CDISNM Blog
If you receive health insurance benefits through work, you may have heard about COBRA coverage. COBRA helps people avoid losing their health insurance abruptly during a qualifying event, such as divorce, death, retirement, or leaving a job. With COBRA, you pay for employer-provided health benefits to continue for you, your spouse, and your dependents for some time until other arrangements can be made. If you will soon be eligible for both Medicare and COBRA, which benefits should you take? If you are a spouse not eligible for Medicare, and about to lose employer coverage, can you still take COBRA? Understanding your options is important for ensuring you have the coverage you need when you need it most. Here’s some background on COBRA, along with some facts that can help you make an informed decision regarding Medicare.
What Is COBRA?
Short for the Consolidated Omnibus Budget Reconciliation Act, COBRA was passed by Congress in 1985 to protect qualified beneficiaries—and their dependents—from losing health coverage abruptly should group health insurance stop. COBRA benefits are typically available when a qualifying event occurs, such as a divorce or legal separation, death of a covered employee, retirement, or, in some cases, eligibility for Medicare.
If you have COBRA when you first become eligible for Medicare:
If you’re already receiving COBRA benefits, and become eligible for Medicare during that time, what should you do? While seniors often delay signing up for Medicare Part B if they have comparable health insurance, COBRA is not considered comparable coverage. If you wait to enroll in Part B until your COBRA coverage ends, you will pay a late enrollment penalty. To be safe, if you have COBRA at the time you become eligible for Medicare, sign up for Part B to avoid the late penalty—you can have both Medicare and COBRA. Remember, enrollment in Part B triggers open enrollment rights for Medicare Supplement. If you plan on using Medigap to help pay out-of-pocket costs, you will have six months from the date you enroll in Part B to choose a plan without regard to your current health condition. If you have COBRA before enrolling in Medicare, your COBRA benefits may end on the date you sign up for Medicare. However, your spouse and dependents may be able to keep coverage for up to 36 months. And, you may be able to keep COBRA benefits for services not provided by Medicare. For example, if dental or vision coverage is provided through COBRA, you may be able to continue paying for benefits for as long as you are entitled to COBRA.
If you have Medicare when you become eligible for COBRA
You may have already signed up for Medicare when COBRA benefits are made available to you. You can sign up for COBRA coverage even if you are already enrolled in Medicare. Medicare becomes your primary payer, while COBRA acts as your secondary payer. However, you will be responsible for both the Part B premium and your COBRA premium. When would it make sense to take COBRA coverage with Medicare? Maybe your COBRA benefits include prescription drug coverage or eye care. With Medicare, these services are not included but are extra. You do have the option to turn down COBRA benefits. But, if you have dependents who rely on you for health coverage, be sure to consider your options carefully. In general, COBRA only applies to companies with 20 or more employees. If you are planning on retiring or leaving employment where COBRA is offered, you should receive a letter notifying you of your rights and offering you the option to elect COBRA continuation coverage. Typically, COBRA benefits extend for 18, and in some cases, 36 months.
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/cobra-7-facts.html
https://www.medicareinteractive.org/get-answers/medicare-and-other-types-of-insurance/understanding-cobra/can-i-have-both-cobra-and-medicare
MUC55-2017-BCBS
CDISNM Blog
If you enjoy traveling, and plan to do a lot of it this year, or will be going abroad for work, it may be worth looking into an international medical insurance plan. With reliable benefits, customizable options, and more, GeoBlue offers a new kind of travel insurance.
Customized Travel Insurance—at Your Fingertips
Whether you’re planning a one-time trip, multiple trips to a favorite locale, or plan to live outside of the country for an extended amount of time, securing the right travel insurance is a smart strategy. GeoBlue makes it easy to create travel insurance that’s right for you—one-time, multi-trip, or expatriate—reliable medical coverage, based on your needs, at a price you can afford.
International Medical Insurance
Single, Multi-trip, and Expatriate Plans
With three different categories of international medical coverage, you can travel abroad with the peace of mind that you’re covered medically, when and where you need it. Choose medical coverage limits from $50,000 to a full $1,000,000 and deductible amounts from $0 to $500. Rest assured, prescription drug reimbursement is available with all plans, ensuring you can get your medication conveniently. Here are a few more of the benefits included with international medical insurance from GeoBlue.
Choice in medical coverage limits
Emergency medical evacuation
Accidental death coverage
Repatriation coverage
Dental care for the relief of pain (multi-trip and expatriate plans only)
Prescription drug reimbursement
Coverage for emergency and nonemergency medical care
Choice of deductible options
24/7 global medical assistance
Global health and safety resources
Expatriate plans are available worldwide (with or without coverage in the U.S.). Expatriate plans also include the following additional benefits:
Preventive and primary care
Professional services
Inpatient hospital services
Ambulatory and therapeutic services
Rehabilitation and therapy
Home health and skilled nursing care
Hospice care
If you know you will be traveling out of the country, once or multiple times throughout the year, international medical insurance may be a good option. With GeoBlue travel insurance, it’s never been easier to customize medical coverage and deductible amounts to meet your needs.
References:
https://www.geobluetravelinsurance.com/product_overview.cfm?link_id=148117&personalized=y&header=y
MUC50-2017-BCBS
CDISNM Blog
If you’ve heard a few commercials on television and you’re wondering whether or not you need to review your Medicare Advantage plan for changes, you’re not alone. Many seniors don’t realize that Part C benefits may change from year to year or that they have the opportunity to review changes before the annual Open Enrollment begins.
