Medicare

Medicare Open Enrollment – comparing your options

Posted on by Michelle Fritsch, Pharm.D.
slide1
October 15 to December 7 is your window to select a Medicare plan. Let us help.

Medicare Open Enrollment for your 2017 plan is from October 15 to December 7, 2016.   Before you make a selection, here are some resources to help you compare your options.

Medicare provides a tool where you can compare options before you make a decision. You can find it at this link.

The information you need is:

  • Your Medicare number
  • If you have a Medigap or Medicare supplement plan, the name and type of the plan
  • Your zip code
  • A list of your medicines prescribed by each of your doctors
  • The name and location of your preferred pharmacy

You can search through options using your specific information or you can do a general search. I highly recommend you perform a search with your specific information at least once before you make final decisions. That will give you the best look at your anticipated likely costs.

The tool will walk you through step by step.

  1. It starts with your zip code and information from your Medicare card.
  2. Enter your current Medicare coverage type. Include whether you get extra help paying for your medication costs.
  3. Enter your prescribed medicines. Include the strength, whether you get your medicine every month or every 3 months, and whether you get your medicines from a local pharmacy or a mail order pharmacy.
    1. Be sure to include all of your medicines
    2. If your doctor has talked about maybe starting new medicine, include these, too. This will make sure the plan you choose will cover all of these medicines.
  4. Select your pharmacy. Note, if your pharmacy doesn’t show up at first, expand the number of miles from your home so that your pharmacy will be on the list.
  5. You can then choose whether you want to compare medication only Medicare D plans, Medicare Health Plans with drug coverage, and Medicare Health Plans without drug coverage.
    1. If you aren’t sure, select all three options
    2. If you know which you want to compare, select just that option
  6. A list of all options will appear on the next page. They appear in order of cost with the lowest annual cost option appearing first after Original Medicare. You have the option to select different sort options.
  7. Select three plans that you want to directly compare.
    1. The three options will be displayed side by side.
    2. You can compare three at a time as many times as you want.
    3. All costs for the year include deductibles, co-pays, gap payments, and other fees will be displayed.
    4. Look at your total annual cost
    5. Look at the deductible which is money you will pay at the first part of the year
    6. Look at the projected money you will pay in the coverage gap

To look at your options with Medigap plans, you can go to this link. This one will let you compare types of Medigap plans and their costs.

NOTE – A friend, and expert in the field, clarified that Medicare Advantage plans can be purchased at any time. Her comment: “Medicare Supplement policies do not have an annual open enrollment, but changes can be made based on your health after your original open enrollment or a special enrollment period.”

If you have any questions about how to use these tools or how to compare your options, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

For Medicare plan decisions, comparisons are good. They are key to making the best decision.

In the rest of your life, comparisons can be hazardous. How often do you compare yourself to someone else? You might not even realize you’re doing it.

Do you ever have negative thoughts about yourself when you see something you admire in someone else?

Do you ever feel extra good about yourself when you can do something that someone else can’t do?

In what sneaky ways can ENVY enter your thoughts?

I’ve read a couple of really good blogs about this from pastors recently. I know I’m guilty of comparison without ever intending for it to happen. I fall into a thought process of envy or comparison then catch myself and feel so ashamed.

Apparently I’m not alone. There are many Bible verses about the problems with envy.

Galatians 5:26 ESV

Let us not become conceited, provoking one another, envying one another.

1 Peter 2:1 ESV

So put away all malice and all deceit and hypocrisy and envy and all slander.

Instructions in the Bible can be very clear. It is clear ENVY is to be avoided. And if it’s mentioned this many times, it must be common.

Titus 3:3 ESV

For we ourselves were once foolish, disobedient, led astray, slaves to various passions and pleasures, passing our days in malice and envy, hated by others and hating one another.

James 3:16 ESV

For where jealousy and selfish ambition exist, there will be disorder and every vile practice.

The antidote to envy is to lay it all before the Lord. God has a very special, very specific plan just for you. Your gifts, your strengths, your weaknesses, your opportunities, your looks, your dreams are very UNIQUELY yours.

It doesn’t matter how other people are blessed. There are other blessings that are all for you!

Proverbs 16:9 ESV

The heart of man plans his way, but the Lord establishes his steps.

Proverbs 19:21 ESV

Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.

This could be the week to turn your eyes from what everyone else has. Instead, look at what God has in store just for you. Ask, He’d be happy to show you all the good things you have and what is still coming you way!!

