PRESCRIPTION DRUG COST TOO MUCH?

  • Preferred Pharmacy: Make sure you are using a preferred pharmacy when filling your prescriptions. Most health and drug plans have preferred, standard and out of network pharmacy options. Using a preferred pharmacy guarantees you will pay the lowest co-payment possible through your insurance.
  • Generic Alternatives: Many Brand name drugs have available generic alternatives. Ask your doctor if this might be an option for you.
  • Samples: Asking your doctor for samples is one way to save you the most money on a brand name prescription drug cost. It is not a guarantee that your doctor will have available samples, but if you don’t ask you’ll never know.
  • Goodrx.com: https://www.goodrx.com/ is a discount website that offers many drugs at a significantly reduced price. You should compare your current drug cost to see if this money saving option works for you.
  • Applying for Co‐Pay Relief and Prescription Assistance Programs: This is a great place to start for people with certain conditions that requires significant out of pocket costs. People who qualify will receive grants to help pay for the cost of their medications. Below is a list of websites and phone numbers for different assistance programs available:

www.healthwellfoundation.org 800‐675‐8416
https://panfoundation.org 866‐316‐7263
www.pparx.org 888‐477‐2669
www.copays.org 866‐512‐3861
www.cdfund.org 877‐968‐7233
www.parientadvoate.org 800‐532‐5274

  • Veterans Administration: For qualified veterans, the Veterans Administration does provide prescription drug coverage. Coverage is dependent on military service and in some cases qualification is determined by income. Most veterans who qualify pay a low co‐payment for all prescription drugs. Please see a local Veteran Service Officer to see if you qualify.

Kane County:

John Fanning * Elgin Armory ‐ 254 Raymond Street, Elgin, IL 60120 (847) 608‐0138

Steven Wells * Kane County Government Center ‐ 719 South Batavia Ave., Bldg A, Geneva, IL 60134 (630) 232‐3550

Cook County:

James Lopez * Schaumburg Township ‐ 1 Illinois Blvd., Schaumburg, IL 60169
(847) 884‐0030 ext. 2019

Scott Goering

Associate General Agent

4 COSTLY EXPENSES NOT COVERED BY MEDICARE

4 COSTLY EXPENSES NOT COVERED BY MEDICARE

With Medicare Part A & Part B (also known as Original Medicare) you are covered for about 80% or less of your medical services1.  The purchase of a Medicare Supplement or Medigap policy will help fill these gaps as well as the Part A & B deductibles which are not covered by Medicare.  Many people think that all their bases are covered at that point, but that is often not the case.  The following are 4 important expenses that are not covered by Original Medicare.

Read More

How to avoid Medicare Part B Excess Charges

Medicare Supplement Plan N does not cover Medicare Part B excess charges. What is excess charges and how do I prevent a bill for excess charges?

DEFINITION: For an Original Medicare enrollee, the excess charge is the difference between a providers fee for service and what Medicare has approved as payment for that service. If a provider accepts Medicare, but does not accept Medicare assignment, providers are allowed to charge up to an additional 15% over and above what Medicare has approved.

ExcessChargesPlanN.jpg

What you can do to protect yourself against Part B excess charges?

The easiest way to protect yourself from excess charges is to only use physicians who accept Medicare assignment (Medicare’s price). Then you know you will never be billed more than Medicare allows for your healthcare services. It’s always a good idea to ask your doctor if he or she accepts assignment before you make an appointment. Don’t forget you need to ask the same question of any Medicare provider, such as lab facilities, home health care companies, etc. Again, all you must do is ask the provider:

“DO YOU ACCEPT MEDICARE ASSIGNMENT or PRICE?”

 

Medicare.gov physician locator tool.

If you have internet access Medicare.gov tells you if your provider accepts Medicare assignment

Click the link above to find a provider in your area that accepts Medicare Part B assignment.

A provider that accepts Medicare assignment will be shown as seen below.

assignment.jpg

Turning 65? Review your Medicare options

Before you turn 65 you need to review your Medicare Health Insurance choices. Everyone, whether working or not, needs to examine their choices for health insurance. We all would love the definitive “Yes” or “No” answers; however, with Medicare, those answers generally don’t exist.  Usually, you have to dig through Medicare.gov and countless amounts of rules and regulations to insure you are taking the correct action within the allotted timeline. The best advice I can give you is to call our office as we are able to discuss your specific situation with you. We can give you your options as they pertain to your specific situation and make sure you side-step any potential problems.  Let’s discuss a few of the common enrollment scenarios:

Medicare beneficiaries that have group health insurance through their employer or their spouse’s employer GENERALLY do not have to sign up for Medicare Part B when they turn 65. Enrollment in Medicare Part A will be automatic and premium free for those beneficiaries (or their spouses) who have paid into Social Security for 40 quarters or 10 years. Even though the beneficiary is enrolled in Part A automatically, typically they can keep their insurance through their (or their spouses) employer as long as the employee is actively working. When the employee retires, they will then have an eight month window in which to sign up for Medicare without facing any penalties for late enrollment.

Sounds pretty clear-cut? But, what If you are 65 or older and your employer has fewer than 20 employees?  In this case, IF the beneficiary’s employer has 20 or fewer employees Medicare GENERALLY would pay first; therefore, they would need to start their Medicare Part B upon reaching age 65. The group coverage would then pay after Medicare pays. Failure to enroll in Medicare would result in a penalty and/or a delay in enrollment.  If you have any question that this may apply to you contact your group health administrator as they should be able to provide you with the information used to determine if your group plan pays AFTER Medicare pays.

Here is the links to the information I have discussed:

Medicare.gov

Should I enroll in Part B?

Who pays first?

Making these determinations can be tricky and making a mistake can be costly, but using an insurance agent will save you time and money. Both of the two situations above are not clear-cut and can have different outcomes. Talk with a licensed insurance agent to make sure that you are making the correct enrollment decision. Now that you have examined your enrollment options you should then examine which path is THE MOST COST EFFECTIVE. Call us at 1-847-697-0104 and let us help you make that determination.

Drew Cosentino

President

ADH Insurance Agency, Inc.