GA Medicare Digest

Published: Tue, 01/12/21

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Saying Goodbye to 2020 -

Hoping Next Year Isn’t a Rerun

With only 3 weeks left in the 2021 Open Enrollment there are a lot of loose ends. Things promised that never happened.

There is still time to make a change if you want.

Most of the distractions have been handled and I am not taking on any new clients until next year.

2021 drug plan enrollment can still happen until December 7th.

Trends in New Drug Plans

By now I have run over 100 drug plan reports and enrolled dozens in new plans. Who should change plans, and who can stand firm?

MOST folks can keep their current plan and see very little change in 2021 vs this year. But there are a few exceptions.

If you are not on any regular maintenance drugs SilverScript Smart Rx is probably where you need to be.
If your generic drugs cost MORE than $5 with your current plan you will probably NOT save $$ by changing to the SilverScript plan
If you are on any of the 3 following plans and NOT using their preferred pharmacy you could be overpaying for your medications
If your GENERIC copay is more than $10 you can probably save $$$ by using GoodRx instead of your drug plan
If your premium almost doubled, as in the case with Envision, you need to change plans
Generic copay’s on 2021 plans are trending higher. Few, if any, $0 copay’s on the 2021 plans.
Many folks are not using their drug plan for generics - only for tier 3 and higher brand or generic drugs

Envision to Elixir

Envision has been rebranded to Elixir. The current $14 plan will be $26 in 2021 and will be branded Elixir RxSecure.

So far I have seen no reason for anyone on the current $14 Envision plan to map over to the higher premium ($26) plan in 2021.

If you like your Envision plan and don't want to pay $26 you need to start a NEW enrollment in the $14 Elixir Plus plan for 2021.

You can handle the enrollment direct with Envision or I can give instructions on how to change to the new plan in less than 5 minutes through your MyMedicare account.

Preferred Pharmacies

As in the past, preferred pharmacies make a BIG difference in your copay. When possible, use ONLY PREFERRED pharmacies.

Below is a list of preferred, standard and out-of-network pharmacies for the 3 lowest premium plans.

Clear Spring Health Premier Rx - $14 premium

SilverScript SmartRx - $7 premium

Elixir RxPlus - $14 premium

MyMedicare Account

If you are not using your MyMedicare account you are missing out on a lot of things.

https://account.mymedicare.gov/

There are so many things you can track, including claims. If you use your MyMedicare account there should never be any surprise claims.

The Medicare drug plan finder is fully integrated with MyMedicare. You can compare plans and enroll in a plan of your choice in minutes. Most of your data is pre-populated.

I have used MyMedicare to track the progress (or lack thereof) in Rachel’s claims. I also enrolled both of us in new 2021 drug plans in less than 3 minutes each.

Wrap Up

With 32 drug plans on the market for 2021 there is a lot of hoopla but very little substance

Higher premium plans are often charging OUTRAGEOUS copay’s for generic drugs. Learn how to use GoodRx so you don’t overpay.

Medicare Advantage plans are heavily promoted almost everywhere. I am getting more calls than in the past from folks who are being swayed by all the “free” stuff.

Some caveats.

If it sounds too good to be true it probably is.

If you currently have a Medigap plan and drop it, then later decide you want to come back, you will most likely have to go through underwriting. Like the Hotel California, you may check out of an Advantage Plan but you may never leave.

Some of the 2021 plans now have higher OOP limits of $7500 for INPATIENT APPROVED medical claims. Combined in and out-of-network claims limit is $11,000.

You have a “guaranteed” right to transition to Medicare but you don’t usually have the same option getting on a Medigap plan.

Dental, vision and hearing plans are still a waste of money in my opinion. The same is true for cancer and hospital indemnity plans.

Cataract Surgery

I have been hoping to create a newsletter and video to address the costs and what to expect when having cataracts removed under Medicare. It has been over 2 months since Rachel’s surgery and very few of the bills have been processed.

The only thing I can tell you is the gross billed charges for both eyes is around $45,000. The surgeon’s portion is around $5,000 and the balance is the outpatient surgical center charge.

Things went smoothly. She is still adjusting to the changes. It might be another month before she is fully recovered and learning how her “new eyes” work.

Holidays

It goes without saying that the holidays everywhere will be different this year.

Fewer gatherings. Less food. More wine. More “face time” with family.

Stay safe. Make the best of the changes.

I will have a reduced schedule but will always be available for questions. Call or email.

Blessings!

Bob & Rachel Vineyard

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