Month: September 2019

It seems like not a year goes by without some major shakeup regarding either Medicare advantage or Medicare Part D Prescription (PDP) plans. This year we have changes on steroids.

The first headache agents and other senior volunteers will be facing this fall is that the Center for Medicare and Medicaid Services (CMS) is changing its Prescription Drug finder (PDF) on Medicare.gov. For years we have had the ability to create a “Drug List ID.” This gave us a unique ten-digit ID number and the date of our search and the option to save our list. It has been an invaluable tool for us.

Let’s say Betty Rubble takes ten meds. Also, let’s say that last fall during the Annual Election Period (AEP from Oct. 15 through Dec. 7) I pulled up her previous list. Betty told me that she dropped one of her meds and added a new one. I would not have to reenter all of her ten meds. I’d simply recall the saved list by populating the fields for the drug list ID and the date of our original search.

Voila, the list of her ten meds pulls up. we delete the one med she has discontinued and add her new one. We enter her preferred pharmacy and hit “Continue to Plan Results.” The website sorts the PDPs in order of the best buys. By best buy we mean the estimated annual cost.

This estimated annual cost includes and is the sum of the following:

• The monthly premium times 12.
• The deductible if there is one.
• The copay for her meds before and after the deductible.
• Her costs when she is in the coverage gap (if applicable).
• Her catastrophic costs once she has moved out of the coverage gap (if applicable).

There have been a few minor traps that a new user could fall into when using the PDF, but a knowledgeable person knew what they were. In short order we advised our clients which PDP that would be their best buy for the upcoming year. One exception for not chasing the lowest cost plan was a PDP with a sub-standard rating. Another exception has been a company known for poor customer service. Other than that, we’d recommend the plan that was the best buy.

Some plans compensate the agents and others don’t. We’d have recommended to you to the most cost-effective PDP irrespective of whether or not the plan compensates agents. Also, there is no incentive for an agent to “churn” people from one plan to another. CMS does not allow any additional compensation for doing this.

We’re happy to provide this service for our clients and we will continue to do so. However, we’re entering uncharted territory this year because of the changes that CMS has made to the prescription drug finder (PDF) on Medicare.gov.

First, our saved drug list will not carry over to the new PDF. That means the hundreds of saved lists are going POOF! Gone!

Medicare wants you to set up a My Medicare account. You enter your date of birth, your Medicare number and create a username and password. So far, the PDF does not give a simple list of the best to the worst buys. It uses a different format for comparing plans. Our experience is that it sorts by premium or copays. Thus, the user has to enter different sort criteria.

The new PDF may be easier for you the consumer to navigate, but it appears to be far less friendly to agents and senior volunteers that do multiple searches per day. You can spend an evening to get set up for yourself, but we’re simply not going to have the time to help everyone set up his/her My Medicare.

Complaints about the new revised PDF have been flooding into CMS, so we don’t know exactly how their new revised PDF is going to play out. There may be more revisions by October 1^st.

What’s really irritating about this is CMS’s timing. They wait until the busiest time of the year to foist their new change onto the public. If they would have chosen April, for example, we’d have six months to learn and understand their new website prior to the October AEP. They would have had six months to work out the bugs.

There is some good news here. There is a private prescription drug plan finder that will be available for agents but not for the public. We’ll still have to input your meds, but at least we’ll have a program that will assist us in making the most suitable recommendation for you. We’ll know more as we use this new PDF.

Big Prescription Plan Changes

CMS puts a gag on revealing specific plan information prior to October 1^st. By this we mean premiums and specific benefits. However, we can provide you some generalities prior to October 1^st.

Humana PDPs

For several years Humana has sponsored three PDPs. They have been as follows:

• Humana Enhanced PDP
• Humana Preferred PDP
• Humana Walmart PDP

Humana is scrapping those three plans and creating three NEW plans. They are as follows:

• Humana Premier PDP
• Humana Basic PDP
• Walmart Value PDP

The Premier plan will have the highest premium. The Humana Basic plan is intended for those on Extra Help from Medicare. (Extra Help is a federal program that subsidizes some or all of a beneficiary’s PDP premium and provides for lower cost copays. Qualification is based in income and assets or resources.)

The new Walmart Value plan will be the budget plan and will compete in the arena of lowest premium plans.

