal poverty level (FPL). In 2023 that is approximately $1,640 per month for one person or $2,219 for a family of two. There are also levels of “partial” eligibility. In 2024, the eligibility levels will increase to 150% of the FPL and the partial eligibility will be eliminated. Therefore, people that qualify will get full benefits only. This means if your income is approximately $1,823 per month for a single person or approximately $2,465 per month for a couple, you are likely to qualify for this program in 2024. You must also meet asset limits to qualify. What is the benefit if you qualify? Most of your out-of-pocket costs (copays and coinsurance) will be covered. You can apply online for the Extra Help program by going to the following Social Security website: https://www.ssa.gov/medicare/part-d-extra-help. If you need help, please call Faye or Don.

Elimination of the 5% co-insurance for Part D: In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs. In effect, this means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This amount includes what Part D enrollees spend out of pocket plus the value of the manufacturer price discount on brands in the coverage gap phase. At this amount, Part D enrollees who take only brand-name drugs in 2024 will have spent about $3,300 out of their own pockets and will then face no additional costs for their medications. Changes coming in 2025: A “Cap” on Prescription Drug Costs: Starting in 2025 there will be a prescription drug spending cap of $2,000 for everyone on Medicare, regardless of income or the prescriptions used. There will also be the option of having an installment plan, currently being called the “smoothing plan”, to pay for your prescriptions. This plan must be requested, it will not be automatic. The net result of the “smoothing plan” will be to take your $2,000 annual cap and divide that by 12 months. This will make your monthly drug costs average out to about $166 per month.

For an in-depth review of how Medicare Part D plans will be changing over the next couple of years, go to the following link. This will take you to a “brief” written by the Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-unde r-the-inflation-reduction-act-and-how-enrollees-will-benefit/

Another Reminder: Please notify us if you are thinking about moving. We can tell you what plans will be available in the area you are moving to and can even change your plan before you move. And we will remain your “agent of record”. In addition to your address, please give us any new phone number or email address.

EMAIL or US Postal Service: In our last newsletter we said we would be sending our “next newsletter” by email. However, we obviously have continued the use of the US Postal Service for this one. Hopefully, we will be using email for the next one. For those folks who do not use email we will still send it by US Postal Service.

For LAUGHS – A young lawyer is working late one night when his door opens and in walks Satan himself. “I have an offer,” says Satan. “If you give me your soul and the soul of everyone in your family, I’ll make you a full partner in your firm.” The lawyer stares icily at the devil for a full minute before demanding, “So what’s the catch?” A couple of pics – Pics, left to right: The ”Dragon” at the Dragon Boat Festival in Denver. Faye, me and Lan Lieu (a team-mate) working at the Devoted Health Plans booth at the festival. Faye and me with Ed Park, the co-founder, President and CEO of Devoted Health Plans.