Seniorstar Insurance Group

Tag: Medicare Part D

  • Things to Consider When Changing Medicare Coverage

    Things to Consider When Changing Medicare Coverage

    Regardless of your coverage type, Medicare gives beneficiaries opportunities every year to change coverage to adjust to their ever-changing needs. The biggest time for changing Medicare coverage is the Annual Enrollment Period or AEP. Every year, from October 15th to December 7th, you can switch up your Medicare coverage and join, change, or drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan. When you start thinking about wanting to change your coverage, there are a few things to consider.

    Costs of Medicare Coverage

    When changing your Medicare coverage, one of your main concerns may be “Will my costs change with my new Medicare plan?” Make sure to compare what you currently pay in premiums and deductibles, how much an unexpected hospital stay might be, or what you will pay out of pocket to what you are estimated to pay with any coverage you consider switching to.

    Original Medicare has no out-of-pocket limits unless you have a Medicare Supplement. However, most Medicare Advantage (Part C) plans provide a yearly limit for out-of-pocket costs. 

    If you have an illness or medical problem that requires you to take a lot of prescription medication, it’s important to understand the costs of the prescriptions you take associated with your Medicare Part D Prescription Drug Plan.  You will want to evaluate and compare formularies and Medicare Part D Prescription Drug Plan costs when choosing a new plan.

     Other Coverage

    It’s important to also look at how enrolling in or changing your Medicare coverage is how it may interact with any other coverage you may have, such as retiree insurance or employer-sponsored coverage.

    Prescription Drug Coverage

    For prescription drug coverage, it’s important to evaluate the plan’s star rating, formulary, and coverage rules. Make sure you compare it against your current Medicare Part D Prescription Drug Plan and ensure the medications you need are covered at a cost you can afford.

    Hospital Choice, Doctors, and Travel

    If you choose a Medicare Advantage plan, the network of doctors and hospitals that accept your plan is a very important thing to consider. This can affect the quality and timing of the care you receive. It’s also important to look at if doctors in a new plan are accepting new patients (if

    If you are enrolled in a Medicare Supplement alongside Orignal Medicare, you can see any provider that accepts Medicare.  Care received when traveling outside the United States is not covered by Original Medicare. If you travel abroad, you may want to consider a Medicare Supplement that covers emergency care when abroad. You also may want to consider a Medicare Supplement if you travel in the US, as you can see all providers who take Medicare and are not restricted to a network.

    Whether you are looking to change your Medicare plan to find coverage that will best fit your needs, or you are looking to review your current plan, Seniorstar group can help. Contact us today for a free, no-obligation coverage review.

  • What is the Medicare Donut Hole?

    What is the Medicare Donut Hole?

    What is the Medicare Part D Donut Hole?

    The term “donut hole” often refers to the coverage gap within Medicare Part D Prescription Drug plans. If you’re new to Medicare, you might not be familiar with this term.

    The donut hole, in short, refers to where a Medicare Part D Prescription Drug Plan reaches its limit on what it covers for prescription drugs. In a calendar year, you reach this coverage gap once your Medicare Part D plan has spent a certain amount on prescription drugs. In 2023, this amount will be $4,660.

    Not everyone enters the donut hole, and beneficiaries with Extra Help will never enter the donut hole.

    What will happen if I reach the “donut hole?”

    Once you have reached the “donut hole” coverage gap, your out-of-pocket costs for brand name and generic drugs covered in your Medicare Part D Prescription Drug plan will change. Details of those changes are listed below:

    • For Generic Prescription Drugs
      • You will pay 25% of the price; Medicare will pay 75%
      • Only the costs you pay count to get you out of the “donut hole.”
    • For Brand-Name Prescription Drugs
      • You will pay at most 25% of the cost of the drug and 25% of the dispensing fee.
      • If you buy your prescriptions via pharmacy or mail, you will pay a discounted price
      • Both what you pay and what the drug manufacturer pays (95%) count towards getting you out of the donut hole.

    Note: Depending on your plan, you may have coverage in the “donut hole.” If so, you will get a discount once your coverage has been applied to the prescription drug’s price.

    Will the “donut hole” go away?