If you do nothing, here is what will happen in 2020. The people in the current Enhanced plan will be moved to the Premier Plan. Those with the Humana Preferred plan will be moved to the new Humana Basic plan. So far, so good.

Attention for those that have the current Humana Walmart plan.

The Humana Walmart members: If you do nothing, will be moved to the Humana Premier plan. You will NOT be automatically be moved to the new Walmart Value plan. Humana will be announcing this in your Annual Notice of Change (ANOC) letter that you’ll be receiving (if not already) from Humana. You may even receive a phone call from a Humana representative regarding this situation.

We will be contacting you as fast as possible to guide you into the most cost-effective plan for 2020. Please be patient, as we cannot service hundreds of people the first day, but we will get to you during the AEP. Also, please feel free to contact us, and we’ll put you on our list.

Aetna and WellCare

CVS bought Aetna, and the merger is complete. One of the obstacles prior to this merger was the concern by the regulators that CVS would have too strong of an influence regarding PDPs. CVS sponsors the Silver Script PDPs. So, to keep the regulators satisfied, Aetna sold off its PDP unit to WellCare. A few of you have already contacted us about the somewhat vague letter from WellCare explaining this situation.

Be sure to read the ANOC that you’ll be receiving from WellCare. Please contact us with any questions.

PDPHelper.com

We really appreciate the large numbers of you that have previously used PDPHelper.com as a method of submitting to us a list of your meds. Please continue to do so for this coming AEP. Our website is not affected by the changes on Medicare.gov.

Lastly, thank you for your continued business. It is your patronage that keeps us operating.

This 2019 AEP is our fourth year of using PDPHelper.com. The following are some tips to help us do an accurate search on your behalf for your 2020 Prescription Drug Plan (PDP). Our goal is to recommend the PDP that will be most suitable for you. This is especially important with the WellCare takeover of the Aetna PDPs and Humana revamping their plans.

Step 1

Please enter your name, phone, email address, your zip code, and your county of residence. Some zip codes span multiple counties, and that’s why we request your county of residence. This means where your residence sits.

Next, please list your top pharmacy choices. We also ask you if you would be willing to use Walmart, Walgreens, or a mail order pharmacy if that will save you money.

Step 2

In this section, only enter your pills, capsules, or tablets. Liquids, gels, creams, insulin, eye drops, patches, etc. are in the next steps.

Enter the name of your prescription, the dose, and the quantity you buy. Important, is the quantity you buy per one month, per every two months, per every three months, or per every twelve months? If you take something as needed, estimate how many pills you buy and how often you buy it. Your estimate does need to be exact. Just get it as reasonably close as you can.

Example #1—Betty take two, 500mg metformin tablets every day. She buys 60 every month.

Name of Prescription: Metformin
Dosage: Enter 500mg
Quantity: Enter 60
Frequency: Enter month

Example #2—John take hydrocodone/apap, 325/10mg, as needed for back pain. Some days he takes none but other days he takes two or three. He estimates he takes around 45 per month

Name of Prescription: Hydrocodone/apap
Dosage: Enter 325/10mg
Quantity: Enter 45
Frequency: Enter month

Step 3

The section is for Insulin, Inhalers and Nebulizers

Example #3—Alice uses insulin. She checks “yes”. She enters her information as follows:

Name of insulin: Lantus Solostar pens
Size: 3 mL
Quantity: 5 pack or just 5
Frequency: per 2 months

Example #4—Shirley uses Advair. She checks “yes” for the category: “Do you use any inhalers or nebulizers?” She enters her information as follows:

Name of inhaler: Advair
Size: 250/50
Quantity: 1
Frequency: 1 month

Step 4

This final step is for Eye Drops. Gels, Creams, Lotions or Salves, and Other Prescriptions.

Example #5—Mary uses eye drops. She checks “yes” for this category and fills in her information. Please do NOT attempt to say “2 drops per eye each day.” We need to know the size of the bottle, usually 2.5 mL, 5 mL, or 10 mL and how often you fill your prescription.

Name of eye drops: Latanoprost SOL 0.005%
Size: 2.5 mL
Quantity: 1
Frequency: 1 month

When finished, please hit the submit button. Thank you in advance for using PDPhelper.com. End

by Dr. David Eifrig

221 million prescriptions…

That’s the latest number available for the number of prescriptions written in a single year (2012-2013) for statins.

