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Corona Virus and Medicare

Covid19, otherwise known as Corona Virus, has hit, and unless you are over 200 years old (and still have a great memory…) you’ve never seen anything affect the world quite like this. It’s affecting every corner of the world, and unfortunately, folks over the age of 65 are at the most risk.

That said, as most folks are doing, the best thing you (or any of us) can do, is to stay put. Stay at home. As much as possible.

The term “telehealth or telemedicine” are terms that a lot of people are inquiring about. Basically, it’s the ability to utilize current technology to video conference with a health provider with a computer, tablet or smartphone. If you have a Medicare Advantage plan, you probably already have this, or some form of this, built into your plan, and it’s probably free. Some plans offer video consultations with a doctor, some have 800 number hotlines to speak with a registered nurse, and some plans offer both! In most plans, these options require no co-pay. For my clients, you can always call me to inquire about these features, but even easier, (and this is true for anyone, client or not) you can call the customer care number on the back of your card for specific details. It’s a GREAT feature! Use it!

Most of all, be safe. Be kind. Help someone if you can. And call me if you need help!

-Will Isaac

Be Very Careful During the Open Enrollment Period!

Just a quick word of warning for all my friends and clients on Medicare. We are currently in a period that Medicare refers to as the Open Enrollment Period. This period started January 1st and ends March 31st. It allows anyone with a Medicare Advantage plan to make a one time change, either to a different Medicare Advantage plan, or go back to original medicare. The reason I bring all this up is that I’ve gotten questions and comments about the commercials that Joe Namath is running about how great this company is that got him his Medicare benefits and how everything is free!! His commercials are not the only ones either.

PLEASE BE WARY! Before you make a change to your coverage, do yourself a favor and consult with an actual insurance professional, preferably and independent broker who ISN’T tied to any one insurance company. These companies WILL put you in a different plan, but likely not the plan that fits you best. You may quickly find that some of your prescriptions may not be covered, and some or all of your doctors may not take the plan they’ve put you on. At that point, it’s too late to do anything and you’d be stuck with your new plan until the next Annual Enrollment period.

Again, it doesn’t have to be me, but before you call an 800 number and make a potentially disastrous plan change, contact an independent insurance broker! Find someone who will look out for YOUR best interests, not the company THEY work for!

Summary of Recent and Proposed Changes to Medicare Prescription Drug Coverage and Reimbursement

The following article is from the Kaiser Family Foundation page. You can see the original article HERE.

Juliette Cubanski Follow @jcubanski on Twitter
Published: Feb 15, 2018

A look at recent and proposed changes to #Medicare prescription drug coverage & reimbursement in the #TrumpBudget and the Bipartisan Budget Act .

Summary of Changes in the BBA of 2018

Part D coverage gap and manufacturer discount: Closes the Part D coverage gap in 2019 instead of 2020 by accelerating a reduction in beneficiary coinsurance from 30 percent to 25 percent in 2019; also increases the discount provided by manufacturers of brand-name drugs in the coverage gap from 50 percent to 70 percent, beginning in 2019. In 2019 and later years, Part D plans will cover the remaining 5 percent of costs in the coverage gap, which is a reduction in their share of costs (down from 25 percent). The manufacturer discount will continue to count towards a beneficiary’s “true out-of-pocket spending” (TrOOP), the spending amount that triggers the start of catastrophic coverage. Estimated budget impact: not estimated separately by CBO; included in biosimilars provision below
Biosimilars: Beginning in 2019, biosimilars will be treated the same as other brand-name drugs in the Part D coverage gap, with manufacturer discounts of 70 percent; previously biosimilars were not included in the coverage gap discount program. Estimated budget impact: -$10.05 billion
Income-related Medicare premiums: Increases Medicare Part B and Part D premiums for beneficiaries with incomes of $500,000 (for individuals) and $750,000 (for married couples) or more, to 85 percent of program costs, up from 80 percent, beginning in 2019. Estimated budget impact: -$1.63 billion

