Free Health Care from the Dept. of Veterans Affairs counts as creditable coverage for prescription plans / Medicare Part D!

 Check out http://www.va.gov/healthbenefits/access/ today -

There are many advantages to applying now. While signing up for VA benefits is free, you have the combined option – freedom, flexibility and choice of doctors with Original Medicare and Medicare Supplement from one of these great companies.

A Consumer Reports Guide – Click Here for the full report
Here’s what you need to know.
What’s covered by parts A, B, and D

Medicare comes in three parts:
Part A covers hospital inpatient care, some types of home health care, hospice care, and care in skilled nursing facilities. There is no premium for Part A if you or your spouse has earned at least 40 Social Security work credits.
Part B covers doctor services, outpatient hospital care, preventive care, and some types of home health care. You have to pay a monthly premium for Part B. In 2011, it’s $115 for individuals with an income of less than $85,000 a year and couples with an income of less than $170,000. Higher-earning beneficiaries pay more on a sliding scale up to $369 a month.
Part D covers prescription drugs. You have to pay a monthly premium for Part D unless you get it as part of a Medicare Advantage plan. In 2012 the average premium for a plan will be about $31 a month, but prices can vary considerably. Individuals with an income of more than $85,000 a year and joint tax filers with an income of more than $170,000 will pay a premium surcharge of up to $66 a month on a sliding scale related to income and tax filing status.
For details on each plan part, see Medicare’s website.
All types of Medicare plans must cover certain preventive services, such as screening tests for breast and colon cancer, without any deductibles or co-pays.
Health-plan rankings from the NCQAPlan CategoryState
Signing up for Medicare for the first time

The “initial enrollment period” for Medicare Parts A, B, and D consists of the three months before, the month of, and the three months after your 65th birthday.
If you already receive Social Security, Medicare will contact you in advance. If not, you must enroll on your own either online or at a Social Security office.
If you do not sign up during this initial period, you must wait until the next annual General Enrollment Period to join Medicare, which runs from January through the end of March.
Normally everyone enrolls in Part A immediately because it’s free. The only exception: If you are still working at a large employer (20 employees or more) and have a high-deductible plan with a Health Savings Account (HSA), you can’t continue contributing to the HSA once you join Medicare. If you want to do so, you can delay Part A enrollment. There’s no penalty for late signup. Whether to delay signing up for Parts B and D can be tricky, especially if you’re still working or have a retiree plan. If you delay signup under certain conditions, you can be penalized with higher premiums.

Part B dos and don’ts

If you don’t sign up for Part B when you should, you will be hit with a harsh penalty: a permanent increase in your premium of 10 percent for every year that you should have been enrolled but weren’t.
Most people should sign up either when they turn 65 or when they or their spouse stops working, whichever comes later. Sounds simple, but be aware of these exceptions and gotchas:
You are still working at a large employer. You can delay enrollment without penalty if you have health insurance through your own or a spouse’s current job at a workplace with 20 employees or more. Once you leave your job, even if you’re getting COBRA or retiree insurance, it’s time to sign up for Part B. You have eight months, starting the month after your job ends, to get this done without penalty.
You are still working at a small employer. If your workplace has fewer than 20 employees, sign up for Part B as soon as you turn 65. Your employee health plan then becomes a secondary plan that kicks in after Medicare has paid its share of the bills. Workplaces this size are allowed to drop you from their employee plan after you reach 65, something that’s against the law for larger employers).
You or your spouse is on COBRA. Even though the COBRA plan is exactly the same as your former group health plan, once you turn 65 you must switch to Medicare. But COBRA can still function as the main insurance for the younger spouse, and you can keep parts of your COBRA plan that Medicare doesn’t cover, such as your dental benefit. Learn more about Medicare and COBRA.
You have a retiree plan. If you have a retiree plan from your old job, you must sign up for Part B when you turn 65, even if your retiree plan doesn’t change at all. After you go on Medicare, the retiree plan becomes a secondary plan (but may still function as the main insurance for your younger spouse). Your plan may not, however, pick up all the costs that Medicare doesn’t, so check with your plan administrator. If coverage is meager and premiums high, compare this to what it would cost to drop your retiree plan and buy a Medigap plan instead.
You receive veteran’s benefits. The Department of Veterans Affairs and Medicare operate independently of each other for the most part. Medicare won’t pay for care you get at a VA facility, and the VA won’t help you with your Medicare co-payments and deductibles (except if the VA authorizes you to get care at a non-VA hospital). The VA encourages veterans to sign up for Medicare A and B to have the flexibility to seek care at non-VA facilities if need be. Moreover, if you are not in one of the VA’s higher priority groups, you could lose your coverage suddenly if Congress decided to cut back the VA’s budget. At that point, you would have to pay a penalty for late enrollment in Medicare Part B. Learn more about VA and Medicare.
You have TRICARE for Life. If your military service entitles you to TRICARE for Life, you must sign up for Part B when you turn 65, regardless of whether you are working or have other sources of coverage. If you don’t, you lose your eligibility for this valuable benefit. Learn more about how TRICARE works with Medicare.
You are on the Federal Employees Health Benefits Plan (FEHB). FEHB will continue to cover you after retirement, even if you don’t take Medicare at all. But if you delay enrollment in Part B after retiring, and then change your mind later, you’ll be hit with the Part B late-enrollment penalty. Because FEHB premiums can be substantial, you need to consider your options carefully. Learn more about how FEHB works with Medicare.

