Open Enrollment Starts October 15 - What You Need to Know

Published: Mon, 12/07/20

Open Enrollment Starts October 15 - What You Need to Know

This is a long newsletter but please take the time to read and learn. I am always available to answer questions but understand my time is going to be limited between now and December 7th.

You are probably “sheltering in” like most of us. You aren’t going anywhere so take a few minutes to prepare for the new year.

Shameless Plug

I never charge a consulting fee and never will. My advice and guidance is free of charge.
Compensation from Medicare supplement premiums make all this possible.
Drug plans are complicated and time consuming. I receive nothing from Part D plans but I truly enjoy helping my clients save money.

Robbing the Bank to Pay for Health Care -

When you have original Medicare and a supplement plan, you don’t have to worry about the cost of health care or access to health care.

Your OOP (out of pocket) cost for medical treatment is capped at $198 for 2020. Most of my clients have Medigap Plan G. The most you will pay for doctor visits, labs, X-ray, MRI, surgery (in or out of the hospital),

ambulance, ER . . . all of your health care . . . is $198. Next year the deductible will probably be different but it is not expected to change much.

You have the ability to anticipate and budget your health care costs. Anyone that has a Medicare Advantage plan can’t do that. Their medical bills can be hundreds or even thousands of dollars in OOP costs.

Living on a fixed income usually means watching every dollar going out for food, utilities and health care. Your G plan allows you to sleep well at night knowing you have the ability to protect your bank account from huge medical bills.

When you have original Medicare you can go to any doctor or hospital and not have to worry if you are in network or not . . . because there are no networks. You don’t have to ask your insurance carrier if you can have a test or treatment. You and your doctor make those decisions, not an insurance company.

Folks who have an Advantage plan don’t have that luxury. They are willing to enroll in a plan that has no premium and in doing so, they let an insurance carrier direct their care. If they need special care they won’t be able to go to Mayo, Sloan-Kettering, Cleveland Clinic because those places don’t participate in MOST Advantage plans.

All the TV ads and mailers that promote their $0 premium plans that often include nominal dental and vision care don’t tell the rest of the story. The “pitch” fails to mention you must use doctors, dentists and hospitals on THEIR list when you use their plan.

You already have access to the BEST medical care and you don’t have to worry about having enough money to PAY for that care.

Envision / Elixir - More than Just a Name Change

If you have the $14 Envision plan and want KEEP the same premium you will need to enroll in the NEW $14 plan. Otherwise you will be rolled over to the $26 plan.
You should have received this Envision/Elixir newsletter.

It’s almost time to re-enroll for your 2021 prescription benefits! This year comes with a new name for your Part D plan. EnvisionInsurance is changing to Elixir Insurance. To ensure you continue to receive the same prescription drug coverage, you must take action between October 15 and December 7 to re-enroll in Elixir RxPlus as your Part D plan for 2021.

Get ready to take action starting October 15!

If Elixir Insurance is right for you, and you want to keep a plan with a low premium and deductible, then you must take action by changing to Elixir RxPlus. If you do not take action by the deadline, you will be automatically enrolled in our plan with a higher premium. Taking no action will result in an automatic enrollment with a higher premium plan.

Mark your calendar for October 15 to take action and re-enroll! For the fastest service, visit elixirinsurance.com/enroll or call 877-583-2624 (TTY 711), 24 hours a day, 7 days a week. Thank you for being an Elixir Insurance member.

If you want to enroll direct in the NEW $14 plan you may do so using the link above or calling the toll free number.
I am not compensated for drug plans, so don't worry about "cutting me out". If you go direct to Elixir I still make the same amount . . . $0.

Part D Tips and Tricks

This won’t make you an expert, but it might help you understand the process. For some folks, paying for medications is the most expensive part of aging. Here are a few ground rules. Details follow.

Low premium matters if you are not on any medications
Deductible is only an issue if your drugs are tier 3 or higher
The pharmacy you use can make a BIG difference in your copay
Total cost (premium + copay) is the BEST way to compare plans
Compare GoodRx pricing to your plan copay to save $$$
New prescription? Call your plan for pricing and compare to GoodRx

The next few weeks are hectic but I will help as many clients as I can. The most time consuming part (for me) is entering your drug information. The rest is quick and simple (most of the time).