In a little more than a decade, from 2002 to 2013, use of this cholesterol medicine increased 80%. The reason? The American Heart Association lowered the guidelines for “normal” cholesterol numbers. Overnight, millions of Americans suddenly had high cholesterol… and doctors turned to Big Pharma to “fix” the problem.

Today, one in four Americans over the age of 40 takes statins. That number makes my blood boil. Particularly when friends of mine resign themselves to taking the drug for the rest of their lives.

I’ve written before about the big myth behind cholesterol. Solely treating a set of numbers with an overprescribed drug class like statins is an irresponsible – and dangerous – practice.

That’s largely due to the fact that inflammation – not cholesterol – is the root cause of heart disease. That’s why simply treating cholesterol numbers doesn’t work. Doctors need to focus on the whole patient – including lifestyle elements like diet and exercise.

But given how many folks still write to me asking about statins, I wanted to address my views on them in today’s issue. Let’s get started…

Please click here to keep reading.

The following are my comments.
by Lance Reedy

My comments: What are these processed foods that Dr. Eifrig refers to? For several years I have used the acronym SORF to describe these unhealthy foods that Dr. Eifrig and others refer to. If you avoid processed foods with one, two, or all three components of SORF you will go a long way to avoid inflammation-causing foods. Sadly, there are hundreds of these dressed up packages sitting on grocery store shelves that unsuspecting shoppers unwittingly purchase.

S = Sugar   This includes sugar, high fructose corn syrup (HFCS), and sugar alcohols. Even though artificial sweeteners such as aspartame, Splenda, etc. aren’t sugar, they are toxic chemicals that you don’t want in your body. Don’t forget the Agave scam. Agave is high in fructose. The over-consumption of these sugars can lead to insulin resistance and metabolic syndrome.

O = Oils   This refers to oils that require a factory to produce. Included in this list are soybean oil, canola oil, safflower oil, corn oil, etc. The industrial processing causes these unstable Omega 6 oils to become rancid. This causes harmless, low-density lipoproteins to become oxidized and transformed into small, B-B-like particles. These particles, in turn, cause inflammation to the lining of your coronary arteries. Please refer to Dr. Stephen Sinatra’s The Great Cholesterol Myth.

What about the advertising the suggests that these oils are heart-healthy? At best they are bogus, and at worst they are fraudulent propaganda.

RF = Refined Flours   This list includes white flour or “enriched” white flour, white rice, or any product made by milling off the bran and germ of any grain. The refining process robs the grains of valuable B vitamins and fiber. Worse, it concentrates the starch, causing your blood sugar to spike as if you had eaten sugar. Again, this contributes to insulin resistance and metabolic syndrome.

Want to stay in optimal health and avoid as much inflammation as possible? Avoid SORF!

Disclaimer

The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Not quite.

Note: I thank Ron Iverson, president of NAMSMAP* for assembling this data. This information comes from the National Association of Insurance Commissioners. *National Association of Medicare Supplement and Medicare Advantage Producers. This article is a revision from one published earlier this year.

A Brief Summary

Plans C and F will not be available for people turning 65 after January 1, 2020. People on Medicare prior to that date can still purchase Plans C and F, subject to medical qualification in most cases. If you’re not a detail person, you can to stop here. For the mavens that enjoy knowing the full details, keep reading.

Now the Details and the Long Version

1)  Why is the standard model for Medicare supplement (Medigap) plans being revised?

A new federal law was passed on April 16, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medigap policies that cover the Part B deductibles for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.

2) What does MACRA require?

As of January 1, 2020, MACRA does the following:

2a) Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries, so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan.

2b) Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.

2c) Who is considered a “newly eligible” Medicare beneficiary under MACRA?

MACRA defines “newly eligible” as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

3) How much is the Medicare Part B deductible?

Medicare Part B deductible is $185 in 2019.

4) How does this relate to efforts to eliminate Medigap or Medicare supplement “first dollar coverage”?

This accomplishes the efforts to eliminate Medigap “first dollar coverage” (coverage of all claims without paying any out of pocket cost) by discontinuing sale of Plan C and Plan F only for “newly eligible” Medicare Beneficiaries

5) How are people eligible for Medicare on the basis of disability impacted by these changes?

