Listen to Ross Blair, CEO of PlanPrescriber, interviewed on Onthemoneyradio.org, provide insights to Medicare and discuss the importance of reviewing your Medicare Advantage and Prescription Drug coverage during the Open Enrollment period.
Steve: Well, it’s open enrollment time for Medicare and that is happening right now as we speak. So, I have invited Ross Blair, the founder and chief executive officer of planprescriber.com, PlanPrescriber is a website that helps seniors and their care givers select and enroll in the best Medicare products for their specific needs. Welcome to the show, Ross.
Ross: Thanks, Steve. Great to be here.
Steve: When does Medicare enrollment begin and when does it end?
Steve: All right. So, as of the airing of this show, the enrollment period has already started, right?
Steve: Okay. So, what are we actually enrolling in. Give us an idea. I know there’s different parts to the Medicare program, Part A, B, C, and D and so on. Would you just give us a quick run down as to what those parts are and what they particularly do.
Ross: So, most folks are already enrolled in Medicare Part A and Medicare Part B. Those are the basic elements of Medicare. They cover both doctor services and hospital services. And many have chosen to enroll in a Medicare Advantage plan or a prescription drug plan to fill the holes that are left by Medicare Part A and Part B, so Medicare Advantage is often referred to as Medical Part C and the prescription drug plans are referred to as Part D. And there is a third type of insurance called Medicare Supplement Insurance which really is subject to whole different set of rules and enrollment periods and so forth. So if we can, we kind of hold those off for the conversation today.
Steve: So, the basic Medicare plan, A and B, what would be an example of something they would not cover?
Ross: Well, the two big things that are missing from Medicare Part A and Part B. First, they are going to leave you with a 20% co-pay with no cap. So, should you need a $50,000 or $60,000 medical procedure, you’re on the hook for 20% of those costs…
Ross: …at the end of the year.
Ross: So, there’s very little upside protection, if you will. And the other thing that’s not covered by Part A or Part B are prescription drugs. You need to enroll in a prescription drug plan in order to get that coverage.
Steve: All right. That’s a good example. So, then you would move to, I guess, additional or supplemental insurance and that would be Medicare Part C, also known as Medicare Advantage. What gaps does that fill?
Ross: Well, most of the Medicare Advantage plans, not all but most, have drug coverage included so you would pick up the drug coverage. But probably even more important is you get what’s called a maximum out of pocket benefit. And the government requires that these Medicare Advantage plans have a maximum amount of pocket no greater than $6,700, but the good news is this coming season there are plans out there that have maximum out of pockets as low as $500. So, that’s one of the very critical things you want to check when you’re enrolling in one of these plans. The only caveat I put out there for folks is that there are networks, physician and health center networks that you have to stay within to get the benefits.
Steve: I see.
Ross: So, make sure you talk to your doctor and ensure that your doctor is in network for these plans when you’re signing up for any health benefits, whether it be Medicare Advantage or a Medicare supplement.
Steve: Well, logically in this world if one company has a maximum amount of pocket of $6,700 and one has a $500, that’s got to be paid for some way. Nobody’s giving us anything, right?
Ross: That’s right.
Steve: So, someone who is signing up and trying to do an apples to apples comparison, what difference would I look for between these two extremes with regards to the maximum amount of pocket?
Ross: Well, what you’re likely to find with the $500 maximum amount of pocket plan is a much higher monthly premium. And there are Medicare Advantage plans out there that have drug coverage, believe it or not, for a zero premium, no additional premium over your Part and Part B premium that you’re already paying to Medicare.
Ross: So, you kind of get what you pay for as you would expect. And you just need to do your homework around probably the four things I think that are really important to consider are what is that monthly premium, is it affordable for me, are my drugs covered under this particular plan, and what are the co-pays and so forth. And what’s that maximum amount of pocket and can I afford it if I need that hip replacement surgery or whatever it might be. And then are my doctors and health centers and so forth, and now this year even consider your pharmacy. Are they all in network and going to give me the best possible co-pay balance.
Steve: It’s a lot of information for the average person to call and make sense of. How does one do that?
Ross: Well, I’ve finally recommend that folks consult an expert and somebody that you trust and to talk you through all the different elements of Medicare. We have call center agents that can help people. And the most important thing to remember around this annual enrollment period is people get very, very busy. So, 70% of the enrollments annually happen during this five week period that we’re about to go into. And importantly, last year most folks procrastinated to the very last week. So, my advice is don’t procrastinate. Consult an expert and get on it early, as early in the season as you can. Forty percent of the people we talked to last year called us in the last seven days of the season.
Ross: It’s very hard to get someone on phone at this time of year.