Part D dos and don’ts

For most people, signing up for Part D at 65 is the best strategy. But be prompt. There’s a penalty—1 percent extra on your premium for every month you could have signed up, but didn’t—for enrolling more than three months after your 65th birthday month.
There are exceptions to signing up right at 65, though. See Medicare Part D for more information.
Choosing between original Medicare and Medicare Advantage

Your basic choice is whether to stay with original Medicare or go to a private Medicare Advantage HMO or PPO.
Original Medicare is the familiar program that’s been around since 1965, in which the government pays Medicare’s share of your medical bills directly to providers of Part A and B services. You can go to any provider anywhere in the country that accepts Medicare reimbursement.
Original Medicare has some substantial deductibles and co-insurance (for example, a $1,100 deductible for a hospital stay and 20 percent of outpatient doctor visits). You may have a retiree plan (a health plan provided courtesy of your former employer) that helps pick up some or all of this cost sharing. If not, you could consider buying Medigap a private supplemental plan that helps cover those fees. And you must buy a standalone Part D plan if you want drug coverage.
Medicare Advantage plans are private plans that you can choose in place of original Medicare. They now cover about one in four Medicare recipients.
Every Medicare Advantage plan substitutes for Part A and Part B. Most of the plans also include Part D drug coverage. If they don’t, you can buy a separate Part D plan.
If you are on Medicare Advantage, you will continue to pay your Part B premium as usual. You might also pay an extra premium for the plan itself.
If you have a retiree plan, check with your plan administrator before signing up for a Medicare Advantage plan because it may affect your eligibility for your retiree benefits.
The vast majority of Medicare Advantage plans are HMOs or PPOs that require you to get your care within a local provider network. You will also be responsible for the plan’s deductibles and co-pays, and the law that created the Medicare Advantage program prohibits you from buying Medigap coverage to help with these expenses.
Read more about Medicare Advantage.
Not sure which kind of Medicare you have? Here’s how to find out.
Changing to a different plan

Once enrolled in Medicare, you can join, switch, or drop a Medicare Advantage or Part D plan once a year during the annual open-enrollment period. In 2011 the dates are Oct. 15 to Dec. 7 for plans beginning on Jan. 1, 2012.
From Jan. 1 to Feb. 14, 2012, you can leave your Medicare Advantage plan, but only if you go back to original Medicare. If you do this, you also have until Feb. 14 to add a Part D drug plan.

Medicare supplement plan F looks to be the best plan because although it is primarily the most expensive, it covers everything. It pays your part B deductible and part B “excess charges”.  But what are “excess charges” or “billing balances”? They are the amounts that a doctor charges in excess of what medicare pays. Doctors who accept Medicare patients also must decide whether they will accept the payments which Medicare approves, an agreement known as accepting assignment. In most states if a health care provider does not accept medicare assignment, they are allowed to charge the patient “excess charges” -a maximum of 15%  of what medicare pays for the service. The patient will be responsible for the balance unless they have supplement plans F or G. These two plans pay 100% of part B excess charges.

Ohio is one of the few states that prohibits Medicare providers from charging more than what Medicare allows (This is also known as the MOM law – Medicare Overcharge Measure). So, unless you need to see an out-of-state provider or spend time in a state that allows excess charges, they are not something to worry about.  With that being said, let us take a closer look at Medicare supplement plans F & G.

Plan F has higher premiums, but pays your part B deductible & 100% excess charges. Plan G does exactly the same but your premiums are lower & you have to pay your part B deductible out of pocket.  Most often when dealing with plan G, the money you save on your premiums more than pays that deductible. But, is it still necessary for even plan G if you do not have to worry about excess charges? This may open a new perspective on these other plans…..

Contact  Michelle at PledgePoint, Ohio’s Medigap Connection for your Medicare plan analysis. We will find out which plan best suits your needs.

michelle@ohiocareplan.com

When Ohio seniors find our website, they are often shocked to receive quotes from so many Medigap / Supplement insurance companies. Sometimes their savings can be so much that they feel it is almost too good to be true! Healthcare, especially senior healthcare has gotten almost too far “out-of-hand”. Many Ohio insurance companies are raising rates on an annual basis and a large percentage of Ohio Medicare beneficiaries do not know they even have options. Here at PledgePoint – Ohio’s Medigap Connection, we urge visitors and clients alike to use the power of the internet to educate themselves before making any major decision. Because of this, our website is quickly becoming very popular with our aging boomer population in Ohio. As many of our clients are turning 65, they are finding all of the resources and information they need to make a well-informed decision right here! All of our clients are very appreciative of what we have put together. We get “thank-you’s” all the time for timely, valuable, and unbiased service. As funny as it may sound, they seem to be most grateful for the ability to handle the process at their convenience without the need for another insurance agent in their home.

Ohio seniors on Medicare anticipate new benefits and changes due to the Affordable Care Act:

First of all, Original Medicare will cover the cost of one wellness visit with your doctor per year.

