Wednesday, April 23, 2014

Info You Need to Know: How Rx Drug Tiers Work

Most people understand that prescription drugs are covered by Medicare Part D and many Medicare Advantage Plans. What’s not quite as clear is the Drug Tier System and how it works. I’m often asked, “How does my insurance plan come up with what I have to pay for my prescriptions, and is there a way to cut my costs?”

Let’s first take a look at prescription drug plans. All prescription drug plans (PDPs) have a list of drugs that are covered by their plan. This list is called the ‘formulary.’ By law, formularies must include both brand name and generic drugs. They also must include choices within commonly prescribed drug categories and classes.

Each plan’s formulary can be different from what is offered by other plans. In addition, formularies can change from year to year and even month to month. This is why it is so important to make sure that the specific drug you are taking, (not just the type of drug) is listed in your plan’s formulary.

Most prescription drug plans divide the drugs they cover into groups called ‘tiers.’ The tier each drug goes into is based on what the plan pays to the pharmaceutical company that makes the drug. If a plan negotiates a lower price on a particular drug, it can pass these savings onto its members so you may pay less for your prescription drugs on one plan over another.

Formularies often change when generic versions of older drugs become available. New prices may be negotiated. Changes like these may lead a plan add or remove a particular drug or move it into a different tier.

You can save money by becoming familiar with your plan’s drug tiers. You can find your plan formulary on your plan website or call your plan to ask. If you’re prescribed a new drug, look for it on the formulary and identify the tier it is in. If the drug is in a higher tier, your doctor may be able to substitute a similar but less expensive drug on a lower tier. You also have the option of filing an exception and asking your plan to allow you to pay a lower cost for the higher tier drug.

For more information, call me a 440-255-5700.




Monday, March 31, 2014

Now what?

I bet you have a hundred good reasons for missing the deadline to sign up for health insurance. But, regardless of why you didn't sign up, if you are without health insurance after today (March 31, 2014), there are some things you'll need to know . . .

First, you've missed your chance to purchase an Affordable Care Plan until the next open enrollment period begins on November 15.

Second, you may be subject to some fines.

Are there any exceptions?
in order to get Affordable Care coverage or make a change in your existing coverage outside the open enrollment period, you must have a qualifying life event. Qualifying life events include:

·         Getting married

·         Having, adopting, or placement of a child

·         Permanently moving to a new area that offers different health plan options.

·         For people already enrolled in Affordable Care coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.

·         Losing other health coverage due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified. Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.

Most special enrollment periods last 60 days from the date of the qualifying life event.

Enrollment for small businesses
Employers generally can start offering health insurance coverage to their employees at any time during the year.

Medicaid and CHIP: Enroll any time
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time You can find out if you qualify for Medicaid or CHIP by filling out an Affordable Care application or going directly to your state Medicaid agency.

If you have a qualifying life event or are shopping for coverage for your small business, call me at 440-255-5700 to discuss your options. Let me help you choose the coverage that’s right for you.

Monday, March 24, 2014

Open Enrollment for Affordable Care Ends March 31

Why sign up for Affordable Care now? 
  
Reason 1:  Affordable Care Plans will not be offered after the deadline.

If you miss the open enrollment deadline of 3/31/14, you will have to wait until the next open enrollment period. After the deadline, you can purchase a new health plan only if you have a qualifying life event like a job loss, birth, marriage or divorce.
Reason 2:  The new Affordable Care Plans provide valuable, preventive care.
Staying healthy will be easier than ever before because preventive care will now be covered. Preventive services include diabetes and cholesterol screenings, mammograms and immunizations. You’ll also be covered for flu shots, smoking cessation programs, diet counseling and much more.
Under the Affordable Care Act, children under age 19 can get their teeth cleaned twice a year, as well as receive X-rays, fillings and medically necessary orthodontia. In addition, children under age 19 will be entitled to an eye exam and one pair of glasses or set of contact lenses a year.