Steve: Sure. And how about just figuring this all out before open enrollment starts.
Ross: Well, that’s something that folks can certainly get a start on, and there are lots of resources online. Medicare has it’s own site, medicare.gov. There’s our PlanPrescriber’s site. I encourage people to go online, do some research, use site like of who I just mentioned that will allow you to compare all plans so that you’re not just locked into one carrier.
Ross: Put your drugs in the tools that are found there and see which plans have the lowest cost. So, get your basic homework done. And then if you have questions, there are resources on both sites really that you can call to get your questions answered.
Steve: I was speaking with CEO of planprescriber.com, Ross Blair. So, we talked about A. We talked about B. We talked about C. Does C also offer other programs like dental coverage or health and wellness programs?
Ross: Some of them do and it’s definitely worth looking into. Not all the Medicare Advantage plans offer those kind of supplemental services, but dental, vision, wellness are all attributes of some of the plans. You just need to do your shopping and see what’s going to be of most help. Sometimes it will help offset the cost of your health club, for instance, which is great.
Steve: Okay. All right. Let’s get to Part D, the drug coverage. I think many people know about this. They know about something called the Donut Hole where you pay a certain amount up until a certain level and then you have to pay the full amount. And then once you get past a certain level, benefit kicks in again. Tell us more about these Plan D programs and how they may supplement standard Medicare.
Ross: Right. So, each of the Part D programs that are out, and whether it’s associated with a Medicare Advantage or a standalone prescription drug coverage have what’s called a formulary. It’s a list of drugs which says whether or not the carrier will cover a specific drug and if so what the amount of coverage is and how much you’re left with as a co-pay amount. And so the plans really have to enter your drugs into these lists and see whether or not your drugs are going to be covered and what your total annual cost is. So, when you’re considering cost, you want to look at both your premium, any co-pay, or co-insurance amounts that you’re due.
And as you said, Steve, look at all the levels of coverage. These tools are smart enough to know, hey, you’re going to hit the donut hole in August, let’s figure those costs in as well. So, look at your all annual cost and then rank all of the plans that are out there to see who is going to give you the best outcome. The goods news this year is that the donut hole is continuing to close thanks to the Affordable Care Act, so discounts on branded drugs has gone up to 52.5% from 50% and generic drugs are now discounted 21% from 14% last year. So, we’re continuing to see the Donut Hole close, so that should become less and less of a factor for folks.
Steve: Are there any new developments with regards to blockbuster drugs that are turning generic that people should know about?
Ross: There are. And so the big new this last year was Lipitor, of course, which has generic. And for all these drugs, seniors need to talk to their pharmacist to make sure that they’ve made the switch as appropriate, and they may have to check with their doctor made the switch to the generic. But just look if you’re on a long term maintenance drug, the pharmacist may not automatically switch you over. But an addition to Lipitor that went generic this year, we have Singulair which actually just went generic, Cymbalta, and Niaspan. Those are all really large drugs in the senior population that we’re talking about here. So, if you’re on one of those drugs, make sure that you get moved over to the generic during the course of 2013.
Steve: I know with your typical health insurance plans, it’s often better to go on mail order as oppose to going into your local pharmacy or something like that. Does that mail order aspect carry over to Medicare?
Ross: It does. Absolutely, Steve. So, mail order is the cheapest way to get your prescription drugs through these Part D programs. And there are an increasing number of plans that actually offer zero co-pays for generics, so these are really great rich plans. And you can get your 90 supply, so it’s more convenient and you make sure you’re always up to date. And so I strongly recommend folks use mail order to get their drugs.
Steve: All right. Well, in the interest of time, I know that you have some final tips for annual enrollment. Would you share those with us?
Ross: Sure. And this is necessarily to do with annual enrollment, but the Affordable Care Act, the other big benefit that some of us may have heard on the reference done in the debates recently is the Affordable Care Act provided a zero co-pay wellness visit for seniors on Medicare which is a big, big deal. Everybody should get that annual wellness visit. And most screening tests are now provided with zero co-pay, and you don’t even need a Medicare Advantage plan to get those benefits. So, talk to your doctor and get those tests. It’s really important once we turn 65 to stay healthy and to get these tests on an annual basis.
Steve: Any other tips? A final tip for us?
Ross: I don’t think so. Just do your homework. Don’t be afraid. I know it’s a lot of information, but don’t be afraid. Most people are in the wrong plan, so it really pays to keep up every year to check to make sure that your health may have changed, your plan may have changed. So, make sure you do your homework every year and try to get through this check list and check with an expert.
Steve: All right. You’ve heard it from an expert, CEO of planprescriber.com, Ross Blair. Thank you so much for joining us.
Ross: Thanks, Steve.