A yearly check-up will include routine measurements like your blood pressure, a review of your prescriptions and medical history, and an assessment of any risks to your physical and mental health.
Until now, Ohio Medicare recipients only received a one-time preventive exam, the “Welcome to Medicare” exam during the first year you sign up for Medicare Part B coverage.
If you’re enrolled in a private Ohio Medicare Advantage health plan, check with your insurer about whether your wellness visit will be covered at no cost in 2011.

Your Ohio Medicare premiums will most likely change.

Most people on Medicare will pay the same Part B premiums this year as they did in 2010 – either $96.40 or $110.50 per month.
But there are several exceptions.
If you enroll in Part B for the first time in 2011, or if your premiums aren’t deducted from your Social Security check, you’ll pay $115.40 a month.
For higher-income beneficiaries (single people with annual taxable incomes over $85,000 or married couples with incomes above $170,000), Part B premiums will range from $161.50 to $369.10.
Also starting this year, Ohioans in those income brackets will pay a monthly surcharge of $12 to $69.10 for their prescription drug coverage.

If you have an Ohio drug plan and reach the coverage gap, or “donut hole,” you’ll receive a discount on your prescriptions.

Ohio Medicare enrollees get 50 percent off the price of brand-name drugs and 7 percent off generics while in the “donut hole.”
Even though you’ll pay less for a brand-name drug, you can count the prescription’s full price toward the amount you’re required to spend on drugs to qualify for catastrophic coverage.
That way, you’ll enjoy lower out-of-pocket costs while in the “donut hole,” but you’ll still become eligible for Medicare’s catastrophic coverage as quickly as you would without the discount.

If you have Original Medicare, you’ll pay nothing out of pocket for most preventive services.

Without an Ohio Medicare Supplement, you’ve usually paid 20 percent of the Medicare-approved amount for lab tests and screenings after you met your annual deductible.
But starting in 2011, you don’t have to worry about a deductible, co-payment or coinsurance for a broad range of preventive services.
Included are Pap tests, colonoscopies, mammograms, prostate cancer screenings!

Explaining New dates for changing your Ohio coverage.
We now have more time to choose and join a private health or drug plan when the annual open enrollment period gets an earlier start than usual in the fall.
This year, it will kick off on Oct. 15 and wrap up on Dec. 7.
If you want or need to change your private Medicare Advantage health plan, there’s a new annual “disenrollment” period allows you to switch back to Original Medicare and a drug plan between January 1 and February 14.
This replaces a January-to-March enrollment period when you could switch between Original Medicare and the Medicare Advantage program or move from one private plan to another.  The best way to understand what’s new is to refer to your “Medicare and You 2011” handbook, which you should have received by mail this fall.
If you still need one, call 1-800-MEDICARE and request a free copy, or visit our guidebook page and download it.

So here is a little Medicare advice every Ohio baby boomer should adhere to: Don’t wait until the last minute to plan or enroll.

You have the option to change your drug coverage each year, and some plan
types allow you to enroll at any time. But it can cost you money if you wait too
long or make a bad choice. Here are five tips for Ohio Medicare newcomers.
1. Learn the Medicare basics Ohio. There are  two basic ways to cover yourself: Original Medicare (Part A and Part B) or a Medicare Advantage plan.
If you choose Original Medicare in Ohio, you will likely need a separate
prescription drug benefit (Medicare Part D). You may also want a Medicare
Supplement (or Medigap) plan to fill in some gaps in Original Medicare.

Medicare Advantage plans typically include a prescription drug benefit
(Medicare Part D). Some may also provide things like vision and dental coverage.

2. Choose an affordable Medicare plan Ohio.
Calculate your income: Social Security benefits, pensions, etc. Then, list your
expenses: mortgage/rent, food, etc. Balance the two and see what you have left
for Medicare coverage.
There are Medicare plans available with no monthly premiums, beyond the
standard Social Security deductions for parts A and B. If you know what you can
afford, it’s easier to shop.
3. Evaluate your health Ohio. Talk to your doctor about your health and long-term health risks. Then, look for coverage that fits your specific needs. Be aware that some Medicare supplement plans charge a higher premium based on your age, so be sure to consider this when evaluating the long-term costs of a specific plan.
4. Get the right drug benefit Ohio. If you take prescription drugs, a drug comparison tool like the one at www.medicare.gov can help you pick a plan that covers your drugs at the lowest possible cost. Not all drug plans cover the same drugs, at the same price or in the same quantities. Trying to calculate the costs on your own is daunting, but a drug comparison tool makes it easy. Do this every year during the annual enrollment period. We will be happy to help you through this process.
5. Challenge brand loyalty Ohio. Some plans come from companies you’ve heard of. Investigate brands you trust but also consider plan prices.
All Medicare Supplement plan types (there are 10: A,B,C,D,F,G,K,L,M and N)
must offer the same benefits. A ”D” supplement plan from one insurer must, by law,
cover the same services as a D supplement plan from another insurer in the same
area. But costs for Ds can vary widely. Use an Ohio online comparison tool to compare
benefits and prices side by side and make an informed decision.
6. Ask for help Ohio. There are resources online, by phone and in person. You can call us at (888) 769-1981 or call the State Health Insurance Assistance Program or the federal
government’s (800) MEDICARE. Good Luck in your search!

