By: Scott Maibor, CFE
This week, here at Family Estate Planning Law Group we are excited to have Scott Maibor, of Senior Benefits Boston, guest blogging for us. We know many of our families have questions about Medicare coverage, and we think Scott has some great experience and expertise to share with you.
After 12 years in the Insurance Industry Scott founded Senior Benefits Boston to help clients with their Medicare health insurance needs. He enjoys simplifying an overly complex system with the goal of maximizing coverage and reducing costs.
In 2017 Scott decided to focus exclusively on Medicare and on helping clients approaching eligibility age. He is a Certified Financial Educator and Medicare (AHiP) Certified for 2021. As an independent Advisor he works with multiple carriers to enable him to serve as a fiduciary for his clients.
For everyone currently on Medicare the period from October 15th to December 7th is known as the Annual Enrollment Period. During this time, any Medicare recipient can change plans for any reason.
I cannot stress enough the importance of reviewing your coverage.
D Drug Plans and Part C Advantage plans should be reviewed. Plans and circumstances change throughout the year with you and your health (new providers, prescriptions, ailments), with the carrier (bought, sold, formulary changes, preferred pharmacy changes) and with the drug manufacturers (price changes, patent changes, etc.). All of which can affect the ultimate cost of your health care and impact which is the “best” plan for you.
Nobody wants to pay more than they should. My goal with a client is to always maximize their coverage while reducing their costs. The lowest premium is NOT always the least expensive plan. By the same token, the highest premium doesn’t necessarily save you money. It is a balancing act, based upon your unique circumstances.
The plan your spouse, brother-in-law or golf buddy has may be great for them, but terrible for you! Even the plan that was great for you this year may not be great next year.
As you weigh your options for 2021, here are some questions to consider:
- Any health changes this past year?
- Any expected/anticipated surgeries or major procedures this coming year?
- Have you added or changed any physicians this past year?
- Do you require the use of a brand name drug when a generic is available?
- Are any of your medications in caplet or capsule form (default is tablets)?
- Do you split or double up on any of your prescriptions (in some cases, it is less expensive to take two 17mg tablets than a single 34mg)?
- If you have any “as needed” or seldom used prescriptions how often do you fill them on a monthly or annual basis?
- Pay particular attention to inhalers and creams/salves/ointments as these are tricky to price.
- Do you use mail-order to fill prescriptions?
- Do you have a preferred pharmacy? Are you willing to change pharmacies for a lower copay?
So how best to review your coverage?
First, your Supplement, or Medigap, plan doesn’t change from year to year, there are no networks and no drug coverage, so you most likely do not need to do anything if you are satisfied. The exception would be if you have moved or would like to change to a higher or lower cost option.
For your Drug & Advantage plans, if you are hands on and want to do it yourself, you can go to www.medicare.gov and enter your zip code, prescriptions (pay attention to the dosages) and preferred pharmacy to look at the list of Drug plans available in your area. Be sure to sort the list by “total costs” so that it includes the premium, estimated copays and the deductible (if applicable) to give you the complete picture of your expected costs.
For those on pricey medications (tier 3, 4 or 5) you will most likely need to satisfy the deductible prior to the plan kicking in. This will give you a large out-of-pocket expense at the beginning of the year that will reduce once the deductible has been satisfied.
If your medications are expensive enough to force you into the “donut hole” ($4130 for 2021) you will see a spike in your out-of-pocket drug costs for those months you are in the hole. When (if) you reach the annual Out of Pocket (OOP) threshold ($6550 in 2021) you will be on “Catastrophic Coverage” and your costs will drop again.
Looking at the details on any plan will give you a month by month estimate of your anticipated costs and the months you will enter and leave the donut hole. This is done on a by pharmacy basis and is why the pharmacy you chose matters.
Advantage plans work the exact same way, just make sure that the plan you choose includes your doctors. The Medicare.gov tool does NOT consider provider networks. The least expensive plan may not work for you if your providers are not included and you are not willing to change physicians…and in my experience most people are not.
Keep in mind, that plans are county based. Leaving your home county or comparing your options to someone in a different county will not be an apples-to-apples comparison.
If you find a plan you like, you can enroll right online through the Medicare.gov tool. The prices are there on the website. The last one you enroll in prior to the December 7th deadline is the one you will have on January 1st.
If you need help, or are confused by all of this, we are happy to help. There is no charge to work with us. The prices will be the same either way!
Good luck! Don’t put it off—I had a client that waited until December 15th to talk to me and by then it was too late; she is still in the plan and will be for another 2 months!
You can learn more about Senior Benefits Boston and the ways they assist with Medicare coverage decisions at www.seniorbenefitsboston.org.