Summary of Proposed Changes in the President’s FY2019 Budget

Part D

Share rebates with Part D enrollees: Would require Part D plans to pass on at least one-third of total rebates and price concessions to enrollees at the point of sale. The Administration solicited comments on potential policy approaches related to this idea in a November 2017 proposed rule for the Medicare Advantage and Part D programs. Estimated budget impact: +$42.16 billion
Add an out-of-pocket limit to Part D and change reinsurance: Would establish an out-of-pocket limit in the Part D benefit by phasing down beneficiary coinsurance in the catastrophic coverage phase of the benefit from the current 5 percent level to 0 percent (no cost sharing) over four years, beginning in 2019.² Also would increase plans’ share of costs in the catastrophic coverage phase of the benefit from 15 percent to 80 percent, and decrease Medicare’s reinsurance from 80 percent to 20 percent. The Medicare Payment Advisory Commission (MedPAC) recommended similar changes to Part D reinsurance in 2016. Estimated budget impact: +$7.36 billion
Change TrOOP calculation: Would exclude manufacturer discounts from the calculation of beneficiaries’ “true out-of-pocket spending.” MedPAC also recommended this change, in combination with the proposed changes to catastrophic coverage above. Estimated budget impact: -$47.02 billion
Change Part D formulary standards: Would loosen Part D plan formulary standards by requiring plans to cover a minimum of one drug per drug category or class, down from the current two-drug requirement. Would expand plans’ ability to use utilization management tools for specialty drugs and drugs in the six protected classes (anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection). Estimated budget impact: -$5.52 billion
Eliminate cost sharing for generics for low-income enrollees: Would eliminate cost sharing on generic drugs for Part D enrollees receiving the low-income subsidy (LIS), including biosimilars and preferred multisource drugs, beginning in 2019. MedPAC recommended a similar change in 2016. Estimated budget impact: -$0.21 billion
Retroactive Part D coverage for low-income enrollees: Would permanently authorize CMS to contract with a single Part D plan to provide Part D coverage to low-income beneficiaries while their LIS eligibility is processed, beginning in 2020; this is currently a demonstration program scheduled to run through 2019. Estimated budget impact: -$0.30 billion

Part B Drug Reimbursement

Average sales price data reporting: Would require manufacturers of Part B drugs to report average sales price (ASP) data and would authorize the Secretary of Health and Human Services (HHS) to apply civil monetary penalties if manufacturers do not meet reporting requirements, beginning in 2019. Estimated budget impact: no budget impact
Establish a limit on Part B reimbursement growth rate: Would establish an inflation limit for reimbursement of Part B drugs paid based on ASP, with the growth in the ASP portion of Medicare’s reimbursement to physicians for these drugs (currently ASP plus 6 percent) limited to growth in the Consumer Price Index for all Urban Consumers (CPI-U), beginning in 2019. Currently there is no limit on updates to the ASP plus 6 percent reimbursement if the ASP increases. Under the budget proposal, reimbursement to physicians for Part B drugs paid based on ASP would be the lesser of actual ASP plus 6 percent or the inflation-adjusted ASP plus 6 percent. Estimated budget impact: not available
Coverage of certain Part B drugs under Part D: Would authorize the HHS Secretary to consolidate coverage of certain drugs under Part D that are currently covered under Part B, beginning in 2019, subject to a determination that there are savings to be gained from the consolidation (shifting from the ASP plus 6 percent reimbursement under Part B to negotiated pricing under Part D). Estimated budget impact: not available
Reduce wholesale-acquisition-cost based reimbursement rate: Would reduce wholesale acquisition cost (WAC) based payments for new Part B drugs where ASP data are not available, from 106 percent to 103 percent of WAC, beginning in 2019. Estimated budget impact: not available
Redistribution of savings from 340B payment reductions: Would make changes to the 340B discount program, building on recent changes to Medicare’s payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program, which is decreasing from ASP plus 6 percent to ASP minus 22.5 percent, beginning in 2018. Under the budget proposal, savings generated by this reimbursement change for 340B drugs would be redistributed to certain hospitals that provide a minimum level of charity care or would be returned to the Medicare trust funds, beginning in 2019. Hospitals would be eligible for an allocation of the savings from the 340B drug payment reduction if the value of uncompensated care they provide equals at least one percent of their total patient care costs. Estimated budget impact: not available

Endnotes

The Administration’s budget did not specify whether the budget estimates took into account changes in the BBA of 2018 that would affect the costs or savings associated with proposals in the FY2019 budget.
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In 2015, 1 million Part D enrollees who did not receive low-income subsidies had spending in the catastrophic coverage phase of the Part D benefit. While those who reach the catastrophic coverage phase of the benefit would see savings from the elimination of coinsurance above the catastrophic threshold, the Administration’s proposed changes to the TrOOP calculation (described above) would likely mean that fewer enrollees would reach the catastrophic coverage phase in future years since they would be required to spend more out of pocket to pass through the coverage gap and enter the catastrophic phase of the benefit.

10 advantages of term life insurance

I can’t take credit for this article. This was originally posted at Lifehealthpro.com. You can see the original article HERE.

Term life insurance is among the devices that people should consider when they want to provide an immediate estate for loved onces after their death.

Although term insurance is not always the most effective type of life insurance for all of a client’s death benefit needs, it can be useful in many circumstances.

Since term insurance is not just one product, but rather many variations on a general theme, different types of term insurance are indicated for different client needs.

Keep in mind, term insurance, more than any other type of insurance, is pure death protection with little or no ancillary or lifetime benefits. Therefore, the two overriding considerations in the use of term insurance, regardless of the specific application, are:

1. Will death protection alone meet the need?
2. Will the coverage last as long as the need?

In short, with term life insurance — as with any other decision about appropriate coverage — the product must match the problem.

Although some agents and advisors believe that whole life insurance is always a superior product, term life insurance does have an important roll to play in a client’s financial plans. Keep reading 10 reasons why a client may want to consider a term life insurance policy, from the 6th Edition of “The Tools & Techniques of Life Insurance Planning” (2015, The National Underwriter Company).