Wow, what a wild open enrollment. The Part D and Medicare Advantage changes were the most we have seen in an open enrollment season....and we've been at this since dinosaurs roamed the earth!
The good news......for prescriptions covered in your Part D drug formulary, there will be a maximum out of pocket of $2,000. This number can be lower.....a weird formula that CMS has not shared with brokers.
Part D Formulary & Tier exceptions - we are seeing doctors processing more of these for our clients, as there are so many new prescriptions hitting the market that the doctor is sold on you using, however it is not covered by your formulary.
There have been many changes to Part D and MAPD compliance. Most of you created Medicare.gov accounts as we worked together to find your best value for 2025 Part D. Once we worked out the kinks, this seemed to work well. I apologize to those caught in the middle of the struggle.
Our screen shares in October to demystify how to set up a Medicare.gov account and what we are looking for when searching for your best Part D values were so much fun. We will schedule more next open enrollment.
Again, please review your Part D or Medicare Advantage during open enrollment 10/15 - 12/7......costs and coverages change....you can be caught in an unpleasant position if you are not reviewing. We are always here to help.
We thought it might help to share an experience. Medicare supplement, mammogram, Medicare did not cover. As we have discussed, this was once again a case of the service being mis-coded. A call to Medicare - 1-800-633-4227 was immensely valuable. The representative shared what the submitted code was, and what that code covered. This was coded as what they call "diagnostic"....meaning there is a symptom or problem the test is looking to diagnose. The situation did not need a "diagnosis", it was a preventative service, and should not be billed to the beneficiary. The correct code was provided by the Medicare rep. Calls back to the billing entity were not met with much co-operation.....until one person with common sense understood and referred the call to a supervisor who could resolve the charge. Typically, your Medicare Supplement insurer will tell you that they pay the remaining balance due of a Medicare covered expense. Most times a call to them does not help remedy your "non-Medicare covered" issue. Remember with a supplement, after your $258.00/yr deductible, the only out of pocket for hospital or medical charges are for non-Medicare covered services. Not likely you will get these, unless explicitly notified up front. Example - the newest 3-d modeling of joints for joint replacement. This is many times not covered by Medicare.
If you are one of the few that runs into these incorrect billings, we love helping you strategize how to remove the charge.
Genworth Long-Term Care coverage premium increases - the state of California is allowing some new options when looking to moderate rate increases. So good!
Those of you with hybrid plans will not see increases.
And as we welcome in the New Year.....some things never change.....Kenzo the attention hog.
Our screen share for Part D is offered Wednesday 10/16 – 5pm PST & Saturday 10/26 3pm PST
Double click the following link - https://meet.goto.com/julie3
You will "Join Browser", you do not need to download app.
“No” to camera access.
“Yes” to microphone on.
I believe in lower right you can raise hand for questions, if I need to mute from my end.
Open enrollment is rapidly approaching for your Part D and Medicare Advantage plans...Oct. 15 - Dec. 7 - Please call in for appointment to review your current coverage. These reviews can be very important for you, going forward. Soon we will have a way to set your own appointment, online, at your convenience. We will email you details soon.....or call/email to set appointments now.
Please call or text 559-960-9655 to set an appointment, or email me at Julie@InsuringByDesign.com
Fresno & Clovis Community Hospitals available in your Medicare insurance plan?
Hi again! We want to pass along some important news for some of you.
Per the link -
https://www.fresnobee.com/news/health-care/article270827482.html
Community Hospitals is not currently in-network for Anthem, Cigna, UnitedHealthCare and I was just told Aetna, in the Medicare Advantage, commercial, and employee group markets.
As we understand it, these Medicare Advantage plan members could have access on a case by case basis.....or not.
Also, as we understand it, these contracts and network restrictions do not apply to Medicare Supplement insureds. This is original Medicare, and all provider payment structures and details are between Medicare and the providers.....insurance companies are not involved. So those of you with Medicare Supplement are unaffected.
Hope this helps!
Mark your calendars! The Medicare Open Enrollment period starts on October 15, 2024, and runs through December 7, 2024. This is your opportunity to review, compare and make changes to your Medicare plan for 2025. Don’t miss the chance to ensure you have the best coverage suited to your needs. Explore your options today!