Current beneficiaries are not impacted. The restrictions under MACRA apply to persons who qualify for Medicare as a result of a disability on or after January 1, 2020.

6) Why are plans “re-designated” for only “newly eligible” Medicare beneficiaries?

The Federal Government wanted to eliminate coverage for the Part B deductible making consumers responsible for that first dollar coverage. The only difference between Plans C and F and Plans D and G is the coverage of the Part B deductible under Plans C and F. All other benefits are exactly the same for D and G. Since Plans C and F will no longer be available for “newly eligible” beneficiaries, it was necessary to designate Plans C and F as Plans D and G for these individuals.

7) How are enrollees in current Plans C and F affected by these changes?

Current enrollees (those eligible for Medicare PRIOR to January 1, 2020) can continue with their Plan C or Plan F, including F High Deductible plan, and may continue to buy Plans C and F beyond January 1, 2020. Current enrollees will also be able to buy the new Plan G High Deductible plan on or after January 1, 2020.

8) What changes are made to High Deductible Plan options?

Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020. The effective date of coverage for Plan G High Deductible must be on or after January 1, 2020. If you are not a “newly eligible” beneficiary and are enrolled in a Plan F High Deductible prior to January 1, 2020, you are able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.

9) When can the new High Deductible Plan G be sold and who can buy it?

Plan G High Deductible can be made available beginning on January 1, 2020; “newly eligible” Medicare beneficiaries and current beneficiaries would be able to buy the new Plan G High Deductible.

10) For high deductible plans, does payment of the Part B deductible count towards the plan deductible?

For Plan G High Deductible; while the Part B deductible is not covered (reimbursed), it does count towards the High Deductible plan’s deductible. If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses and Part B Deductible expenses are then incurred, these expenses will not be covered expenses until the beneficiary meets the Medicare Part B deductible.

11) For the new High Deductible Plan G sold on or after January 1, 2020, what happens if a policyholder meets the high deductible amount with all Part A out of pocket expenses?

If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses any Part B Deductible expenses incurred will not count towards meeting the High Deductible nor will they be covered expenses.

12) What changes are made to Guaranteed Issue requirements?

Since two of the current guaranteed issue plans, Plans C and F, will no longer be available for “newly eligible” Medicare Beneficiaries on or after January 1, 2020, Plans D and G will become two of the guaranteed issue plans for these individuals. Current enrollees can remain with or buy Plans C and F and individuals who do not fall within the definition of “newly eligible” Medicare beneficiary will still be able to purchase Plans C and F.

13) How does this change the way Plans C or F, and D or G, may be sold in the state?

Insurers can continue to sell Plans C or F to current Medicare beneficiaries. However, “newly eligible” Medicare beneficiaries cannot apply for or purchase Plan C or F. The “newly eligible” would be offered Plans D or G on a guaranteed issue basis instead. All other currently available plans may continue to be offered to all Medicare beneficiaries regardless of their date of eligibility for Medicare.

You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.  

Key Takeaways

1)  Plans C and F, and High Deductible F, will not be available to anyone who turns 65 (“newly eligible”) after January 1, 2020, including those eligible for Medicare by reason of disability.

2)  People currently with Plans C and F and High Deductible F will be able to keep them after the date.

3)  People who turn 65 and register for Medicare before the date, can still purchase Plans C and F because they are not considered “newly eligible.”

4)  And…even though a person who purchases Part B after January 1, 2020, they can still purchase Plans C or F because he/she turned 65 before the date.

5)  The current Plan C will become (be designated) the current Plan D after the date.

6)  The current Plan F will become (be designated) the Current Plan G after the date.

7)  All High Deductible Plan Fs will be available as they currently are after the date, and will become (be designated) High Deductible Plan G.  Available purchase will include people who turn 65 before the date, but again, not those “newly eligible.”

8) Guaranteed Issue (GI) Plans C and F will not be allowed to be sold to newly eligible, but GI plans D and G will.

9)  Plans K and L will remain the same, with the exception of the yearly raise of out-of-pocket expense.

10)  Plans M and N will not change.

11)  The rules also apply to “Medicare Select” plans.