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October 16, 2024 • 25 mins
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Episode Transcript

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Speaker 1 (00:01):
Hi, this is Mark Manual, program director for WOC Radio.
Dick Shillig has been a part of the WOC family
for fifteen years, hosting Safe Money in this timeslot since
two thousand and seven. It is with a heavy heart
that we announced Dick Shilig passed away late last week.
It's in his honor that we run his final show
now on WOC.

Speaker 2 (00:22):
Good Saturday Morning. Do all. We are beginning our fourth
quarter of twenty twenty five. Believe it or not. One thing.
One reminder is that we still have our thirty five
percent bonus that we are paying on premium to invest
in an annuity on a deferred annuity, either qualified or

(00:48):
non qualified, and the minimum amount is five thousand dollars
to invest the maximum amount is one million dollars, So
that thirty five percent bonus is still good for qualified
or non qualified money. Boy, take advantage of that. I
encourage you to take advantage of that. Lots of stuff
going on during this first quarter. One of the most

(01:12):
important happenings is that all Medicare people should have received
or will be receiving. There are twenty twenty five Medicare
and new handbook. Now the Medicare and New Handbook is
your official guide to Medicare. CMS mails and updated printed

(01:33):
handbook to all Medicare households in September now. You can
also download a copy anytime or access it electronically for
the most updated information available. The handbook is available in
many different formats and languages, including large print, Braille and more.

(01:54):
But the twenty four excuse me, the twenty twenty five
medical Care a new handbook, and now it says it
will not be available until after October first. It says
that they mailed them in September, but they won't be
available to October first. So that's that's the government for you.
But you'll get your handbook very shortly. Now. You keep

(02:18):
your handbook as a reference. It has very very important
information about Medicare benefits, costs, rights and protections. It has
important information about health and drug plans. It has important
information about answers to common questions. So check out the
new twenty twenty five Medicare and New Handbook. The e

(02:41):
handbook is easy to search or download, so you can
quickly find out what you're looking for, what's new and important.
Check out What's new in Medicare this year to help
you manage your overall health and wellness. The first sign, first,
very important thing is new and it's in the handbook

(03:04):
at Starting in twenty twenty five, you're out of pocket
drug costs will be capped at two thousand dollars. So
the Medicare and You handbook clearly difines us. Because of
President Biden's new prescription drug law. In twenty twenty five,
you're yearly out of pocket drug costs will be capped

(03:27):
at two thousand dollars. So if you have Medicare drug
coverage Part D and your drug costs are high enough
to reach this cap, you don't have to pay a
co payment or co insurance for Part D drugs for
the rest of the year. Boy, that's a that's a huge,
huge benefit. Starting in twenty twenty five, you will also

(03:51):
have the option of spreading your drug cross your drug
costs across monthly payments throughout the year, so you can
do that if you choose to do that now. Mental
health and Wellbeing. Medicare covers expanded mental health care like

(04:11):
intensive outpatient program services in certain location in certain locations,
and services from marriage and family therapists and mental health counselors.
During your yearly wellness visit. Your health care provider can
also use a health risk assessment to better understand your

(04:32):
social needs and refer you for appropriate services and support.
Now there are more resources available for caregivers. Medicare covers
additional caregiver support like training that helps your caregiver better
care for you, and relief when you are caring for

(04:53):
family members in hospice care especially. Also, some people living
with the mention and their caregivers may be able to
get more support through a new pilot program starting in
January twenty twenty five US Postal Service employees. At US
Postal Service employees, retirees, and their families will get coverage

(05:19):
through a new benefits program instead of through the federal
employee health benefits program. So that's for all US Postal
Service employees, including the retirees and their families. They will
get coverage through a new benefits program instead of through

(05:40):
the federal employee health benefits program. So boy, that's a huge,
huge change for them and a positive change for those
people affected by that as well. In now, there are
changes next year to telehealth coveries. Telehealth, telemedicine, and related

(06:03):
terms generally refer to the exchange of medical information from
one site to another through electronic communication. You can get
telehealth services at any location in the United States, including
your home, through December thirty first of this year. Now,
after December thirty first, you must be in an office

