By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
Medicare Annual Enrollment is October 15-December 7th for January 1st, 2025, effective. What can be changed at this time is Medicare Part D Drug Plans and Medicare Advantage Plans. Approximately mid-month of September you will receive a Notification of Change from your current insurance plan. This outlines the current to the new change, as an example if your primary care provider cost $10 now it might say $15 in 2025 (no correlation just an example).
Big changes to Medicare Part D, stand alone drug plans as well as Advantage Plans won’t have to pay more than $2,000 in out-of-pocket costs, which include deductibles, co-pays, coinsurance. It is very important to check your plans formulary as medication must be in formulary to be capped. There is a lot of speculation still as to the cost of the plans & copays, deductibles will be capped at $590.00. As a reminder the cost of the plan is not as important as the cost plus your medications, that’s what you look at, the total cost. It is important to know what the medication is used for to determine if it is covered by the plan. Example Wycovy may be covered but in order to be covered it must be used for a Heart conditions or Diabetes, Medicare does not cover weight loose medications at this time.
Medicare Part C / Advantage Plans annually Medicare Advantage Plans make changes. They must include all the same features as Original Medicare but not at the same cost share. They can have a premium, Medical and or Prescription deductible, copays and coinsurance can change. Extra Value such as Vision, Dental, Over the Counter, Part B Give Back, transportation, etc. can all change or be eliminated. Medicare set’s the annual in-network out of pocket maximum, in 2024 it is $8,850 and $13,300 for in-network and out-of-network services combined. However, individual insurance plans may set lower limits. These limits apply to Part A and B services only, and do not apply to Part D cost share.
The old saying if it’s not broken don’t fix it DOES NOT apply to Annual Enrollment. Every year I see many people that have not checked/compared their current plan to what’s new. I have saved so many people hundreds and in many cases thousands of dollars. You should be working with a broker that represents many insurance companies. Make sure you check them out, especially if you are going to allow someone in your house. I recommend meeting in their office. For myself we represent most carriers in our area and to carry all their literature with me is almost impossible. We use 3 large screens so that our clients can clearly see and compare the differences between the plans. The minimum information always needed is all your doctors, medications: names, milligrams and dosage. We load your current plan and then compare it to all the other companies in your area. What companies have all your doctors, the price for your medication normally makes a big difference. Then the Extra Value what is most important to you. We do NOT CHARGE for our review and if warranted to change your insurance plan. Ethics is most important and if you are on the best plan we will tell you, plus you can see for yourself.
We start now by sending our clients notification to send us their doctors and medications. On October 1st we can see the new 2025 plans and we review with clients; on October 15th we can start making the changes for January 1st effective.
As a reminder it is illegal for an insurance agent to contact you unless you give them permission. There are specific forms that you should sign, such as a Scope of Appointment which outlines what you want to talk about. This form should be signed at least 48 hours prior to your meeting or if you walk into their office, prior to speaking about Medicare.
Medicare Seminar’s they are good for general information. A one-to-one appointment where you can dive into your doctors and medication is best, plus you can then compare other companies in one place.
When you turn 65 you are eligible for Medicare, once you have worked 40 quarters roughly 10 years there is no cost for Medicare Part “A”. Part A covers Hospitals, Skilled Nursing, Home Health & Hospice. Medicare Part B you can choose to take at 65 or you can hold off if you are still working and have credible coverage. If you do not have group health insurance that is considered qualified, and then you want it you would have a late enrollment penalty for each month you did not have Part B & Part D and that penalty will last for the rest of your life. Part B covers doctors, imaging, blood work, ambulance, durable medical equipment, etc. Part D is a Medicare Drug Plan and covers medications. During your initial enrollment period it is especially important to understand your options! Medicare Supplements/Medigap Plans are NOT guaranteed issue, you may need to medically qualify. You can purchase a Medigap Plan during your 1st 6-month on Medicare Part B without medical underwriting. There are a lot of things you need to know. Again, work with an agent you can trust! Especially important: when you move you need to know your options. Can you keep the same plan? Do you need to make a change and what does that look like?
Logical Insurance Solutions is a SWFL Insurance Broker that works with most of the insurance carriers in your area, we are happy to help you through the maze. We offer Free Medicare Seminars, Personal Appointments & Virtual appointments.
Please e-mail info@logicalinsurance.com to register or call 239-362-0855 for dates. Medicare’s website is www.Medicare.gov.
239-362-0855
www.Logicalinsurance.com
info@Logicalinsurance.com