Things You can do to Help Both of Us

https://www.medicare.gov/plan-compare/#/?lang=en&year=2021

Use THIS ^^^ link

Once inside you drug history is automatically populated unless this is your first time. Printing the side x side comparison report allows me to review your options and give guidance in 3 minutes. When I input your drugs, dosages, refill information and select drug stores can take 20 minutes or longer.

The more time spent entering this information means less time available for others.

If the computer is overwhelming I can do a “mini” review that will still save money for you and time for me to help others. Here is what I need.

List each drug in order of HIGHEST copay to lowest
I need each drug listed like this. - Lisinopril 20mg, $4, 90 days, 90 pills, CVS
If you currently have a drug plan, give the carrier name and premium - Envision, $14

Read on if you want to know more about Part D.

SilverScript introduces a low premium ($7.30 per month) plan for 2021. It might be a fit for those who are not on ANY medications

Others may do better with a higher premium ($23.60) Anthem plan.

If you want to run your own reports, print as a PDF, and email to me for review, that will help both of us. Step by step instructions follow.

But What About Prescription Drugs?

Medication can be very expensive. For many of us, our monthly drug costs can meet or exceed what we pay for a Medigap plan.

But you can hold down the cost of medicine with the right drug plan and know when to use it and when to pay cash.

Medicare Part D is the most confusing element of Medicare. It can also be the most costly if you have the “wrong” plan or if you fail to shop wisely.

In 2021 there are 32 drug plans. Your option includes 27 plans that have a deductible and 5 that do not. There are 13 plans with a monthly premium that is less than $25.

Higher premium plans often have LOWER copay’s on HIGHER priced drugs.
The $0 deductible plans often have HIGHER copay’s on generics but LOWER copay’s on high priced brand names.

If you take a brand name drug it usually is not covered by a drug plan if there is a generic equivalent.

If all your drugs are generic, most plans do not apply the deductible unless you drugs are tier 3 or higher. The plan deductible lowers your premium AND usually lowers your copay.

But What About Prescription Drugs?

What follows is a general overview of what you should consider in evaluating 2021 drug plan options.

Medicare requires Part D plans to cover about 800 most prescribed drugs. There is no way to evaluate all 32 plans + medications + pharmacy’s so I have picked a handful of commonly used drugs as a reference point.

The drugs I used are:

Amlodipine (blood pressure) https://www.goodrx.com/hypertension

Atorvastatin (cholesterol) https://www.goodrx.com/high-cholesterol/drugs

Diclofenac (arthritis pain) https://www.goodrx.com/diclofenac-sodium

Levothyroxine (thyroid) https://www.goodrx.com/hyperthyroidism/drugs

Lisinopril (blood pressure) https://www.goodrx.com/lisinopril

Meloxicam (arthritis pain) https://www.goodrx.com/meloxicam

Omeprazole (GERD) https://www.goodrx.com/omeprazole

Here are links to the reports generated using the above medications. Your medication list will be different and produce different results.

SAMPLE report, 6 medications, 5 pharmacy’s, 3 low premium drug plans

THIS ^^^ report is a starting point.

SilverScript low premium plan
Notice how your copay’s change in comparing a PREFERRED pharmacy vs STANDARD vs OUT-OF-NETWORK.

Anthem MediBlue - higher premium, lower copay’s
Depending on your MEDICATIONS, a HIGHER premium may yield more savings. Four pharmacy’s are PREFERRED the fifth is STANDARD. Again, look at copay changes.

There are 32 plans, hundreds of pharmacy’s and hundreds of medications. The combinations are endless.

I run about a thousand reports like this each year. You won’t become an expert at comparing the information, and I am not asking you to. I am always glad to REVIEW your reports and suggest plans with the LOWEST total cost.

If you want to run your own reports this format is helpful in comparing plans.

Closing Thoughts

I don’t know about you, but I am exhausted from doing this.

I really hate to ask you to “chip in” and help but this is the only way to handle all that needs to be done in a short time.

My next planned newsletter will cover Medicare coverage for cataract surgery.

At least that is my goal. We will see what happens.

Take care,

Bob

But Wait - There’s More!

Where Are the Medicare Part D No Premium Plans?

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