Every Buckeye over 65 is entitled to Medicare Part A. Medicare Plan F is the most commonly selected Medigap plan available and covers other costs associated with regular health care like outpatient services, doctor visits, labs and x-rays. Almost all Medicare benefit recipients select Medicare Plan F as part of their insurance package. As I have wrote about in the past, that decision is not always the most financially appropriate. I like to refer to a Plan F in Ohio as more of a peace of mind choice.
     Medicare Parts A and B are supplied by the government but even with the standard coverage they provide, there are additional medical expenses which may not be covered. This requires many Ohio seniors to buy a Medicare supplemental insurance plan to balance out their wellness and health coverage costs.
     Even with original Medicare, you will have deductibles and coinsurance costs. Medications aren’t covered under Medicare Part A or B either, which means you may need a supplemental prescription plan (Part D) to pay for maintenance medications or drugs required for treating short-term illnesses as well. Many Ohio seniors choose to purchase Medigap plans to pay additional healthcare costs. It is always the wisest decision as long as it is affordable. I am often asked about Ohio Medicare Advantage Plans – while they do make sense for some people, it is like comparing apples to oranges – I discuss the differences in a different blog.
     Also referred to as Medigap insurance, supplemental Medicare insurance is administered by the government, but is actually bought directly from private insurance firms. There are many insurance companies that sell Medicare Supplement plans, making it easy to get confused about which plan is which and even harder to choose which one is right for your specific needs. Each state has different insurance companies that sell Medicare Supplements. For a list of Medicare Supplement Companies in Ohio, click here.
     Each Medicare supplemental plan contains a letter in its name, helping individuals differentiate one from another. Of the 10 Medicare plans available, Letters F, G and N are the most commonly chosen plans in Ohio. That being said, you should survey the plan specifications of all the supplements available before making a determination about which is right for you.
     Every Ohio insurance company that provides Medicare supplement plans is required by law to offer the same benefits for each specific plan. In other words, Medicare Plan C will be the same regardless of where you live or who you buy coverage from. That makes things a little easier, as you need not worry about differences in plan offerings between the various insurance companies. You simply need to understand the differences between the different supplements and make a choice based on that.
     Make sure you carefully read your Ohio guides/handbooks, or speak with a representative to explain these Ohio plan differences. Once you understand the basic plans, you then need only decide which of the supplemental plans works best for your specific health care needs, keeping in mind that your current physical state is not always going to be the norm for you. As you age, you will inevitably have some health issues arise, hopefully none which are serious, but choosing the best plan can help you deal with whatever life throws at you.
     Every Ohio insurance company does not provide all of the 10 Medicare plans but purchasing multiple plans (i.e. Spouse) from the same provider can earn you discounts, so you may want to consider choosing all the supplements for your family from the same company. Getting multiple quotes from various companies is also advisable. Doing so will help you get the most bang for your buck.
     Additionally, don’t base all your decisions only on the cost of monthly Medicare supplement premiums. While you have a budget and need to stick to it, the premium cost should not be the only factor in your decision of which plan to go with. You should also take a look at the reputation of the company providing the insurance coverage. You will inevitably have to call on their customer service staff from time to time, and you want a company that will work well with you in resolving any issues which may arise.
     Michelle Hill is a customer service representative of www.ohiomedigapinsurance.com. Our local experts make the process of selecting a great Ohio Medicare supplement very easy by offering free advice about the Medicare Supplement plans offered in your area. We compare all Medicare Supplement Plans, Companies and prices to make sure you save as much money as possible while still receiving excellent coverage!

 As of Jan. 1, 2011, Ohio Medicare beneficiaries considered high-income earners are paying more money for their Part D Medicare prescription drug coverage. The government is deducting additional premium amounts from the beneficiary’s Social Security benefit payments. The increase will not impact the rates charged by their health insurance company. Individuals with an income of $85,000 or above, or married couples filing jointly with an income of $170,000 or above, must pay an extra premium amount for Part D coverage. This extra premium amount is called the income-related monthly adjustment amount (IRMAA). This amount is based on modified adjusted gross income as reported on the beneficiary’s most recent IRS tax return. CMS recently provided the following tables showing the Part D premium adjustment amount based on income threshold. If the beneficiary is single and filed an individual tax return, or married and filed a joint tax return, the following will apply:

Here are the Part D income-related monthly adjustment amounts (IRMAA):

• $0 (individuals with income of $85,000 or less; married couples filing jointly with income of $170,000 or less)
• $12.00 (individuals with income between $85,001-$107,000; married couples filing jointly with income between $170,001-$214,000)
• $31.10 (individuals with income $107,001-$160,000; married couples filing jointly with income between $214,001-$320,000)
• $50.10 (individuals with income between $160,001-$214,000; married couples filing jointly with income between $320,001-$428,000)
• $69.10 (individuals with income above $214,000; married couples filing jointly with income above $428,000)

If you are married, but file separately, here are the Part D income-related monthly premium adjustment amounts:

• $50.10 (income is between $85,001-$129,000)
• $69.10 (income is greater than $129,000)

PART D CHOICES

This is an excerpt taken from the Center for Medicare Advocacy:

…with Medicare Part D – some of us find that our current prescription drug plan isn’t such a good fit these days. That’s because plans change every year. Premiums and deductibles may change, and, worst of all, beneficiaries may find drugs they need taken off their plans’ formularies or made subject to new prior authorization rules and other restrictions. It is a necessity that beneficiaries and their helpers compare different plans before the Part D Annual Election Period from November 15 – December 31.
CMS also projects that for 2011, 1.2 million beneficiaries will have to change plans as a result of plans leaving the market or reducing their service area. The vast majority of people who will need to change, 925,000 of them, are in Private Fee for Service (PFFS) plans that have decided they no longer want to participate in Medicare as a result of additional requirements passed in the 2008 Medicare Improvement for Patients and Providers Act (MIPPA), not the recent health care reform law. The changes from 2008 go into effect for the 2011 plan year.