    Medicare Part D Prescription Drug plans have fourth payment stages, and the “donut hole” is the third. You move through the four stages based on how much you, your plan, and anyone on your behalf have paid for your prescription drugs throughout the year.

    How do I leave the “donut hole?”

    Your out-of-pocket costs must reach $6,550 to leave the “donut hole.” After the “donut hole,” you enter the fourth stage – catastrophic coverage. In this stage, your Medicare Part D Prescription Drug plan covers the majority of the cost of your drugs. You will remain in this stage for the rest of the year.

    Costs that count towards the dollar limits include:

    • Copays and coinsurance
    • Your deductible
    • What your plan pays during the initial coverage stage
    • Manufacturers’ discounts provided in the coverage gap stage
    • Amounts paid on your behalf, such as those through a financial assistance program – at any stage

    Coverage Gap Tips

    It is best to avoid entering the “donut hole” if possible. However, for those who do, navigating it wisely can help a beneficiary get the most from a Medicare Part D Prescription Drug plan. Here are some tips to help you mitigate prescription drug costs, even if you never enter the “donut hole.”

    Tip 1: Estimate your annual prescription drug costs ahead of time. This can help you plan and prepare to pay for your prescription drugs if you are likely to enter the “donut hole.”

    Tip 2: Discuss lower-cost drug alternatives with your providers and pharmacists.

    Tip 3: Look for options where you may be able to get your prescription drugs for discounted costs.

    Tip 4: When possible, opt for generic drugs instead of brand-name.

    Tip 5: Make sure you are using an in-network pharmacy.

    Understanding the coverage stages of Medicare Part D Prescription Drug plans can make everything seem less overwhelming. If you have questions or want a no-cost, no-obligation coverage review, reach out to Seniorstar Insurance Group today!

  • The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    Commonly referred to as AEP, the Medicare Annual Election Period (AEP) is the time each year when you can change your Medicare coverage if you choose. The Medicare Annual Election Period (AEP) lasts from October 15 to December 7 every year, with plan changes going into effect on January 1 of the new year.

    Changes You Can Make to Your Coverage During AEP

    Depending on your coverage, you can make various changes during the Medicare Annual Election Period (AEP). Here are some tips based on the coverage you are currently enrolled in:

    I am Enrolled in…

    Original Medicare Parts A & B

    If you are currently enrolled in just Original Medicare Parts A & B, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage. Note: You may be charged a penalty if you do not have other creditable drug coverage
    • Join a stand-alone Medicare Part D Prescription Drug Plan. Note: You may also be charged a penalty if you are not currently enrolled in creditable drug coverage.

    You also have the option to make no changes; your coverage will remain as-is.

    Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan

    Suppose you are enrolled in Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan. In that case, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.

    You also have the option to make no changes; your coverage will remain as-is.

    Medicare Advantage (Part C) with a Stand-Alone Medicare Part D Prescription Drug Plan

    If you are enrolled in a Medicare Advantage (Part C) plan with a stand-alone Medicare Part D Prescription Drug Plan, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your current Medicare Advantage (Part C) plan and return to Original Medicare.

    You also can make no changes, and your coverage will remain as-is.

    Medicare Advantage (Part C) with Built-in Drug Coverage

    If you are enrolled in a Medicare Advantage (Part C) plan with built-in drug coverage, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a stand-alone Medicare Part D Prescription Drug Plan if you enroll in a Medicare Advantage (Part C) plan that does not include drug coverage or if you go back to Original Medicare Parts A & B.
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your Medicare Advantage (Part C) plan and return to Original Medicare.

    You also have the option to make no changes; your coverage will remain as-is.

    Review Your Coverage with a Licensed Agent

    The Medicare Annual Election Period (AEP) is a great time to review your current coverage and ensure that you are enrolled in the Medicare coverage that meets your needs – medically and financially. At Seniorstar, we offer no-cost, no-obligation coverage reviews. We will help you evaluate your Medicare options, including Original Medicare Parts A & B, Medicare Advantage (Part C), Medicare Part D Prescription Drug Plans, and Medicare Supplements (Medigap).

    Click here to schedule an appointment, or call 732 658 5100