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CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

Part of the continued roll-out of American Patients First, CMS sends letter to Part D plans explaining that gag clauses that keep patients from knowing how to get the best deal are completely unacceptable. Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs. In Part D, Medicare pays prescription drug plans to cover medicines, which beneficiaries buy at a pharmacy. Gag clauses are provisions in contracts that insurance plans and their pharmacy benefit managers enter into with pharmacies. These clauses prevent pharmacists from telling patients when they could pay less for a drug by paying cash, instead of billing their insurance and paying the required copay or deductible. “President Trump and Secretary Azar are committed to lowering drug prices, and CMS today took another important step to help patients who are feeling the pain,” said CMS Administrator Seema Verma. “Many patients don’t know that some drugs are actually more expensive when they use their insurance. What’s worse is that some pharmacy benefits managers are preventing pharmacists from telling patients when this is happening, because they get a share of the transaction when the patient uses their insurance. Today we are taking a significant step towards bringing full transparency to all the back-end deals that are being made at the expense of patients.” A copy of the letter that was sent to all Part D Plan Sponsors today is included below, and to learn more... read more
New Medicare Cards Protect Your Personal Information

New Medicare Cards Protect Your Personal Information

https://www.medicare.gov/new card Starting in April 2018, Medicare will mail new Medicare cards to all people with Medicare, to help protect you from identity fraud. Fraudsters are always looking for ways to get your Social Security Number so they’re removing Social Security Numbers from all Medicare cards to make them safer. Your new card will have a new Medicare Number that’s unique to you. The new card will help protect your identity and keep your personal information more secure. Your Medicare coverage and benefits stay the same. And there’s more good news—Medicare will automatically mail your new card at no cost to the address you have on file with Social Security. There’s nothing you need to do! If you need to update your official mailing address, visit your online my Social Security account or call 1-800-772-1213. Once you get your new Medicare card, take these 3 steps to make it harder for someone to steal your information and identity: 1. Destroy your old Medicare card right away. 2. Use your new card. Doctors, other health care providers, and plans approved by Medicare know that Medicare is replacing the old cards. They are ready to accept your new card when you need care. 3. Beware of people contacting you about your new Medicare card and asking you for your Medicare Number, personal information, or to pay a fee for your new card. Treat your Medicare Number like you treat your Social Security or credit card numbers. Remember, Medicare will never contact you uninvited to ask for your personal information. This information was taken from:... read more
Medicare Enrollment Deadlines You Shouldn’t Miss

Medicare Enrollment Deadlines You Shouldn’t Miss

Most people become eligible for Medicare during the months around their 65th birthday. If you don’t sign up for Medicare during this initial enrollment period, you could be charged higher premiums for the rest of your life. Here’s a look at when you need to sign up for Medicare and the penalties you could be charged for late enrollment. Medicare parts A and B. Retirees who are receiving Social Security benefits are automatically enrolled in Medicare parts A and B, and coverage begins the month they turn 65. But retirees who haven’t claimed Social Security will need to take action to sign up for Medicare. You can first sign up for Medicare Part A hospital insurance and Medicare Part B medical insurance during the seven-month period that begins three months before the month you turn 65. Your coverage can begin as early as the first day of the month you turn 65, or the first day of the prior month if your birthday falls on the first of the month. Medicare Advantage Plans, a private sector alternative to original Medicare, have the same initial enrollment period. If you don’t enroll in Medicare during the initial enrollment period around your 65th birthday, you can sign up between Jan. 1 and March 31 each year for coverage that will begin on July 1. However, you could be charged a late enrollment penalty when your benefit starts. Monthly Part B premiums increase by 10 percent for each 12-month period you delay signing up for Medicare after becoming eligible for benefits. “The idea behind the penalty is to give people a financial incentive... read more
The Latest Battle in the Prescription Drug Coverage Wars

The Latest Battle in the Prescription Drug Coverage Wars

Drug companies and insurance companies aren’t getting along lately, and patients as well as their doctors are caught in the crossfire. Certain drug therapies have changed the way we fight and live with serious diseases such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis and many forms of cancer. As a result, for one thing, cancer is no longer a death sentence. But limitations on insurance coverage can often stand in the way of patients getting the treatment they need. Now, thanks to the Affordable Care Act, everyone must purchase insurance, expanding the marketplace while simultaneously turning the insurance industry into a runaway train with unchecked power to deny care in an effort to increase profits. Here’s where it gets even more complicated: Insurance companies and drug companies negotiate the price of drugs and coverage plans for drugs in total secrecy. No two plans pay the same amount for a drug because drugmakers and insurers – as well as pharmacy benefit managers, another arm of insurance companies focused entirely on drugs – have made deals that include negotiated rates for certain drugs. So when you hear about escalating drug prices, it’s not a totally accurate representation of cost; almost always, the manufacturer provides hefty discounts or rebates to the insurer. It’s a confusing, broken system that operates largely out of the public view, but we’ve reached a tipping point. Now, there’s a nonprofit at the center of the prescription drug coverage wars called the Institute for Clinical and Economic Review. This group of health economists, originally funded by the health insurance industry and today sustained by a weathy former Enron... read more
5 Reasons to Switch to a New Medicare Advantage Plan

5 Reasons to Switch to a New Medicare Advantage Plan

Medicare Advantage plan participants are allowed to switch plans or resume original Medicare each year during the open enrollment period from October 15 to December 7. But most retirees (78 percent) don’t choose a new health insurance plan, according to a new Kaiser Family Foundation report. An average of 9 percent of retirees voluntarily changed plans each year between 2007 and 2014, and another 5 percent were forced out because their existing plan ended. Just 2 percent of retirees went back to traditional Medicare. But swapping plans might save you money or improve the quality of your benefit. Retirees who switched often gained lower premiums and a higher rated plan. Here’s how to tell if you should look for a new Medicare Advantage plan. A similar plan has lower premiums. Significant premium increases frequently motivate retirees to start shopping around for a new plan. Participants facing a premium hike of over $20 were especially likely to select a new plan, ranging from 21 percent of people whose premiums were scheduled to increase between $20 to $29 and climbing to 29 percent of those whose premiums grew by $40 or more, KFF found. In contrast, only 11 percent of those with a premium increase of less than $20 switched plans. Medicare Advantage enrollees who switched plans in 2014 saved an average of $210 on premiums. Smaller out-of-pocket costs. Besides premiums, retirees in Medicare Advantage could be expected to pay a variety of other out-of-pocket costs. But Medicare Advantage plans have an annual limit on out-of-pocket expenses for medical services, which varies among plans and can change each year. Once you... read more

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