• Medicare may not pay for telehealth.
• Creative ways to save money on prescription drugs
• What your doctor won’t tell you . . .
• The doctor WON’T see you now

Medicare May Not Pay for Telemedicine/Telehealth (Virtual Visits) in 2025

Through December 31, 2024, you can get telehealth services at any location in the U.S., including your home. After this period, you must be in an office or medical facility located in a rural area (in the U.S.) for most telehealth services.

After December 31, 2024, you'll still be able to get certain Medicare telehealth services without being in a rural health care setting, including:

• Monthly End-Stage Renal Disease (ESRD) visits for home dialysis.
• Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit.
• Services to treat a substance use disorder or a co-occurring mental health disorder (sometimes called a "dual disorder"), or for the diagnosis, evaluation or treatment of a mental health disorder, including in your home.
• Behavioral health services, including in your home.
• Diabetes self-management training.
• Medicare nutrition therapy.

https://www.medicare.gov/coverage/telehealth

Starting in 2025 you can still access telehealth but you may have cost sharing.

How to Pay For Prescription Drugs Without Using Your Drug Plan

The Medicare Part D landscape is still unfolding and it is not going to be pretty.

Fewer plans, smaller networks, higher copays and deductibles, some drugs NC (not covered).

All of this means you need to look for alternative ways to pay for your medicine WITHOUT using your drug plan (especially for generics).

Assistance, Grants & Discounts . . .

• Patient Assistance Programs (privately funded)
• Grants (privately funded)
• Discount cards (generics only)
• Prescription drug “clubs” (small membership fee)
• Canadian pharmacy mail order (generic and brand)

PAP’s and Grants may have income requirements to qualify. Ask me for specific details.

Discount cards include offerings like GoodRx and SingleCare

Cost Plus . . . not a true membership club but you are required to set up an account and provide a credit card. Low cost generics where you pay the “wholesale” (PBM cost) + a 15% markup + $5 (per prescription) and a $5 shipping fee.

https://costplusdrugs.com/

MapleLeaf meds is our “go to” for most situations but there are others that we will recommend from time to time.

https://www.mapleleafmeds.com/

Many of my newsletters encourage using generic drugs where possible, and especially using discount cards instead of your insurance. It is an easy way to save money . . . just ask your pharmacist to see if you will pay less with a discount card or your plan.

What Your Doctor Won’t Tell You . . .

This happens all too frequently but a recent situation was so glaring I said (to myself) . . . REALLY?

New client is currently taking a very expensive brand name medication. When you are under 65 and covered by an employer group health insurance plan (EGH) you may qualify for deep discounts from the manufacturer. You may only pay $30 or so for a drug costing over $1,000 . . . but this changes when you go on Medicare.

The deep discounts usually go away and you have to either pay a LOT more or find other discounts (if available).

In this case the new copay would be $600 for a drug with a $2500 (per month) retail cost. A significant savings but still too expensive.

I suggested asking the doc for a lower cost drug that would be just as effective.

The doc offered a different drug that cost $19,500 per month.

Clearly, the doctor had no clue about how much medications cost. This is not unique. They rarely know the cost of the prescribed medication but will suggest an alternative only if you ask.

The Doctor Will NOT See You Now

CONCIERGE MEDICINE

“You had to pay the fee, or the doctor wasn’t going to see you anymore.”

That was the takeaway for Terri Marroquin of Midland, Texas, when her longtime physician began charging a membership fee in 2019. 

Americans are paying for the privilege of seeing a doctor — on top of insurance premiums that cover most services a doctor might provide or order. Many people seeking a new doctor are calling a long list of primary care practices only to be told they’re not taking new patients.

Annual fees range from $199 for Amazon’s One Medical (with a discount available for Prime members) to low four figures for companies like MDVIP and SignatureMD that partner with physicians, to $10,000 or more for top-branded practices like Massachusetts General Hospital’s.

Liz Glatzer felt her doctor in Providence, Rhode Island, was competent but didn’t have time to absorb her full health history. “I had a double mastectomy 25 years ago,” she said. “At my first physical, the doctor ran through my meds and whatever else, and she said, ‘Oh, you haven’t had a mammogram.’ I said, ‘I don’t have breasts to have mammography.’”

In 2023, after repeating that same exchange during her next two physicals, Glatzer signed up to pay $1,900 a year for MDVIP, a concierge staffing service that contracts with her new doctor, who is also a friend’s husband. In her first couple of visits, Glatzer’s new physician took hours to get to know her, she said.

Deb Gordon of Cambridge, Massachusetts, said she is searching for a new primary care doctor after hers switched to concierge medicine — a challenge that involves finding someone in her network who has admitting privileges at her preferred hospitals and is accepting new patients.

https://kffhealthnews.org/news/article/concierge-medicine-primary-care-doctor-pay-to-play/

Concierge medicine is a  growing trend, but less than 5,000 membership practices exist in the United States at this time. My doctor asks permission to conduct a “mini physical” during my annual wellness in exchange for paying a little extra for an office visit. The $126 fee is worth it to me so I agree to pay.

Unlike Advantage plans, Original Medicare does not have networks, mandatory referrals, access to any provider who participates, prior authorization (for most procedures), etc.

The memes in this month's edition might not fit the topics, but don’t blame me. With all that is going on right now I think all of us need to take a moment and laugh at something . . . better than crying.

The 2025 drug plans won’t be available for review until the first of October. I would like to get CURRENT prescription drug lists from you no later than 9/10/2024. New 2025 enrollment starts 10/15. I anticipate significantly more requests than in the past, so please be patient.

Enjoy the rest of your summer!

Bob

https://www.youtube.com/c/georgiamedicareplans