Changes Can You Expect
As a member of Medicare Advantage, each fall, you should receive a Plan Annual Notice of Change (ANOC). This document includes important information about any changes to your plan that will take effect the following January. This is your opportunity to review your plan to decide if it will still meet your needs the following year. Expect to see changes to your monthly premium, deductibles, prescription drug coverage and cost, provider networks, and copayments. Your maximum out-of-pocket limit may be reduced, your drug plan’s formulary or list of covered medications may increase or decrease or your current plan may be merged into another Medicare Advantage plan.
Review Changes to Your Plan
Changes to your current plan may not affect you or your benefits at all. However, even small changes can have a significant impact on how you receive your benefits, how much you pay out-of-pocket, and even where you can go to receive services. Your plan’s drug formulary may cover fewer medications next year. If you take a specific drug, it’s a good idea to review your notice of change carefully to ensure the medications you rely on are still available. Are they in a different tier? Can you still use the same pharmacy? Look for changes in how much you will need to pay to continue receiving the prescriptions you use regularly. It’s also important to review changes that may affect where you go to receive services. Is your doctor still in the network? How about the hospital you use?
Plenty of Time to Review
The good news is, that Medicare plans must send an Annual Notice of Change no later than September 30—a couple of weeks before the start of Open Enrollment. If you don’t receive it, contact your plan. Details on how to request the notice can be found on the back of your membership card. If you decide to keep your Medicare Advantage plan, you don’t need to do anything at all and you will automatically be re-enrolled in your current plan for another year.
References:
Annual Notice of Change: https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html
MUC47-2017-BCBS
CDISNM Blog
If you’re considering Medicare Advantage (MA), you’re not alone. In 2018, over 17 million seniors chose Part C coverage, also known as Medicare Advantage (MA). With benefits above and beyond Original Medicare, the right MA plan offers security and peace of mind that when you need health care, you can get it—no questions asked. But what about prescription drug plans? Are you covered under Part C? Here’s a brief overview of how prescription drug benefits work with Medicare Advantage and information on MA Plans that include prescription drugs, called (MAPD).
Coverage Depends on the Type of Plan
There are many different types of Medicare Advantage plans, some with prescription drug benefits included, and some without. Medicare Advantage HMOs and PPOs are not required to offer prescription drug benefits. If you choose an HMO or PPO MA plan that does not offer coverage, you may not join a separate Medicare Prescription Drug plan.
Compare Prescription Drug Benefits
The good news is, that most Medicare Advantage plans do include benefits for prescription drugs, known as MAPD, but no two plans are alike. It makes sense to find the one that fits your prescription needs best. If you take specific medications, compare plans by looking at the drugs that are included on the formulary (list of covered medications), and be sure to identify which tier or tiers they are assigned to, how much they cost, and where you can get them.
Your Drug Benefits May Change Yearly
You already know that different Medicare Advantage plans provide different prescription drug benefits. But did you know that each plan’s benefits might change yearly too? If you have Medicare Advantage with prescription drug coverage, your plan is required to send you an Annual Notice of Change each year. This document (which should come by mail at the end of September) informs you about any changes that will take place the following January to your plan in network pharmacies, drug formulary, and cost for medications you take.
References:
Different types of MA plans: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/types-of-medicare-advantage-plans.html
How Medicare Prescription Drug Coverage Works with a Medicare Advantage Plan, https://www.medicare.gov/Pubs/pdf/11135.pdf page 2, 3
Medicare Advantage enrollment, 2016, http://kff.org/medicare/fact-sheet/medicare-advantage/
MUC47-2017-BCBS
CDISNM Blog
Medicare prescription drug coverage ensures you get the medications you need to stay healthy and strong. But whether you receive benefits through a standalone Part D plan or Medicare Advantage, understanding drug coverage can be complicated. With formularies and tiers, there’s much to know. To help you make sense of prescription drug coverage, here’s a quick summary of a formulary and how it works.
Formularies and Tiers
Each Medicare prescription drug plan has its own formulary or list of medications that are covered. The formulary organizes both generic and brand-name drugs into different classes or tiers that are grouped by cost. Generally, drugs in lower tiers cost less than those in higher tiers. For example, a brand-name drug to treat high blood pressure may be in Tier 3, while the generic version of the same drug might be available in Tier 1. Most prescription drug plans offer 4 tiers, and some offer 5:
Tier 1: Most generic prescription drugs, lowest copayment
Tier 2: Preferred, brand-name prescription drugs, medium copayment
Tier 3: Non-preferred brand-name prescription drugs, higher copayment
Tier 4: Specialty, unique, costly prescription drugs, highest copayment
Formularies change from year to year and you must review your Medicare Annual Notice of Change (ANOC) to make sure any medications you take are still covered. However, if your plan makes changes that impact you, they are required to let you know 60 days before the change takes effect.
Saving Money Using Formularies
Medicare drug plans negotiate pricing with drug companies, securing lower prices for medications than you could get yourself. Because of this, using drugs listed in your plan’s formulary may cost you less than using drugs outside of the formulary. Also, choose the generic version of drugs whenever possible to save even more. Generic drugs are essentially copies of brand-name drugs. How they are administered, dosage, safety, and strength are the same with both. Generic drugs use the same active ingredients as brand-name drugs and are used safely as a reliable alternative to more costly versions. The majority of prescriptions filled today use generic drugs.
When Your Drug Is Not on the Formulary
In the event a drug you need is not covered by your plan’s formulary, you may be able to get a formulary exception—a type of Medicare prescription drug coverage determination where your plan decides to cover a drug that’s not on the list. There are exceptions to tiers and formularies, but each requires a request from you or your provider as well as a supporting statement from your doctor explaining the medical reason behind the exception.
References:
Costs associated with using formularies: https://www.medicare.gov/Pubs/pdf/11136-Pharmacies-Formularies-Coverage-Rules.pdf page 2, 3
Formulary and tiers: https://www.medicare.gov/part-d/coverage/part-d-coverage.html
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