Episode Transcript
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Speaker 1 (00:00):
Good Saturday morning to all. We are beginning a 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
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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
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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
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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.
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But the twenty four excuse me the twenty twenty five
Medicare and New Handbook. Now it says it will not
be available until after October. Vers 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 your
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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 handbook
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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.
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At Starting in twenty twenty five, you're out of pocket.
Drug costs will be capped at two thousand dollars. So
the Medicare and New Handbook clearly defines us because of
President Biden's new prescription drug law in twenty twenty five,
your yearly out of pocket drug costs will be capped
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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 huge, huge benefit.
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Starting in twenty twenty five, you will also have the
option of spreading your drug cross your drug costs across
monthly payments throughout the year, so you can do that too,
if you choose to do that. Now. Mental health and
well Being, Medicare covers expanded mental health care like intensive
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outpatient program services in certain location in certain locations, and
services from marriage and family therapists and mental health counsel
during your yearly wellness visit. Your healthcare provider can also
use a health risk assessment to better understand your social
needs and refer you for appropriate services and support. Now,
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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 family
members in hospice care especially. Also, some people living with
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dimension and their caregivers may be able to get more
support through a new pilet program starting in January twenty
twenty five US Postal Service employees at US Postal Service employees, retirees,
and their families will get coverage through a new benefits
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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 the federal Employee Health
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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 terms generally refer
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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 or a medical facility
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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, but that's our government
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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 Extra Health Program, you
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won't pay a co payment or co insurance for covered
Part DY drugs for the rest of the calendar year.
If you get extra US your help, you won't have
some of these Part D costs. So very important that
you visit wwwmedicare dot gov forward slash plan to compare
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to get specific Medicare Drug Plan and Medicare Advantage Plan costs,
and call the plans you're interested 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 now noon. Next
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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
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across the calendar year January through December. 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 caped at two thousand dollars, so that's a big
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bonus that two thousand dollars cap. Plus the 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 apart dy program, So take advantage of those.
If you select this option monthly payment option. Each month,
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you'll continue to pay your plan premium if you have
a planned 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 gene,
a big change. All plans offer this payment option, and
participation is voluntary. It doesn't cost anything to participate in
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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
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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
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five six y 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,
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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
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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,
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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
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don't take drugs nowould 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 with little
to know monthly premiums. So if you sign up for
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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 credible coverage. So credible prescription drug
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coverage can include drug coverage from a current or a
former employer or union, Drycare, 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
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coverage is credible. If you go sixty three days or
more in a row without Mediccare drug coverage or other
credible prescription drug coverage, you may have to pay a
penalty if you sign up for Medicare drug coverage later.
So keep records showing what you had, keep records showing
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when you had additional credible prescription drug coverage, and tell
your plan when they ask 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
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pay for a late enrollment penalty? That late Roman penalty is.
It's figured by taking the national base beneficiary premium, the
national average, which is thirty four dollars and seventy cents,
and multiplying that by one percent and by the number
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of months that you failed to have prescription drug coverage.
So that is a huge penalty that can be imposed
if you don't have prescription drug coverage. So I have
an 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
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me at five six three three three two twenty two hundred.
I am an independent insurance agent. I represent multiple insurance companies.
I don't represent Medicare. I'm not associated with the federal government.
I simply help people make their choices on what they
have to make choices on. And this prescription drug coverage
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plan is a very very helpful plan, but it's very difficult.
There's a lot of entities involved with that, and sometimes
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,
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all plans must cover a wide range of prescription drugs
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 coverage
drugs is called a formulary. Now, the formulary isn't included
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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
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plan can make some changes to US drugs less 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
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for a particular plan for a particular plan named drug
or generic drug when the manufacturer raises the price. Your
co payment 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,
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but 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 outpatient drugs,
which is sometimes used for organ transplant. Organ transplant receive
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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.
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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 formulas. Drugs in
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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. Most 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
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do not have a co insurance. So the more prescriptions
that you can receive in that generic orferred generic category,
the savings that you have all the time. But remember
that plans can change their formularies at any time. Your
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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,
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so it's relatively if you're familiar with them. Using the internet,
it's 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 plan sends you an
explanation of benefits notice. Review this notice and check it
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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
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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
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of a drug to patience to patients who meet certain requirements.
Before you can fill the prescriptions, a 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
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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.
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Quantity limits is another way pharmacy companies use to limit prescription,
and 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 try one or
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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 pharmacy perform additional
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safety checks like checking checking for drug interactions and incorrect
does 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 pain medications can
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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 need to take
that medication, check with your doctor or pharmacist if you
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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, getting opioid
prescriptions from multiple doctors or pharmacies, or if you had
recent overdose from opioids, your plan will contact doctors who
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prescribe them for you to make sure that these are
medically necessary and you're using them properly. If 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
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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 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
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would like to appeal. Opioid safety reviews at the Pharmacy
and Drug Management Program generally don't apply if you 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
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believe that your plan should waive one of these coverage rules,
you can ask for an exception. Opioid 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
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in case you need to rapidly reverse the effects of
opioid juice, so talk with your doctor 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,
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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
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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
Dickshullig dot com, scroll over to the contact icon and
get my email address and send me a note via email.
(25:15):
Good talking with you this morning, Have a great, great weekend.
Looking forward to talking with you again next week. Good day,