New Generic Drugs on the Horizon

Cutting Drug Costs Down to Size

Do you think you’re spending too much on your prescription medications?  You’re probably
right!  But the good news is that there are a number of commonly prescribed brand name drugs scheduled to lose their patents this year. This opens the way for new, lower cost generic
versions of these medications to become available.

Among the medications scheduled for generic release this year are:

Actonel (Osteoporosis) June, 2014

Copaxone (Multiple Sclerosis) May 2014

Detrol LA (Urinary Incontinence) March, 2014

Evista (Osteoporosis) March, 2014

Lunesta (Sleep Disorders) May 2014

Lovanza (Hihg Cholesterol) 2014

Nasonex (Nasal Allergies) 2014

Nexium (Ulcers) May 2014

Restasis (Dry Eyes) May 2014

The dates for generic drugs becoming available are subject to change. 

You can find out whether a drug is available as a generic version by visiting the commercial website www.GoodRx.com and searching for the drug by name and ask your doctor for more information.

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 the 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.

Get the Facts on Medicare

If you're turning 65 soon or going on Medicare for the first time, please join me for my seminar, Getting Started with Medicare. You'll be armed with the facts when the time comes for you to sign up for this important health care benefits. In class, we'll cover all the basics, including the difference between Original Medicare, Medicare Supplements and Medicare Advantage Plans. I'll also talk about Prescription Drug Plans and what you should consider when selecting a plan. Plus much more. 

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

Wednesday, May 7, 2014
Morley Library
6:30 pm – 8:00 pm
Meeting Room B
184 Phelps St., Painesville, OH 44077 
440-255-5700

Monday, May 19, 2014
Willoughby Hills Library
6:00 pm – 7:30 pm
354 Chardon Rd., Willoughby Hills, OH 44094
440-942-3362

Tuesday, May 20, 2014
Concord Community Center
6:30 pm – 8:00 pm
7671 Auburn Rd., Concord, OH 44077
440-639-4650

Wednesday, May 21, 2014
Polaris Career – Strongsville High School
6:30 pm – 8:00 pm
20025 Lunn Rd., Strongsville, OH 44149
440-891-7600

Thursday, May 22, 2014
Andover Library
2:00 pm – 3:30 pm
142 W. Main St., Andover, OH 44003
440-293-6792

For more dates and times of classes, please visit my website at www.mutskoinsurance.com

Medicare. Medicaid. Do you know the difference?

Their names sound similar. They’re both government-run health care programs. But, there are a number of important differences between Medicare and Medicaid that you should be aware of.

What is it?

Medicare is a federal health insurance program generally for U.S. citizens and legal residents who are 65 or older or under 65 with certain disabilities, end-stage renal disease, ALS or complications from chemical exposure from a war. Most people become eligible for Medicare because they have contributed to the Medicare trust fund while working. The trust fund covers the cost of Medicare expenses.

Medicaid is a jointly funded state and federal program that helps pay health care costs for people with limited income and resources. Medical bills are paid from a federal, state and local tax fund. The federal government also pays the states for a percentage of their program expenses.

Who runs it?

Medicare is a federal program run by the Center for Medicare and Medicaid Services. The rules for Medicare are basically the same throughout the United States.

Medicaid is run by individual state and local governments who operate within federal guidelines. Unlike Medicare, the administration and rules for Medicaid vary from state to state.

What does it cover?

Medicare coverage includes care and services in a hospital or skilled nursing facility (part A), doctor visits, care and services received as an outpatient and some preventive care (part B), prescription drug coverage (Part D).  Medicare Advantage Plans combine Part A and B coverage and often include Part D coverage in one plan.

Medicaid programs are created by the individual states and may offer some benefits not normally covered by Medicare, including nursing home care and personal care services. Mandatory benefits include care and service received in a hospital or skilled nursing facility; care and service received in a federally qualified health center, rural health center or a free-standing state recognized birth clinic; doctor, nurse, midwife and certified pediatric and family nurse practitioner services. Prescriptions and other services may also be covered.

Some people qualify for both Medicare and Medicaid and the two programs can work together to cover most of their health care costs.

To learn more or find out if you qualify for Medicaid, please visit Ohio’s Medicaid website at http://www.medicaid.ohio.gov/.  For Medicare information, please visit http://www.Medicare.gov.

Why You Shouldn't Count on Your Boss for Medicare Advice

When people get ready to retire, many need to switch from their employer sponsored health insurance plan to Medicare. They naturally turn to their human resources department for answers to their questions. But, looking to your boss or human resources department for Medicare answers may not be your best bet.

Consumer experts are warning that employers don’t always have the most current or correct Medicare enrollment information. The transition to Medicare often presents complex situations and any mistakes you make can result in costly premium penalties and coverage gaps for YOU.

Your employer or human resource staff may be experts on their own benefits packages but, Medicare is not one of their benefits. Misinformation from employers is one of the most frequent sources of problems that prompt people to call Medicare helplines.

Companies may have a retiree transitioning to Medicare once a month or less. Unlike insurance professionals and Medicare experts, employers and human resource professionals are not working with Medicare related issues on a daily basis.

One way to get the most up-to-date Medicare information is to attend Getting Started with Medicare, a class where I cover all the basics on Medicare. After class, I am available to answer your questions. Getting Started with Medicare is presented at local colleges, libraries and community centers and is for informational purposes only. No plan specific information or product sales are discussed during the classes. You can find a complete list of class dates and times on my website at http://www.mutskoinsurance.com/seminars.

If you prefer, I will be happy to review your Medicare options with you. Call me at 440-255-5700 or toll free at 1-888-951-6201. You are also welcome to email me at lmutsko@mutskoinsurance.com to set up an appointment.

A visit to your human resources department isn’t a bad place to start. But, be sure to allow yourself enough time to double check all the information you receive. It will save you time and frustration to do so.

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.

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.