Reason 3: You no longer have to guess whether you’re covered for many important services
You can rest easier knowing you are protected against financial setbacks from unexpected health care emergencies. The Affordable Care Act requires all health insurance plans to include the following ten essential health benefits:
      Emergency services
      Hospitalization
      Laboratory tests
      Maternity and newborn care
      Mental health and substance-abuse treatment
      Outpatient care
      Pediatric services including dental and vision care
      Prescription drugs
      Preventive services and management of chronic diseases
      Rehabilitation services
Reason 4:  You risk having to pay a penalty if you miss the deadline.
For the 2014 tax year, the penalty will be $95 per person or 1 percent of a household’s taxable income, whichever is greater, with the amount decreased by one-half for dependents under the age of 18. Those who choose to pay the penalty will receive nothing for it and will still be responsible for the full bill for any of their routine or emergency medical expenses.
Open Enrollment for the Affordable Care Act ends March 31st so time is running out for you to sign up. Call me at 440-255-5700 to discuss your options. Let me help you choose the coverage that makes the most sense for you, your family and your budget. 

Friday, March 21, 2014

Home Visits Becoming the Norm

Don't be surprised if a representative of your Medicare Advantage Plan calls and asks if they can visit you. Home visits are becoming increasingly common and are helping to cut down on hospital readmissions and improve care coordination.

We are often seeing these visits in cases of people who have complex care management needs or who have just returned home from the hospital. If you are selected for a visit, you will be seen by a Registered Nurse or a Nurse Practitioner. Their goal is to make sure you understand and are receiving the care and medications you need.

The home visit will only take place with your consent. In addition, a doctor's order will be needed before a visit can be arranged. Both you and your doctor will receive a copy of all information gathered during the home visit.

Home visits are for your benefit. They are one more assurance that the plan for your recovery is complete.

Tuesday, February 11, 2014

Turning 65 this year? There are some things you need to know.

If you're turning 65 or going on Medicare for the first time this year, there are some things you need to know before you sign up. Please join me for Getting Started with Medicare, an informational seminar that covers all the basics. We'll  answer all your questions so you'll be ready when the time comes to go on Medicare. 

Preregistration is required. Please register by calling the phone number listed for the class you wish to attend. These events are only for educational purposes and no plan specific benefits or details will be shared. Some venues charge a nominal fee.

Wednesday, February 19, 2014

Willoughby Senior Center

1:00 pm – 2:30 pm

38032 Brown Avenue, Willoughby, OH 44094

440-951-2832


Wednesday, February 26, 2014

Chagrin Falls Community Education

7:00 pm –  8:30 pm

342 E. Washington St, Chagrin Falls, OH 44022

440-247-5375


Tuesday, March 4, 2014

Lakeland Community College

6:30 pm – 8:30 pm

7700 Clock Tower Drive, Kirtland, OH 44094

440-525-7116

Please visit my website at www.mutskoinsurance.com 
for additional class dates and times.

Monday, February 3, 2014

If you have health insurance, you're covered for these 10 essential services

      You no longer have to guess whether you’re covered for many important services. 

The Affordable Care Act requires that all health insurance plans cover the following ten essential health benefits:
     Emergency services
     Hospitalization
     Laboratory tests
     Maternity and newborn care
     Mental health and substance-abuse treatment
   Outpatient care
   Pediatric services including dental and vision care
   Prescription drugs
   Preventive services and management of chronic disease
   Rehabilitation services

Wednesday, January 29, 2014

Affordable Care Fact: What will happen if I don't get insurance?

The deadline to sign up for a healthcare is March 31. Anyone who has not signed up for health coverage by then will be charged a penalty. The penalty in 2014 will be calculated one of two ways . . . either 1 percent of the annual household income or $95 per person for the year, whichever is higher. If there is a child in the home under the age of 18 the penalty will be $47.50 for that child.
The penalties increase next year to 2 percent of the yearly household income or $325 per person. The penalty for children will be $162.50.
Choosing to pay the penalty may not save you as much as you think. Many consumers are  eligible for insurance plans at surprisingly low rates. Those who choose to pay the penalty will receive nothing for it, and will still be responsible for the full bill for any of their routine or emergency medical expenses. A one-time trip to the emergency room can run into thousands of dollars making insurance the smarter choice.
Open Enrollment for the Affordable Care Act ends March 31st so time is running out for you to get signed up. To learn more, call me at Mutsko Insurance Services, LLC at 440-255-5700 to discuss your options. Let me help you choose the coverage that makes the most sense for you, your family and your budget.