Beneficiaries whose plans leave Medicare will still have health insurance through the traditional Medicare program. They will have a special enrollment period in which to enroll in a Part D plan or another MA plan, and they will have guaranteed issue rights to certain Medigap policies. Beneficiaries and helpers should pay attention to the plan non-renewal notice if a plan is leaving Medicare, and, if a plan will be available in 2011, they should be sure to read the Annual Notice of Change (ANOC). The ANOC will explain exactly how the plan is changing for next year. If the plan no longer fits a beneficiary’s needs, it’s time to “shop around” for a new plan.

Ohio specific drug Details provided by www.q1medicare.com

Based on the 2011 Medicare Part D plan information released by the Centers for Medicare and Medicaid Services (CMS), Ohio seniors and Medicare beneficiaries will find that 2011 will bring a number of changes to prescription drug coverage and they should be prepared to examine their current 2010 plans closely to see what changes are on the horizon for 2011.

Please note that the information we provide below is based only on stand-alone Medicare Part D prescription drug plans (or PDPs). As many people know, a number of the Medicare Advantage plans also include comprehensive prescription drug coverage, along with Medicare Part A (hospitalization) and Medicare B (physician) benefits (also called MA-PD plans). However, because MA-PDs include many additional features (including Part A & B coverage) as compared to a stand-alone Medicare Part D plan, we do not try to compare the stand-alone drug plans directly with MA-PDs.

What is new for 2011 Medicare Part D Prescription Drug Plans?
First, the number of prescription drug plans available in Ohio has decreased.
Most notably, some carriers have consolidated plans, most notably, the Coventry AdvantraRx Part D plans will be replaced by the Coventry First Health plans and the PrescribaRx plans will be replaced by the CCRx plans (PrescribaRx and CCRx were both provided through Universal American in 2010). The Medicare prescription drug plans from Aetna are not represented in the landscape as Aetna continues to be sanctioned by CMS. However, Fourteen (14) companies will offer 2011 Medicare Part D plans in most states across the country. In addition, a wide assortment of regional and local Medicare Part D plans are offered within each state or CMS region, with the average number of prescription drug plans offered per state decreasing from 46 plans in 2010 to 30 plans in 2011.

Locally, Ohio residents will find that the total number of stand-alone Medicare prescription drug plans has decreased from 46 in 2010 to 31 in 2011.

As a note, if you find that your current 2010 Part D plan is not being offered in 2011, you may wish to review your Part D plan’s Annual Notice of Change (or ANOC) letter to see if you will be automatically moved to another 2011 prescription drug plan or whether you will need to actively choose a new Medicare Part D plan for 2011.

29% of Ohio seniors can expect to see their monthly prescription drug plan premiums increase in 2011.
Across the country, the national average monthly Medicare Part D premium will increase from $46.58 in 2010 to $53.77 in 2011. Based on the 2010 enrollment figures, 64% of Medicare Part D beneficiaries nationwide (over 8 million people) could experience an average increase in premium of $6.74, unless they switch to a lower priced plan. At home, Ohio residents will also notice an increase in their Medicare Part D premiums. 29% of Ohio seniors and other Medicare beneficiaries enrolled in a stand-alone Medicare Part D plan, (or around 111,782 people) will see an average increase in monthly premiums of $9.55 in 2011 — if they do not switch to a lower cost prescription drug plan. Overall, monthly 2011 prescription drug plan premiums in Ohio will increase 6.83% from a 2010 average monthly cost of $45.40 to a 2011 average Part D plan premium of $52.23.

The average monthly premiums discussed above treat all Medicare Part D plans equally. Perhaps a more telling average is the weighted average – that is, looking at each plan’s monthly premium based on number of people enrolled in that plan. Based on the weighted average, Ohio residents can expect to see a 2% increase in their monthly premiums. This means that if everyone stays in their current 2010 prescription drug plan through 2011, then across the state we can expect beneficiaries to pay 2% more for their monthly premium.

The range of monthly drug plan premiums will decrease.
Across the country, 2011 Medicare Part D plan premiums range from a low of $14.80 (Humana Walmart-Preferred Rx Plan (PDP) in WI) to a high of $133.40 (BlueRx Enhanced (PDP) in DC DE MD) . Comparatively, the premiums within Ohio will range from $14.80 (Humana Walmart-Preferred Rx Plan (PDP) in OH) to $111.50 (Humana Complete (PDP) in OH) – as compared to the 2010 Ohio monthly premium range of $22.60 to $102.20. Of those 2011 plans, 1 plans will have a premium under $25 (in 2010, 1 Part D plans were offered in Ohio with a premium under $25).