Blessings,

Michelle

Advertisement

Medicare Open Enrollment – Which plan type for you?

Posted on by Michelle Fritsch, Pharm.D.
slide1
October 15 to December 7 is your window to select a Medicare plan. Let us help.

I find Medicare and Medicare Open Enrollment to be very confusing. Do you? Let’s spend the next two weeks trying to better understand your options and guide you through the Open Enrollment process. I highly encourage you to delay your final decisions until we walk through this process and you compare your options.

The first big decision is which TYPE of insurance coverage is best for you.

Main TYPES of insurance coverage options over age 65

Original Medicare – When you turn 65 and meet eligibility criteria (use this link), you can have Medicare Part A, Medicare Part B, and Medicare Part D. Medicare has a list of items they do and do not cover at this link. Medicare covers part of the expenses, and you pay the rest through your copay and deductible.

  • Part A covers hospital, long term care, home care, hospice, lab tests, and surgery.
  • Part B covers doctor visits, other healthcare provider visits, outpatient care, durable medical equipment, some prevention, and home health care.
  • Part D covers medicines.

Medigap – This is a supplemental insurance to go with your Medicare Part A and Medicare Part B. Medigap will cover some of the copayments, coinsurance, and deductible expenses not covered by original Medicare. You purchase a Medigap policy through a private insurance company. You will pay a monthly premium for this co-insurance.

Medicare SELECT – Medicare SELECT is a managed care version of Medigap. It is the health maintenance organization (HMO) of Medigap plans. These plans contract with specific provider groups for a lower fee. So, they are typically less expensive. Be sure your provider or a provider with whom you are comfortable is participating before you select this type of plan.

Medicare Advantage – This is also known as ‘Medicare Part C’. Medicare Advantage plans are private insurance plans that you can select IN PLACE OF Medicare. They have similar coverage to Original Medicare and can have additional benefits as well. These have a wide range of prices.

A Medicare Medical Savings Account Plan is a high deductible Medicare Advantage Plan with a bank account. The plan puts money from Medicare into the account, and you use that money to pay for Medicare-covered expenses. This limits your out-of-pocket expenses to meet your deductible.

NOTE: you cannot have both a Medigap and a Medicare Advantage plan. You can have one or the other.

Other – You might have insurance through your former employer, insurance through special programs, Tricare, Veteran’s benefits, Indian Health Service plans, or other unique plans.

Medicare resources to help you

The Medicare website has a list of eight questions to consider when you are thinking about changing plans. You can find them at this link.

Next week we will talk about the tool(s) available to you to help you compare your plan options. These will let you predict your costs over the next year. You can compare several aspects of the types of plans you want to consider. I encourage you to compare your options before making your final decision. I’ll walk you through it step by step.

For more information about your Medicare options, contact us at www.medsmash.com/contact. If we can’t answer, we have some colleagues who are experts in the field.

BIBLICAL APPLICATION

Medicare is not the only area of life where there can be a lot of confusing messages. I have teens.   I know just a few of their areas of confusing message are:

  • What to wear
  • How to act

Many of my recent pharmacy students are working their way through messages about:

  • What job to choose
  • How much of their income to spend on houses, cars, vacations
  • When to start a family; or whether to start a family

Many of my peers are sorting through messages about:

  • Helping children with college and career decisions
  • How much independence to allow teen children
  • Preparing for empty nest and soon retirement

My patients are working through message about:

  • Living at home vs. a senior living community
  • Options to move in with children when assistance is needed
  • Activities that enhance quality of life and keep them active

And we know there are countless people struggling with even more life-altering decisions surrounded my many confusing messages.

So, where does the truth reside?

John 14:6 NIV

Jesus answered, “I am the way and the truth and the life. No one comes to the Father except through me.

Psalm 145:18 ESV

The Lord is near to all who call on him, to all who call on him in truth.

Not to sound too pious, God is with you always. Whether you ‘feel’ His presence or not, He’s there…with you…always! When the messages from the many sources are confusing, you can just ask.

Matthew 7:7-8 ESV

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.  For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened.

When the messages are all confusing, ASK!

Blessings,

Michelle

When the Rules Don’t Quite Make Sense

Posted on by Michelle Fritsch, Pharm.D.
Airplane ors.od.nih.gov
Interpretation of rules has created an airplane that has launched with no plans to build the runway in healthcare.