(06:26):
or a medical facility in a rural area for most
telehealth services. However, you can still get certain telehealth services
like for mental for mental and behavioral health in your
home no matter where you live. So is that is
that contradicting what is said earlier? I really don't know,

(06:49):
but that's our government for you. In twenty twenty five,
you're yearly out of pocket drug costs will be capped
at two thousand dollars. So once you reach this limit
in twenty twenty five, from your out of pocket spending
plus certain payments other people or entities make, including Medicare's

(07:10):
Extra Help program, you won't pay a co payment or
co insurance for covered Part D drugs for the rest
of the calendar year. If you get Extra Help, you
won't have some of these Part D costs. So very
important that you visit wwwmedicare dot gov forward slash Plan

(07:36):
to compare to get specific Medicare drug plan and Medicare
advantage plan costs and call the plans you're interested in
to get more details, or call us and we can
help you get those planned details. For help comparing costs,
call your state Insurance Assistance Program SHIP program for additional help.

(07:59):
Now new next year is the Medicare Prescription Drug Payment
Plan starting in twenty twenty five, This new payment option
works with your current drug coverage to help you manage
your out of pocket drug costs by spreading them across
the calendar January across the calendar year from January through December.

(08:24):
This payment option might help you manage your expenses, but
it doesn't save you money or lower your drug costs. Now,
the drug costs that we need to pay for twenty
twenty five are cap dot two thousand dollars, So that's
a big bonus that two thousand dollars cap plus the

(08:44):
fact that we can pay that two thousand dollars over
a calendar year basis from January through December. So those
are huge additions to the party program, So take advantage
of If you select this option monthly payment option. Each month,

(09:05):
you'll continue to pay your plan premium. If you have
a plan premium and then you'll get a bill from
your health or drug plan to pay for your prescription
drugs instead of paying the pharmacy. So that's a big change,
a big change. All plans offer this payment option and
participation is voluntary. It doesn't cost anything to participate in

(09:30):
the Medicare Prescription payment plan. So boy, if that will
help you, look into that the Medicare Prescription Payment Plan. Remember,
we are limited to two thousand dollars out of pocket
maximum for calendar year twenty twenty five for prescriptions. So

(09:51):
you contact your plan or visit Medicare dot gov Prescription
Payment Plan for more information and to find out if
this payment option is right for you. Now sounds confusing,
it is confusing. If we can help with that, Listeners,
don't hesitate to give us a call. Call me at

(10:12):
five sixty three three three two twenty two hundred, or
go to my website. Go to dickshillig dot com, scroll
over to my contact drop down for my email address.
If you'd like to send me an email with more
details on it, feel free to do that. So, now,

(10:33):
what is the Medicare drug coverage late enrollment penalty? Now
that still exists, the late enrollment penalty is an amount
that permanently that is permanently added to your Medicare drug
coverage Part D premium. You may have to pay a
late enrollment penalty if you enroll anytime after your initial

(10:56):
enrollment period is over and there's a period of sixty
three days or more in a row that you don't
have Medicare drug coverage or or other credible prescription drug coverage.
You'll generally have to pay that penalty for as long
as you have Medicare drug coverage. If you get extra help,

(11:21):
you don't pay a late enrollment penalty now. There are
three ways to avoid paying a penalty. First way is
you get drug coverage when you are first eligible for it,
so you sign up for Part D when you become
eligible for Medicare Parts A and B. Even if you

(11:43):
don't take drugs now, you should consider joining a separate
Medicare drug plan or a Medicare advantage plan that has
drug coverage to avoid this penalty. You may be able
to find a plan that meets your needs will little
to no monthly premiums. So if you sign up for

(12:06):
Part D when you are first eligible, then you avoid
you certainly avoid any likelihood of a penalty. The second
way to avoid pan penalty is to add Medicare drug
coverage if you lose other credible coverage. So credible prescription
drug coverage can include drug coverage from a current or

(12:31):
a former employer or union. Trycare, Indian Health Service, the
Departments of Veterans Affairs, or individual health insurance coverage. Your
plan must tell you each year if your non Medicare
drug coverage is credible. If you go sixty three days

(12:51):
or more in a row without Mediccare drug coverage or
other credible prescription drug coverage, you may have to a
penalty if you sign up for Medicare drug coverage later.
So keep records showing what you had, keep records showing
when you had additional credible prescription drug coverage, and tell

(13:14):
your plan when they asked for it. If you don't
tell your plan about your previous prescription drug coverage, you
may have to pay a penalty for as long as
you have Medicare drug coverage. How much more will I
pay for a late enrollment penalty? That late enrollment penalty is.

