09-27-2023 Primtime Living - Flipbook - Page 20
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A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 27, 2023
MEDICARE UPDATE
Updating
Medicare 2024
New legislation aims
to help lower costs
By Margit B. Weisgal, Contributing Writer
F
or my 65th birthday, my brother-in-law gave me the name of his independent insurance agent who specialized in Medicare Supplement insurance.
It was the perfect gift.
Ron Jacobson, LTCP, started selling insurance in 1982 and started specializing in senior
health care in 1986. He also works with the
Maryland Health Connection, the state insurance marketplace for the Patient Protection
and Affordable Care Act (Obamacare), and
keeps his hand in working with individuals,
families and small employer groups. Because
of all this, he has a great overview of what’s
going on with health care insurance.
When I started to write an article on any
changes in Medicare, Jacobson was my first
call. He was excited about the Birthday Rule,
passed in 2022 by the state legislature, but
it just took effect on July 1, 2023. This one
change in the rules for Medicare Supplement
(also known as Medigap insurance) has
already helped many of those on Medicare
save money and made our lives easier.
As terrific as that is (one friend’s Medigap
premium was cut in half!), there are also
changes to Medicare Part D, the prescription
drug plan. Jacobson helps his Medigap customers determine their best option for Part D
based on their medications list, location and
preferred pharmacy. Part D options change
every year – the base rates, the formularies
(a plan’s list of covered drugs and their tiers),
and any fees – so this can be daunting.
If you’re just turning 65, make sure you
enroll in a Part D plan as soon as you sign up
for Parts A and B (Original Medicare) or you
will have a penalty payment added to your
monthly fee for the rest of your life.
“A new prescription drug law that went
into effect January 1, 2023,” says Medicare,
“will help save money for people with Part D.”
Here’s what the law means for you.
Vaccinations:
People with Medicare Part D drug coverage now pay nothing out-of-pocket for even
more types of vaccines. Your Part D plan
won’t charge you a copayment or apply a
deductible for vaccines recommended on
the Advisory Committee on Immunization
Practices list, including the vaccines for shingles, whooping cough, and more.
Some vaccines are covered under
Medicare Part B; they include Flu (once per
season), Hepatitis B, pneumococcal shots,
COVID, and RSV (Respiratory Syncytial Virus).
Visit the Centers for Disease Control and
Prevention’s ACIP Vaccine Recommendations
and Guidelines for a complete list.
Insulin
Next, this new law caps the maximum
amount of money you will pay for each covered insulin at $35 per month. A three-month
supply will be $105. If you have an insulin
pump, covered under Part B’s durable medical equipment benefit, the cost of insulin will
be paid by your Medicare Supplement policy,
so it may be less than $35 a month.
Certain coinsurance out-of-pocket costs
will be lower for drugs and biologicals covered under Medicare Part B. These amounts
can change every quarter.
If your total costs of medications are high
enough to reach the catastrophic phase of
your Part D plan, there will be no coinsurance
or copayment in 2024.
There is an option for extra assistance
with medications costs called “Part D LowIncome Subsidy (LIS) program.” Called ‘Extra
Help,’ it will cover more drugs in 2024.
“’Extra Help’ is a Medicare program to help
people with limited income and resources pay
Medicare drug coverage (Part D) premiums,
deductibles, coinsurance, and other costs,”
according to Medicare.gov.
Future Negotiations
Medicare will start negotiating prices for
an initial 10 medications that will take effect
in 2026: Eliquis, Jardiance, Xarelto, Januvia,
Farxiga, Entresto, Enbrel, Imbruvica, Stelara,
and Fiasp, Fiasp FlexTouch; Fiasp PenFill,
NovoLog, NovoLog FlexPen, NovoLog
PenFill. More will be added each year, but
that takes time. And, let’s face it, this is for
two years down the road.
Meanwhile, given the high costs of so
many medications, don’t ignore options like
Good Rx and similar medication discount
cards – and there are a lot of them. Good
Rx is generally acknowledged to be the best
overall discount card, but there are many
others. Some focus on local pharmacies,
some on home delivery. A quick online search
will turn up cards like SingleCare, America’s
Pharmacy, Optum Perks and FamilyWize.
There are no restrictions to using them, even
with your Part D plan. When you choose your
local pharmacy for Part D medication fulfillment, check to see if it accepts any of the
discount cards.
Going Outside the U.S.
Many people wonder if it is OK to go “out
of network” for your medications to get better pricing, especially for drugs that have a
very high monthly cost, such as buying them