To finish a thought from last week’s blog, sometimes the rules create their own problems. The Centers for Medicare and Medicaid (CMS) created a new risk-sharing payment strategy with hospitals. If someone has health insurance through Medicare, and if they are readmitted to the hospital for the same condition within 30 days, then the hospital will not be paid for the second admission. (Of course it’s a bit more complex than that, but this is the gist).

This ruling has created a whole new ‘market’. A group of very smart technology experts and entrepreneurs have identified this as a place to create new ways to keep people healthy at home. Tools and solutions are created that help people be successful at home after being in the hospital.

  • Patients benefits by having new resources to help them maneuver their care at home and stay at home.
  • The hospital benefits by losing less money on readmissions within 30 days.
  • The new companies, technology gurus, and entrepreneurs make money by being paid through the hospital’s cost savings.

Rules (and solutions) – make sense?

These are the parts that are missing, in my opinion.

  1. Once we determine how to keep people home safely for 30 days, I anticipate CMS will expand the time window to 60, 90, or more days. So short–sighted solutions will not survive.
  2. What happens after 30 days? Many of these new solutions involve technology. Who pays for the technology and the monitoring after the 30 days? Will it just be removed from the person’s home? Then what happens? Is that cost effective? Does it even make sense?
  3. What about people who are fearful of technology? Again, most of the solutions I’m hearing and reading about are based on technology. What if the person doesn’t have internet access or land-line phone access? What if the person has no interest in learning how to use the technology? What if the person just can’t get the hang of the technology?
  4. As I mentioned last week, I am finding very little data on what users/people with chronic medication conditions want. Solutions are being developed with little to no input about whether people will actually want or use the solutions.

For some of these issues the answers I’ve received are that there will always be exceptions. Those will be dealt with one by one. The goal is to find solutions for the majority.

It was funny, in one of these conversations we likened the current technology solutions boom to the airplane that’s in the air but no one has thought yet about the runway. That seems like a fitting analogy to me right now.

Hope

There is hope. I talked yesterday to a company taking a MUCH broader view of helping people stay healthy in their homes. They are not even thinking about the 30 day readmission rules. They are looking at long-term solutions that are created and maintained around the person that is using them. I know that company is not alone. I’ll put my hope in these types of companies!

For more information about new technologies in healthcare, please contact us at www.medsmash/contact.

BIBLICAL APPLICATION

Do you ever feel like the ‘rules’ of Christianity don’t make sense? Are you left wondering why the Christians around you are doing things a particular way? Have you been instructed to do something that doesn’t make sense?

In these instances, I encourage your FIRST question to be, ‘Is it Biblical’?

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

2 Peter 2:1 ESV

But false prophets also arose among the people, just as there will be false teachers among you, who will secretly bring in destructive heresies, even denying the Master who bought them, bringing upon themselves swift destruction.

I’m not saying every pastor or spiritual leader who says something that is not Biblical is a false prophet. People, even pastors, do make mistakes. But we have A LOT of examples of people adding rules to what is in the Bible. These ‘human’ rules are just that. Each denomination has their ‘way of doing things’. Even these are often the result of people trying their best to understand and interpret the scriptures. So see if the item that you question is from people or from God.

Your SECOND question should be, ‘Did I understand correctly’? Never hesitate to ask clarifying questions. We are all guilty of making assumptions about the other person’s knowledge when we answer a question. This often leads to complete misunderstanding.

Proverbs 18:13 MSG

Answering before listening

    is both stupid and rude. 

1 Timothy 6:20-21 MSG

And oh, my dear Timothy, guard the treasure you were given! Guard it with your life. Avoid the talk-show religion and the practiced confusion of the so-called experts. People caught up in a lot of talk can miss the whole point of faith.

I encourage your THIRD question to be, ‘Does it glorify God?’ By this I mean, does it promote the type of life and interaction we are called to live?

James 3:17-18 MSG

Real wisdom, God’s wisdom, begins with a holy life and is characterized by getting along with others. It is gentle and reasonable, overflowing with mercy and blessings, not hot one day and cold the next, not two-faced. You can develop a healthy, robust community that lives right with God and enjoy its results only if you do the hard work of getting along with each other, treating each other with dignity and honor.

The real ‘rules’ and instructions are in the Bible. The rest are interpretations, good/spot on and sometimes misguided. So discernment helps us sort them out. I know I have trouble sorting through it all on my own. Bible reading, study, trusted people to talk with, and prayer help me through.

Blessings,

Michelle

Image source: Office of Research Support; National Institutes of Health; U.S. Department of Health and Human Services.