(13:37):
It's figured by taking the national base beneficiary premium a
national average, which is thirty four dollars and seventy cents,
then multiplying that by one percent and by the number
of months that you failed to have prescription drug coverage.

(13:57):
So that is a huge penally that can be imposed
if you don't have prescription drug coverage. So I woun
encourage you boy to take a look at that and
make sure you have it. And like I say, if
you have questions on that, please call me. Call me
at five sixty three three three two twenty two hundred.
I am an independent insurance agent. I represent multiple insurance companies.

(14:23):
I don't represent Medicare. I'm not associated with the federal government.
I simply hope people make their choices on what they
have to make choices on. And this prescription drug coverage
plan is a very very helpful plan, but it's very difficult.
There's a lot of entities involved with that, and sometimes

(14:43):
it gets very very complicated. So if we can help
with that, feel free to give us a call or
send me an email. I'll be happy to visit with
you about your situation and determine if we can help you. So,
all plants must cover a wide range of prescription drugs

(15:05):
that people with Medicare take including most drugs in certain
protected classes drugs like special drugs to treat cancer or
AIDS or depression. Information about a plan's list of covered
drugs is called a formulary. Now, the formulary isn't included

(15:25):
in this handbook that you receive. The formulary must be
provided by the insurance company that you're dealing with. But
there's an alphabetical listing of all the drugs, all the
prescriptions that are covered, and it's very easy to determine
if your prescription is in that formulary or not. A

(15:46):
plan can make some changes to US drugs list during
the year if it follows guidelines set by Medicare. For example,
your plan may change is drug lists during the year
because drug therapies change, new drugs are released, or new
medical information becomes available. Your plan co insurance may increase

(16:10):
for a particular plan. For a particular plan name drug
or generic drug when the manufacturer raises the price. Your
copayment or co insurance may increase when a plan starts
to offer a generic version of a brand name drug
or a biosimilar version of an original biological product, but

(16:33):
you can't continue to take the brand name drug or
original biological product. In some cases, the plan may cover
a drug for one health condition but not another. Medicare
Medicare Part B covers a limited number of out patient drugs,
which is sometimes used for organ transplant. Organ transfer plant

(17:00):
receive a limited number of drugs and those are covered
by Medicare Part B, not by your prescription plan. Medicare
Drug Coverage Part D includes drugs to treat opioid use disorders.
It also covers drugs to treat other special mental health problems.

(17:26):
So if you're confronted with these, be in touch with
your pharmacy, be in touch with myself, and I can
help you steer you in a direction or a plan
that may help cover those. Part D typically places drugs
into different levels called tiers on their formularies. Drugs in

(17:49):
each tier have a different cost. For example, a drug
in a lower tier will generally cost you less than
a drug in a higher tier. Drugs in Tier one
or tier two don't have a co payment to go
with it. Most of these are paid directly by the
pharmacy or directly by the insurance company, and you do

(18:12):
not have a co insurance. So the more prescriptions that
you can receive in that generic or preferred generic category
the savings that you have all the time. But remember
that plans can change their formularies at any time. Your

(18:34):
plan may notify you of any formulary changes that affects
drugs you're taking. You can contact your plan for its
current formulary or visit the plan's website. If you go
to a Medicare dot gov there's a listing of plans
with all the formularies included with a plan on it,

(18:56):
so it's relatively if you're familiar with them. Using the
internet is relatively easy to determine what drugs are covered
and at what tier they're covered. So remember too that
each month you fill a prescription, your plans sends you
an explanation of benefits notice. Review this notice and check

