Walgreens to quit Anthem Rx for 2012
November 22, 2011 by Ray Martinez
Medicoverage.com has been notified by Anthem of an upcoming Walgreens provider network status update. All current Anthem members will want to take note of this change when filling future prescriptions.
Walgreens, a pharmacy retailer, has announced its intent to exit the Express Scripts pharmacy provider network when its current contract expires on December 31, 2011.
What does this mean?
Unless an agreement is reached between Express Scripts and Walgreens, Anthem members will no longer be able to receive coverage for their prescription medications from Walgreens pharmacies, beginning January 1, 2012. This will also affect members who are using other pharmacies owned by Walgreens, most notably Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare.
Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens. On average, there is another network pharmacy within one-half mile of a Walgreens.
Should we receive notification of a pending agreement between Walgreens and Express Scripts, we’ll post up another update.
CT and NH Announce Last Days for New Tonik plans
September 26, 2011 By Mark Wilson
Anthem Blue Cross Blue Shield of Connecticut and New Hampshire have announced that Oct 14th will be the last day new members can join Tonik. This means Tonik will be effective full and anyone hoping to join after October 14th will be out of luck. Those members who have already joined Tonik can keep their plan and no action is required at this time.
The Tonik application page will still be up for new applications until the deadline. We are recommending that all CT and NH applicants submit their application by October 13 as it is unclear at what time on the following day the application will no longer be functioning.
If you have any questions about the above, please contact us at 800.930.7956
Applying for Medicare
April 04, 2011 By Melanie Rose
When should I apply?
If you are currently receiving Social Security retirement benefits, disability benefits, or railroad retirement checks, you will be contacted a few months before you become eligible for Medicare and given the information you need. If you live in one of the 50 states or Washington, D.C., you will be enrolled in Medicare Parts A and B automatically. However, since you must pay a premium for Part B coverage, you are given the option of turning it down.
NOTE: Residents of Puerto Rico or foreign countries will not receive Part B automatically. They must elect this benefit.
If you are not already getting retirement benefits, you should contact the Social Security Administration about three months before your 65th birthday to sign up for Medicare. You can sign up for Medicare even if you do not plan to retire at age 65.
Special enrollment situations
You also should contact Social Security about applying for Medicare if the following circumstances apply to you:
- You are a disabled widow or widower between the ages of 50 and 65, but you have not applied for disability benefits, because you are already getting another kind of Social Security benefit;
- You are a government employee and became disabled before age 65;
- You, your spouse, or your dependent child has permanent kidney failure;
- You had Medicare medical insurance in the past but dropped the coverage; or
- You turned down Medicare medical insurance when you became entitled to hospital insurance (Part A).
Initial enrollment period for Part B
When you first become eligible for hospital insurance (Part A), you have a seven-month period (your initial enrollment period) to sign up for medical insurance (Part B). A delay on your part will cause a delay in coverage and result in higher premiums. If you are eligible at age 65, your initial enrollment period begins three months before your 65th birthday. It will include the month that you turn 65, and it will end three months after that birthday. If you are eligible for Medicare based on disability or permanent kidney failure, your initial enrollment period depends on the date your disability or treatment began.
When does my enrollment in Part B become effective?
If you accept the automatic enrollment in Medicare Part B, or if you enroll in Medicare Part B during the first three months of your initial enrollment period, your medical insurance protection will start with the month you are first eligible. If you enroll during the last four months, your protection will start from one to three months after you enroll.
General enrollment period for Part B
If you do not enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins the following July. However, your monthly premium increases 10 percent for each 12-month period you were eligible for, but did not enroll in, Medicare Part B.
Special enrollment period for people covered under an employer group health plan
If you are 65 or older and are covered under a group health plan, either from your own or your spouse’s current employment, you have a “special enrollment period” in which to sign up for Medicare Part B. This means that you may delay enrolling in Medicare Part B without having to wait for a general enrollment period and paying the 10 percent premium surcharge for late enrollment. The rules allow you to:
- Enroll in Medicare Part B any time while you are covered under the group health plan based on current employment; or
- Enroll in Medicare Part B during the eight-month period that begins following the last month your group health coverage ends, or following the month employment ends—whichever comes first.
Special enrollment period rules do not apply if employment or employer-provided group health plan coverage ends during your initial enrollment period.
If you do not enroll by the end of the eight-month period, you will have to wait until the next general enrollment period, which begins January 1 of the next year. You also may have to pay a higher premium, as explained above.