More Medicare prescription drug plans will offer some level of coverage gap protection.
The selection of prescription drug plan coverage options has also changed with more companies offering 2011 Part D plans with donut hole coverage. In 2010, 9 plans offered plans with some form of donut hole coverage and in 2011 that number will increase to 11. People are reminded to see what drugs are actually covered in the donut hole because some Part D plans only cover a “few” drugs through the coverage gap.

Less Medicare prescription drug plans will offer plans with enhanced options.
Ohio residents will find that less Part D plans will offer enhanced prescription drug coverage options with 14 enhanced Part D plans in 2011 as compared to 23 in 2010. Enhanced Medicare Part D coverage includes prescription drug plans that have a lower or no initial deductible and a variation of cost-sharing (for instance, copayments instead of co-insurance). For example, in 2011, fewer Ohio Part D plans will offer prescription drug coverage with a $0 initial deductible (13 in 2011 as compared to 19 in 2010).

Low-Income Subsidy Recipients in Ohio will have more Part D plans that qualify for the $0 monthly premium.
Ohio Medicare beneficiaries who qualify for full “Extra Help” will find that more Part D plans qualify for the $0 premium Low-Income Subsidy as compared to last year. In 2010, 5 Medicare Part D plans qualified for the $0 premium Low-Income Subsidy as compared to 7 Part D plans in 2011. Please note, if you received “Extra Help” in 2010 and your plan does not qualify for the $0 premium in 2011, you may be automatically moved to a new Part D plan that does qualify for the $0 premium. If this occurs, please check to be sure that your prescriptions are covered on your new plan. If they are not, you can switch to a plan which will cover your medications.

So what is the Bottom Line? Review your 2011 Medicare prescription drug plan options.
Ohio seniors and Medicare beneficiaries will see fewer prescription drug plan choices in 2011 and higher premiums.

In addition, behind the numbers, some of 2010’s more popular Medicare Part D plans will change their 2011 plan structure. Some plans are adding initial deductibles or changing cost-sharing limits (for instance, how much you pay after for a covered drug). Also, some plans actually change the initial coverage limit defining when you enter the coverage gap.

Accordingly, people are reminded to consider their 2011 prescription drug plan options carefully. If you are a Medicare beneficiary and make no decision to change your existing prescription drug coverage, you will be automatically reenrolled in your existing prescription drug plan – along with any changes that have been made in coverage or cost for 2011. If your prescription drug plan is discontinued, and you are not automatically moved into a new plan, then you will need to enroll in another Part D plan or not have prescription drug coverage in 2011.

CMS indicates that the national average monthly premium will increase about $1 (to $30) in 2011, but the overall range of premiums is up among PDPs. In part, this may be because more plans are offering some coverage during the Donut Hole. The most important thing we can say about premiums is: Don’t shop by premium alone! Consumers need to look at total annual costs, including the premium and cost sharing (the deductible, co-pays and co-insurance). Even more importantly, consumers need to compare plan formularies to be sure the drugs they take are offered by the plan with as few restrictions (such as prior authorization) as possible. Beginning October 15, plan premiums, deductibles, co-pay amounts, formularies and formulary drug restrictions can be viewed and compared on-line at www.medicare.gov.

*Total price of the brand name drug counts toward TrOOP, even though member is paying 50%. For generic drugs, only the amount the member pays – 93% – counts toward TrOOP.

Reminders for Selecting a Plan

•First and foremost, compare needed drugs to the drugs on the plan’s formulary. Make sure the needed drugs are on the formulary and have no restrictions (such as prior authorization, quantity limits and step therapy).
•Consider whether or not coverage is needed during the Donut Hole, keeping in mind that this year, most people will get a 50% on brand name drugs purchased while in the Donut Hole.
•If the beneficiary travels, look for a national plan.
•If it is an issue, find out the circumstances when the plan will cover brand name drugs when a generic alternative is available.
•Even after finding a compatible plan, compare annual cost per year, including premium, deductibles and co-pays. Don’t assume that a deductible will make the plan more expensive overall, and don’t assume that mail order is always less expensive.
There are several sources for help in choosing a plan. Compare plans on-line using the Plan Finder tool at www.medicare.gov. Read the “Medicare & You 2011″ handbook. Call 1-800-MEDICARE, or contact your local broker.

For a synopsis of 2011 Health and Drug plans in all 50 states go to: http://www.cms.gov/Partnerships/downloads/statefactsheets_all.pdf

If you live in any one of these Ohio towns, Ohio’s Medigap Connection can help: Aberdeen
Ada Adamsville Addyston Adelphi Adeni Akron Albany Alexandria Alger Alledonia Alliance Alpha Alvada Alvordton Amanda
Amelia Amesville Amherst Amlin Amsterdam Andover Anna Ansonia Antwerp Apple Creek Arcadia Arcanum Archbold
Arlington Ashland Ashley Ashtabula Ashville Athens Attica Atwater Augusta Aurora Austinburg Ava Avon Avon Lake
Bainbridge Baltic Baltimore Bannock Barberton Barlow Barnesville Bartlett Barton Bascom Batavia Bath Bay Village
Beach City Beachwood Beallsville Beaver Bedford Bellaire Bellbrook Belle Center Belle Valley Bellefontaine Bellevue
Bellville Belmont Belmore Beloit
Belpre

Zaleski
Zanesfield
Zanesville
Zoar

As you may already know …

When it comes to Ohio Medicare supplemental insurance there are no real differences in offerings between companies for like plans. A particular plan letter from one company works identically to that same plan letter from any other Medicare supplemental insurance company. As an example, a standard plan F from let’s say Blue Cross Blue Shield works identically to a standard plan F from AARP (United Healthcare) or one of the Mutual of Omaha companies.

