We have been working with Medicare Beneficiaries for over 10 years and helped 25,000+ Medicare Beneficiaries across the country with their Medicare Planning Needs and Questions.
We wanted to gather some of the most common questions we have heard and provide some answers so we can help even more people. You can find our new FAQ Page by clicking this link.
The information is broken down into categories of questions that we hear frequently.
We hope you find the information helpful.
This is a relatively new plan that provides up to $5,000 per year in Maximum Benefit ($72/month in premium). This is significantly higher than most other plans which are capped at $1,500 or $2,000 per year in benefit. Here is a link to the brochure and highlights are below.
Click here to get more info and Enroll.
Each year, there are changes to the Part D Prescription Drug Coverage of Medicare. We won't have visibility to the actual Part D Plans until October 1, but there are some structural changes that occur each year with Part D. Key updates for 2021 are below.
The government sets a maximum deductible amount for the Part D Plans. In 2020, the maximum deductible was $435. In 2021, this is increasing $10 to $445. On most of the Part D Plans, the deductible only applies to higher tiered drugs (e.g. Tiers 3, 4, 5). Also, some Part D Plans have a $0 deductible, or other amounts lower than the maximum deductible.
Initial Coverage Level
The Initial Coverage Level will increase $110 from $4,020 in 2020 to $4,130 in 2021. This amount is based on the Retail Cost of the Medication for the year (Calendar Year). Most people (about 85%) do not exceed the Initial Coverage Level and thus continue to pay their Copay/Coinsurance amount for the entire year. However, for the people that have very expensive medications that exceed the Initial Coverage Level, they will reach the Part D Coverage Gap, aka Donut Hole where they have to pay 25% the cost of their medications. The minor increase of $110 to the Initial Coverage level will have a minimal impact on Drug Costs in 2021. Basically, for those 15% of people with expensive medications, there will be a very slight delay to reaching the Part D Donut Hole which could save someone ~$20-$40 for the year.
True Out of Pocket Limit (Tro-oP)
The True Out of Pocket limit will increase $200 from $6,350 in 2020 to $6,550 in 2021. The Tro-Op is used to determine when someone exits the Part D Coverage Gap, aka Donut Hole, and moves into Catastrophic Coverage where they only have to pay 5% the cost of their medications. The increase of $200 in the Tro-oP only effects about 5% of people (those that would reach Catastrophic Coverage), and it creates a slight delay for when they will reach Catastrophic coverage. The net impact to this individual is likely less than $50 cost increase for the year.
Click the video below for a more detailed explanation of these changes, including a detailed example for someone who reaches the Part D Donut Hole.
As part of the eMedicare initiatives, CMS recently launched a new Care-Compare tool.
This tool allows you to search for Medicare-Participating Providers: Doctors, Specialists, Hospitals, Nursing Homes, Home Health Services, and more.
The interface is pretty slick and aligns with the mobile-optimized launch of the Medicare Plan Finder tool in 2019.
You can search by Keywords (e.g. Cardiovascular, Knee Injury, etc.) and identify providers in your area that participate with Medicare.
There is a nice Map feature so you can see where each of the Providers are located.
You can select up to 3 providers to "Compare".
The Compare allows the user to see:
Important NOTE: This tool is only for Original Medicare providers. If you have a Medicare Advantage Plan, the Provider Lookup Tools on the Carrier Website for your Medicare Advantage Plan would have to be used to find Participating Providers.
Overall, I think the new Care Compare tool is a good tool for searching for Medicare Participating Providers in a particular area for a specific need. I look forward to additional data elements being added to the Comparison charts (e.g. Reviews, Ratings, etc.), and updates to include Medicare Advantage Plan Providers in the future.
See bio here