People who receive Social Security disability benefits and are covered under a group health plan from either their own or a family member’s current employment also have a special enrollment period and premium rights that are similar to those for workers age 65 or older.
Medicare Part D (Medicare Prescription Drug Coverage)
April 04, 2011 By Melanie Rose
Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. There are two ways to get Medicare prescription drug coverage:
1. Medicare Prescription Drug Plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, and Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plans are other Medicare health plans that offer Medicare prescription drug coverage. They include full Part A and Part B coverage, as well as prescription drug coverage (Part D).
If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.
How Much Does Medicare Prescription Drug Coverage Cost?
Each plan can vary in cost and drugs covered. Our Quoting Tool can help you find and compare plans in your area.
Your Part D monthly premium could be higher based on your income. This includes Part D coverage that you receive from a Medicare Prescription Drug Plan, a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium.
Many people qualify to get assistance in paying for their Medicare prescription drug costs, but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. For those who need additional help, there are Medicare Savings Programs available to aid in making health care and prescription drug costs more affordable.
How Do I Get Medicare Prescription Drug Coverage?
To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. To join a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.
Remember, costs and coverage varies with each plan. Using our Quoting Tool can help you find and compare plans in your area.
How Does My Other Insurance Work with Medicare Drug Coverage?
If you have other insurance, find it below to understand how it works with, or is affected by, Medicare prescription drug coverage.
Employer or Union Health Coverage
This is health coverage based on the current or former employment of you, your spouse, or other members of your family. If you have prescription drug coverage based on employment, the employer or union will notify you each year to let you know if your drug coverage is creditable. It is important to keep the information that you receive.
If you join a Medicare drug plan, you, your spouse, or your dependants may lose your employer or union health coverage. Call your benefits administrator for more information before making any changes to your coverage.
COBRA
This is a Federal law that may allow you to temporarily keep employer or union health coverage after employment ends, or after you lose coverage as a dependent of a covered employee.
There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends.
Medigap (Medicare Supplement Insurance) Policy with Prescription Drug Coverage
Medigap policies are no longer sold with prescription drug coverage. If you currently have drug coverage under a Medigap policy, you may keep it. However, you may opt to join a Medicare drug plan instead, because most Medigap drug coverage isn’t creditable.
If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.
The types of insurance listed below are all considered creditable prescription drug coverage. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.
Federal Employee Health Benefits Program (FEHBP)
If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 1-888-767-6738, or visit the Office of Personnel Management website. TTY users should call 1-800-878-5707. You can also call your plan if you have questions.
Veterans Benefits
You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 1-800-827-1000, or visit the VA website. TTY users should call 1-800-829-4833.
TRICARE (Military Health Benefits)
Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage Plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 1 877 363 8779, or visit the Tricare website. TTY users should call 1-877-540-6261.
Indian Health Services
If you get prescription drugs through an Indian health pharmacy, you pay nothing and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health provider with costs, because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator - they can help you choose a plan that meets your needs and explain how Medicare works with your health care system.
Medicare Advantage Plan (Part C)
April 04, 2011 By Melanie Rose
What is a Medicare Advantage Plan (Part C)?
A Medicare Advantage Plan is another health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies that offer Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs, and they can have different rules for how you obtain services (such as whether you need a referral to see a specialist). These rules can change each year.
Different Types of Medicare Advantage Plans
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNP)
There are other less common types of Medicare Advantage Plans that may be available:
- HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
- Medical Savings Account (MSA) Plans—A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
How Much Does a Medicare Advantage Plan Cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:
- Whether the plan charges a monthly premium.
- Whether the plan pays any of your monthly Part B premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayments or coinsurance).
- The type of health care services you need and how often you get them.
- Whether you follow the plan’s rules, like using network providers.
- Whether you need extra benefits and if the plan charges for them.
- The plan’s yearly limit on your out-of-pocket costs for all medical services.
What Does a Medicare Advantage Plan Cover?
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers, with the exception of hospice care. Original Medicare covers hospice care, even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans are not supplemental coverage; they may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
How Do I Get a Medicare Advantage Plan?
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare health plans in your area. You can find quotes and compare plans easily using our Quoting Tool.
Medicare Part B
April 04, 2011 By Chris Mihm+
What Is Part B (Medical Insurance)?