Other than there not being any difference in benefits from like plans (example plan F from AARP vs. plan F from United of Omaha) you will also see no difference in:

1) Doctors Networks – One of the really nice things about Medicare supplements is there are not different doctors network for each company. If a doctor accepts Ohio Medicare supplemental insurance he or she will accept any company’s Medicare supplement. This has mainly to do with the fact that Medicare processes the claim first and the claim then gets passed to the Ohio Medicare supplement insurance carrier to pay their part.

2) Claims Paying History – Because Medicare makes the decision on whether a claim will be paid the Medicare supplemental insurance companies cannot go against Medicare’s ruling. So, if Medicare approves the claim the supplement company just has to pay their part. They cannot go against Medicare’s decision. So, by virtue of the claims-filing process, all companies claims paying history is the same.

3) Over all Experience – When clients switch from a particular plan to that same plan from another company we let them know not to expect a change in service. The main difference they will see is a lower premium and a different companies logo on their Medicare supplement ID card.

The biggest changes you’ll likely want to consider are:

1) A.M. Best Rating of Insurer – You want to ensure you’re dealing with a company that is not in financial distress. Any company rated a B+ or better with AM Best is considered stable. AM Best is the primary organization that tracks the financial stability of insurance companies. (we usually recommend only A rated carriers in Ohio)

2) Medicare Supplement PRICES (of course) – THIS IS REALLY WHAT MATTERS. It really all comes down to getting the best rate for the plan you would like to have. It’s important to find an agent or agency that represents the top companies and can guide you through to finding the best rate from stable companies for the plan you prefer. There are also many factors to consider when looking at pricing and a good agent can help you understand the differences.

Ohio Medicare supplemental insurance benefits are mandated at the same coverage since 1992. As I have blogged before for example, a Plan F provides the same benefits for senior Ohioans no matter which company underwrites the policy. Ohio Medigap companies, however, can design their own prices and the premiums can be VERY different.

Ohio Medigap Plan Benefits and Company offerings

Summary of Basic Ohio Medigap Insurance Plans and Companies that sell them:

(brought to you by State of Ohio Consumer Education Series)

Click Here

As of June 2010 Medicare company reporting, the state of Ohio’s average cost of a Plan F Medigap policy for a 65-year-old ranged from $1,164 to $4,848 per year according to the above publication – An Ohio consumers guide to Medicare Supplements, Medicare Options, and Part D.
Differences in prices are just as ridiculous on other Ohio Medicare insurance plans. These wide ranges in Ohio state premium rates seem to be slowly leveling out. We have seen a few new insurance companies introduced to the Ohio Medicare Supplement market within the last year that are not included in these statistics. It is our personal belief that we will also soon see others exiting the Ohio Medigap market.

Ohio Seniors shopping for the least expensive Medigap policies in Ohio with the safest insurers can download all federal and Ohio state Guides here.

Many Ohio based Medigap insurance companies have price increases of ten percent or more every year!

There are several ways to reduce your monthly premiums.

As long as you are relatively healthy, Ohioans can change Medicare supplements anytime they want. In Ohio, there is no open enrollment period once you are already a Medicare beneficiary. If your premiums have increased dramatically, then you simply contact an independent Medigap focused agency (like us) to help you find a new carrier offering the exact same coverage at a lower rate.

Regarding your health: In some cases, a certain amount of time must have elapsed since a particular health event occurred before you can be underwritten. In our experience, most consumers can be underwritten for a new plan as these questions and time limits do not apply to the majority of the general population.

Ohio Guaranteed Issue Medicare Supplement Insurance

Mutual of Omaha and some of its subsidiaries (United of Omaha and United World Life) have increased premiums somewhat substantially over the last year in several areas of the country. As long as you are in decent health, you will be able to purchase the same coverage (Plan F for instance) with one of their sister companies (Assured Life and Gerber Life) or one of their competitors (Family Life, GPM-Government Personnel Mutual, AARP, Christian Fidelity) at a lower rate.

However, for those who cannot medically qualify for new coverage, Plan N is now available from United of Omaha and GPM on a guaranteed issue basis in Ohio. While this is a type of cost sharing  plan, prices will be lower and may offset any additional out of pocket expenses that you might have.

It is conceivable that other carriers will follow suit and offer guaranteed issue plans as well. However, Plan N through Mutual of Omaha or any of its affiliates will be a good option if you are stuck in an expensive Medicare supplement plan because you cannot be underwritten elsewhere.

Request More Medicare Supplement (Medigap) Information

We are senior financial-health focused independent professionals licensed with the most affordable carriers in the state! We offer several competitively priced Ohio Medicare supplement insurance plans. There is no additional cost to use our services as Ohio Medigap prices are controlled by law.

