Allen Heffler Part D 2018

There are four stages in  Part D.

Phase 1.  Yearly Deductible

 You pay the first $405 (year 2018) of drug costs before plan starts to pay.

Phase 2.  Initial Coverage (ICL)

 Year 2018- $3,750 For each covered drug  you pay a copayment/coinsurance (defined by the plan), and the plan pays its share. CMS’ standard coinsurance is 25%, i.e. you are paying 25% of the drug costs, the insurance company pays the rest. The initial coverage continues until the total drug costs (total of what you’ve paid and what insurance company paid) reaches $3,750 (year 2018). Medicare beneficiaries will leave the Initial Coverage Phase and enter the Donut Hole or Coverage Gap when the total negotiated retail value of their prescription drug purchases exceeds their plan’s Initial Coverage limit.  So if you purchase a medication with a $100 retail cost and pay $30, the $100 counts toward meeting your ICL or Initial Coverage Limit.

Phase 3.  Coverage Gap (Donut Hole)

 Once the total costs of prescriptions (paid by you and your plan) has reached $3,750 (year 2018): Brand Name DrugsYear 2018- 35% You’ll pay 35% of the plan’s cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.Generic Drugs Year 2018- 44% In 2018, Medicare will pay 56% of the price for generic drugs during the coverage gap. You’ll pay the remaining 44% of the price. What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap

Phase 4.  Catastrophic Coverage

 Total Out-of-Pocket Costs or TrOOP. Once you’ve spent $5,000 out-of-pocket in 2018, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” In the 2018 Catastrophic Coverage phase, you pay a minimum of $8.35 for brand drugs or $3.35 for generics (or 5%, whichever is higher).

Coverage vary significantly from various carriers.  For example, there are several plans that do not have an up-front deductible.  For an in-depth analysis from plan to plan, call Allen Heffler (215) 658-1776.

Medicare Part B Changes 2018 by Allen Heffler

Medicare Part B for 2018: No change in Annual Deductible- remains $183. No change in Standard Monthly Premium- remains $134. There IS a change in the “surcharge” for those seniors with higher incomes. For 2018, the income thresholds have been reduced, resulting in higher premium surcharges at different income levels. Click  HERE for complete details. Questions? Just call Allen Heffler, MyMedicareAdvisor in Philadelphia, PA at 215-658-1776

Seven Medicare Mistakes to Avoid- Mistake # 1 Failing to Pay Your Part B premiums

Posted by Allen Heffler on 05/11/2017

Seven Medicare Mistakes to Avoid- Mistake # 1 Failing to Pay Your Part B premiums by Allen Heffler

Failing to Pay Your Part B premiums

In today’s world, many of us work past the age of 65. Many of us might delay our Social Security income benefit to age 67 or 70, since you have sufficient income from work. Because you are not receiving a Social Security check, Medicare is unable to deduct your Part B premiums from a Social Security check. Thus, Social Security mails a quarterly bill for Medicare Part B instead. Medicare Beneficiaries get a lot of mail! It can be very easy to overlook a piece of mail from Social Security- which could be your quarterly invoice. Sadly, the result could be catastrophic. Social Security can revoke your Medicare Part B for non-payment. If this occurs, not only will you not have Part B/Medical coverage through Medicare, they also could notify your Medigap carrier, who might cancel your Medigap plan. It is possible that you might be left with no coverage for outpatient services, which includes doctor visits, lab-work, medical equipment, surgeries, chemotherapy, dialysis and many other expensive services. To make matters worse, you will now have to wait until the next Medicare General Enrollment Period (GEP) to enroll in Medicare Part B. The GEP runs from January 1st – March 31st each year. Though you can enroll during this period, your coverage won’t start until the following July. A serious illness or injury during this uncovered time could result in thousands of dollars of unpaid medical expenses. We want to avoid that at all costs. Best tip: If you are enrolled in Part B before you begin taking Social Security, contact them at 1-800-772-1213 and ask them to set up bank draft for you. This is the easiest way to make sure you don’t overlook paying your Part B and causing yourself a world of hurt. While mistakes do happen, it is important to try to avoid them! Since even the most prepared person might encounter issues, it’s in your best interest to work with an independent Medicare broker who knows what they are doing when it comes to Medicare. We are here to help you every step of the way! Wouldn’t it be nice to have someone on your side with Medicare? Just call Allen Heffler – MyMedicareAdvisor at (215) 658-1776.