Part B helps cover medically-essential needs, such as doctors’ services, outpatient care, and home health services. Part B also covers some preventive services. Check your Medicare Card to find out if you have Part B.
How Much Does Part B Cost?
If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
Some people automatically get Part B. Learn how and when you can sign up for Part B via our Applying for Medicare article
What Does Part B Cover?
Part B covers two types of services: - Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive Services—Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Medicare Part A (Hospital Insurance)
April 04, 2011 Melanie Rose
What Is Part A (Hospital Insurance)?
Part A is hospital insurance that helps cover inpatient care in hospitals and skilled nursing facilities, as well as hospice and home health care.
How Much Does Part A Cost?
Most people don’t pay a premium for Part A, because they paid Medicare taxes while working. This is called “premium-free Part A.”
If you are not eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:
- You are 65 or older, entitled to (or enrolling in) Part B, and meet the citizenship or residency requirements.
- You are under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)
In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may assist you in paying for Part A and/or Part B
How Do I Get Part A?
Some people automatically get Part A. Learn how and when you can sign up for Part A via our Applying for Medicare article
What Does Part A Cover?
In general, Part A provides coverage for:
- Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
- Inpatient care in a skilled nursing facility (not custodial or long term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Non-Medical Health Care Institution
Note: Staying overnight in a hospital doesn’t always mean you’re an inpatient. You are considered an inpatient the day a doctor formally admits you to a hospital with a doctor’s order. Being an inpatient or an outpatient affects your out-of-pocket costs. Always ask if you’re an inpatient or an outpatient.
Medicare Under Health Care Reform
March 28, 2011 Melanie Rose
- Due to a reduction in waste, fraud, and abuse, as well as a slowing cost growth in Medicare, the life of the Medicare Trust fund will be extended to at least 2029 (a 12-year extension). This will provide you with future cost savings on your premiums and coinsurance.
- Medicare plans on taking strong action to reduce payment errors and keep waste, fraud, and abuse at low levels. In addition, the President has made a commitment to reduce Medicare fraud by 50 percent before the year 2012. With the Affordable Care Act, an historic $350 million investment has been made to enforce this commitment. The financial boost will help prevent, detect and fight fraud in Medicare, as well as Medicaid and the Children’s Health Insurance Program.
- In 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name medications. Every year after, the cost of prescription drugs in the donut hole will be reduced, until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
- The coordination of care between doctors and the overall quality of care will be improved. This way, you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
Hospitals will have new, strong incentives to improve your quality of care.
- Starting in 2014, the Affordable Care Act will offer additional protection for Medicare Advantage Plan members. Such measures include taking strong steps that limit spending on administrative costs, insurance company profits, and things other than health care.
5 Tips When Shopping for Health Insurance
March 16, 2011 By Melanie Rose
Finding coverage that meets your healthcare needs and fits your budget can be challenging. This is because health insurance that covers more tends to cost more. Listed below are 5 useful tips to keep in mind when shopping for a health plan.
1) Do your best to balance the cost (monthly premium) of a policy with the protection that it offers.
2) Determine what you will have to pay out-of-pocket for covered services (such as a deductible, coinsurance, or copayments).
3) Estimate costs for non-covered care (services excluded or limited by the policy). Also be aware of any additional fees (charges above what the plan recognizes).
4) Avoid policies that don’t have some kind of out-of-pocket limit on covered charges. (An out-of-pocket limit is the maximum amount that you are required to pay per calendar year for services under a health plan)
5) Don’t mistake insurance-like products for comprehensive coverage.
For pricing information on available health plans, please refer to our Health Insurance Quote Tool. You can also contact a MediCoverage Agent at (800) 930-7956
Young Adult Coverage until Age 26
March 16, 2011 By Melanie Rose
Under the Affordable Care Act, if your health plan covers children, you can add or keep them on your policy until they turn 26 years old.
What This Means for You
Before the act was enacted, health plans could remove enrolled children at the age of 19, with some exceptions for full-time students. Now, most health plans that cover children must make coverage available to them until they turn 26. By allowing children to stay on their parents’ plan, the Affordable Care Act makes it easier and more affordable for young adults to get health coverage.
Adult children can join or remain on your health plan whether or not they are:
- married
- living with you
- in school
- financially dependent on you
- eligible to enroll in their employer’s plan. however, there is a temporary exception to this provision: Until 2014, “grandfathered” group plans are not required to offer dependent coverage up to age 26, if a young adult is eligible for group coverage outside your plan.
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