We will provide you with quotes on the plan(s) of your choice and can advise you on your options when it comes to changing coverage when your monthly premiums have increased or when you are in your open enrollment period.

When Can You Sign Up?

Most people find it difficult to keep up with all of the different “Enrollment Periods” in Ohio.

First, Ohio Medicare Enrollment is based on age, aka INITIAL ENROLLMENT PERIOD:

Ohioans can sign up when first eligible for Part B. (i.e., if you’re eligible for Part B when you turn 65, this is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.)

Ohioans have a six-month Ohio Medigap (Medicare Supplement Insurance) policy open enrollment period which starts the first month you’re both 65 and enrolled in Part B. This period gives you a guaranteed right to buy any Medigap policy sold in your state. Once this period starts, it can’t be delayed or replaced.

PLEASE KEEP IN MIND THAT YOU CAN SHOP FOR AND EVEN SWITCH YOUR OHIO MEDIGAP POLICY ANYTIME THROUGHOUT THE YEAR (yes, even if you are 75 years old) if you have relatively good health).

Enrollment periods for Ohio Medicare Supplements are different because of this fact, during the six month period discussed above, however, you will be guaranteed coverage even with major illness and/or disease.

Some Ohio Seniors get confused in thinking that they can shop and switch Medicare Supplement Insurance Companies in Ohio during Annual Enrollment Periods such as the period that recently ended December 31, 2010. While this is true, Ohio Medigap Companies have the right to request health information and perform complete underwriting before issuing supplemental health coverage. It is very wise to check rates among Ohio Medicare Supplement Insurance Companies, especially if you have no Major health issues.

Other special circumstances can be researched here

ANNUAL ENROLLMENT PERIODS:

Pertains primarily to Ohio seniors wanted to get out of Medicare Advantage Plans and those that may need or want to change Part D prescription drug coverage.

Are You Turning 65?
The best time to purchase a Medigap policy, also known as a Medicare Supplement policy, is during your Medigap “open enrollment period”. – Oct. 15 thru Dec. 7 is Ohio’s Open Enrollment this year. Federal law gives you a 6-month open enrollment period to apply for a Medigap insurance policy, beginning with the first month that you enroll for benefits under Medicare Part B.
Note: You can send in your application for a Medigap policy before your Medigap open enrollment period starts. This may be important if you currently have coverage that will end when you turn age 65 and will allow you to have continuous coverage.
The below information will help you understand your rights during Open Enrollment.

During your open enrollment period, an insurance company is not allowed to medically underwrite your policy. This means the insurance company can’t do any of the following:
 Refuse to sell you any Medigap policy it has available
 Make you wait for your coverage to start
 Charge you more for a Medigap policy because of any health conditions

 Make you wait for your coverage to start
 Charge you more for a Medigap policy

The insurance company can’t make you wait for your coverage to begin but they may be able to make you wait for coverage of a pre-existing condition. A pre-existing condition is a health condition you have before your Medigap insurance policy starts. In certain cases, the insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a “pre-existing condition waiting period.” Coverage for a pre-existing condition can be excluded from your Medigap policy if the condition was treated or diagnosed within 6 months before your new Medigap policy begins.

If you buy a Medigap policy during your Medigap open enrollment period and you recently had certain kinds of health coverage in place called “creditable coverage,” it is possible to avoid or reduce waiting periods for pre-existing conditions. Creditable coverage is generally any other health coverage you had before applying for a Medigap policy. If you’ve had at least 6 months of prior creditable coverage, the Medigap insurance company is not able to make you wait before it covers your pre-existing conditions.
There are several types of health care coverage that qualify as creditable coverage for Medigap policies, but they will only count if you didn’t have a break in coverage for more than 63 days. If there was any time that you did not have health coverage of any kind and you were without coverage for more than 63 days, you can only count the creditable coverage you had after that break in coverage.
If you buy a Medigap policy during a guaranteed issue period (also called “Medigap protection”), the insurance company can’t use a pre-existing condition waiting period at all.

By law, the benefits of each Ohio Medigap Plan A – N are the same for every insurance company. Because Medicare Supplements are Federally Standardized, it will be in your best interest to continuously (annually or at least biennially) shop for the most competitive premiums as long as your health allows. We have found that many Medicare supplement insurance agents in Ohio will sell a Medicare supplement to a client and not check back with them to re-evaluate options.

Switching to another company is a pretty easy process and the application typically only takes about 10 minutes to complete and generally can be handled over the phone.
There’s nothing to lose by switching if you can save money and get the same benefits you had before.

Medicare Advantage Disenrollment -

We are finding more and more Medicare Advantage plans in Ohio being phased out or dropping policyholder coverage. If this is happening to you, you do have options. Every year Medicare allows you to make changes to your existing Medicare Advantage Coverage.
The Annual Election Period (AEP) is a period from October 15th to December 7th this year.
Open Election Period (OEP) is a period each year from January 1st through March 31st.

If you are not falling under the following enrollment periods, you may qualify for a Special Election Period (SEP). One example is if your company is dropping your coverage. You will generally have 45 days in which to find another plan – you will be guaranteed coverage. To find out what criteria you meet please contact one of our specialists.