(19:20):
for mistakes. Boy. I would encourage you boy to keep
that explanation of benefits, especially especially the most recent explanation
of benefits. When clients come to me or when people
come to me and talk about the use of their prescriptions,
I ask them to bring this explanation of benefits notice

(19:43):
with them if they have a prescription drug plan, and
if they have that prescription drug plan boy that is
a very valuable tool to use. Plans may have coverage
rules for certain drugs, and for certain drugs, many of
the drugs have prior authorization prior authorizations which limits coverage

(20:05):
of a drug to patience to patients who meet certain requirements.
Before you can fill the prescriptions or prescriber must contact
your plan to show the drug is medically necessary and
that you meet certain requirements. Plans may also use prior
authorization when they cover a drug for only certain medical

(20:29):
conditions it's approved for, but not others. When this occurs,
plans will likely have to have alternatives drugs on their
list of cover drugs on their formulary. So prior authorization
is a way that insurance companies limit the use of prescriptions.

(20:54):
Quantity limits is another way pharmacy companies use to limit
prescription and the pacy. The quantity limits limits how much
of a drug you can take at a time and
for how long you can take that drug. Another way
is that they use step therapy. You may need to

(21:15):
try one or similar drugs which lower lower costs before
the plan will consider a higher cost prescribed drug opioid
pain medication. There are safety checks at the pharmacy. Before
the pharmacy fills your prescription for opioids, your plan and

(21:36):
pharmacy perform additional safety checks like checking checking for drug
interactions and incorrect dosages. The opioid safety checks also include
checking for possible unsafe amounts of opioid pain medications, limiting
the day's supply of a first prescription for opioids. Opioid

(22:01):
pain medications can help with certain types of pain, but
have risk in side effects that these can increase when
you take opioids with other certain drugs, so be aware
of that. Pay close attention to opioid use if you

(22:23):
need to take that medication. Check with your doctor or
pharmacist if you have questions about risks or side effects.
Medicare Drug Coverage has programs in place to help you
use opioids. If your opioid use could be unsafe, for example,

(22:43):
getting opioid prescriptions from multiple doctors or pharmacies, or if
you had recent overdose from opioids, your plan will contact
doctors who prescribe them for you to make sure that
these are medically necessary and you're using them properly. If

(23:04):
your plan decides your use of prescription opioids, may not
be safe. The plan will send you a letter in advance.
This letter will tell you if the plan will limit
coverage of these drugs for you, or if you will
be required to get prescriptions for these drugs only from
one doctor or pharmacy that you select. You and your

(23:26):
doctor have the right to appeal these limitations if you
disagree with the plan's decision. The letter will also tell
you how to contact the plan if you have questions
or would like to appeal. Opioid safety reviews at the
Pharmacy and Drug Management Program generally don't apply if you

(23:47):
have cancer or sickle cell disease, are getting palatative or
end of life care, are in a hospice, or live
in a long term care facility. If you or your
prescribers believe you that your plan should waive one of
these coverage rules, you can ask for an exception. Opioid

(24:11):
medications can be an important part of pain management, but
they can also have a serious health risk if misused.
Medicare covers prescription drugs that a doctor may prescribe as
a safety measure in case you need to rapidly reverse
the effects of opioid juice, so talk with your doctor

(24:31):
about having this in place. Talk with your doctor about
having your dosage and length of time you'll be taking opioids.
Talk with your doctor about other options that Medicare covers
to treat your pain, like opioid medications and devices, physical therapy, acupuncture,

(24:52):
or such drugs of that nature. Never take more opioids
than prescribed. Also talk with your doctor about other medications
and substances you may be using. You know during the
month of September, we'll continue holding our virtual monthly community meetings,
So if you are aging into medicare, if you would

(25:15):
like to participate in these meetings and learn more about
your choices for Medicare, please give us a call at
five sixty three three three two twenty two hundred or
send me an email. Go to my website Go to
Dickshilly dot com, scroll over to the contact icon and
get my email address and send me a note via email.

(25:38):
Good talking with you this morning, Have a great, great weekend.
Looking forward to talking with you again next week. Good day,
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