The information in this blog pertains mostly to those who are aged 65 and up and do not already qualify for Medicare due to a disability. The information provided is meant to serve as a guideline and does not qualify as legal advice. For questions or more information, we recommend you visit the medicare.gov website or speak with a local insurance agent.

It is highly recommended that everyone reviews their Medicare plan annually as your plan often does not reflect changes to your health and medication needs. Additionally, plans also change every year, so there may be a plan out there that better fits your needs.

Which Medicare plan is right for me?

Knowing which Medicare Part D plan is right for you can be difficult. However, there are six key things to consider when reviewing your plan as well as other plan options.

1. Is my medication in the same coverage tier?

Your current plan’s formulary may change, and your medications could then be placed into different tiers. This often changes year to year, so be sure to look at this closely when it is time to review and renew your plan.

2. Do I take the same medication as last year?

Your medication needs often change over time. Whether you have switched to a new medication formula, are taking an additional prescription to treat something new, or no longer need to take a medication that you had been taking last year, reviewing which plans are best based on your current medication needs is crucial. For example, you may have previously selected a specific plan that had a high premium because it placed a needed recurring medication in a low tier; since last enrollment period, you switched to a generic version of that medication that is less expensive across all plans. In this scenario, you  may be able to pay a lower premium and still have the coverage you need. ¹

3. Is my pharmacy in the plan’s network?

Insurance companies often instruct plan participants to use certain pharmacies or mail-order services. Before signing up for a plan, talk with your current pharmacy to ensure you will be able to use them or if there is another plan that will work that also allows you to keep your current pharmacy.

4. Am I paying for a high premium that I don’t use?

It’s sometimes worth paying up for a Part D plan that offers better coverage because whatever you spend in premiums, you make up for in copay savings. But if you don’t have any ongoing prescriptions or if your medications are covered on a lower-premium plan, then you may be better off opting for a lower-cost plan. ¹

5. Does my income affect my benefit eligibility?

If you have a lower income, you may qualify for better benefits. Low-income members, including those who have both Medicare and Medicaid, can apply for different benefits. It is important to know all your options. Click here for more information on the “Extra Help” program.

6. Does the Medicare plan have a good record?

A plan’s quality of customer service and attention to detail are measured in star ratings. Good star ratings – especially ratings of four stars and above – can mean a plan has demonstrated quality customer service and has a track record of paying attention to your many healthcare needs (such as periodic screenings or health assessments). Conversely, you should be wary of plans with fewer than four stars. Those plans often have a history of mistreating their members, providing underwhelming customer service, and being slow to process member claims and appeals – delaying or even preventing access to needed health care. ²

When can I enroll in a Medicare plan?

You can enroll in Medicare coverage during designated enrollment periods. The enrollment period varies for different situations. The three main periods to pay attention to are:

1. Initial enrollment is a seven-month period that begins three months prior to your 65^th birthday, includes the month you turn 65, and extends another three months after your 65^th If you sign up for a plan during the three months prior to your 65^th birthday, your coverage begins the first day of the month you turn 65. If you sign up during your birthday month or in the three months after your birth month, coverage beings the first day of the month after you ask to join the plan. ³
2. Open enrollment occurs annually from October 15 through December 7. During this time, you can join, switch, or drop your plan. Coverage under whichever plan you select begins January 1.

   If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to enroll. Instead, you must use the Medicare general enrollment period, which runs from January 1 to March 31. ⁴

3. Medicare General Enrollment and Medicare Advantage open enrollment is from January 1 through March 31 every year. If you enroll during the general enrollment period, your coverage will take effect July 1. ⁴

What can I do during open enrollment?

There are several changes that can be made during the Open Enrollment period: ³

• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
• Join a Medicare drug plan.
• Switch from one Medicare drug plan to another Medicare drug plan.
• Drop your Medicare drug coverage completely.

You cannot, however, make changes to any Medigap plans. These plans are only guaranteed-issue in most states during a beneficiary’s initial enrollment period and during limited special enrollment periods. ⁴

What is Medigap?

Medigap is another name for Medicare Supplement insurance plans that help patients pay for out-of-pocket healthcare costs that may be incurred with Original Medicare Parts A and B. Medigap enrollment is a six-month period beginning the first day of the month you turn 65 years old. You must be enrolled in both Medicare Part A and Part B to be able to purchase a Medigap plan. During that time, you can buy any Medigap policy sold in your state, regardless of your health status. During the six-month Medigap enrollment period, insurers must charge people with preexisting conditions the same price as they charge people in good health. ⁵

If you apply for Medigap coverage outside of your open enrollment period, insurers are allowed to use medical underwriting to deny or charge more for coverage in most states. This means you may pay more or be denied coverage if you have preexisting medical conditions, such as diabetes or heart disease, or if you are facing an upcoming surgery. ⁶

Sources:

¹ https://www.medicareresources.org/medicare-benefits/four-signs-you-need-a-new-medicare-part-d-plan/

² https://www.medicareresources.org/medicare-benefits/seven-rules-for-shopping-medicare-part-d-plans/

³ https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

⁴ https://www.medicareresources.org/medicare-open-enrollment/

⁵ https://www.nerdwallet.com/article/insurance/medicare/what-is-medicare

⁶ https://www.medicareresources.org/states/

Across the United States, hospitals are reaching their capacity again while treating patients with COVID-19. It has become crucial that we do what we can to help prevent the spread of the flu and reduce the burden on the doctors and nurses who have been fighting against COVID-19 for so long.

People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with the flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes. ¹

Beyond that, people with the flu are contagious beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. This means you may be sick with flu and pass it on to someone else before you even experience any symptoms. Children, and some of those with weakened immune systems, may pass on the virus for longer than 7 days. Even if you experience zero symptoms, you are still able to pass the virus on to others. ¹

To keep you and your family healthy all flu season long, let’s look at the 5 best habits to employ to avoid getting and/or spreading the flu.

Keep your distance

Much like COVID-19, adding physical space between yourself and others will significantly reduce your risk of contracting the flu. It is believed that the flu can be spread to others up to approximately 6 feet away, so keeping your distance from others is a great way to protect yourself. Additionally, personal contact with an infected person, such as a handshake or hug, is a common way these viruses spread. ²

Whenever possible, keep interactions outside as the risk for spreading the flu decreases when compared to indoors. However, outdoor transmissions do happen, and being outdoors does not make you immune to contracting or spreading the virus.

Stay home when sick

For flu, the Centers for Disease Control and Prevention (CDC) recommends that people stay home for at least 24 hours after their fever is gone except to get medical care or other necessities. Fever should be gone without the need to use a fever-reducing medicine. ³ Additionally, people may still be infected with the flu and have respiratory symptoms without fever. Other flu symptoms include cough, sore throat, runny or stuffy nose, body aches, headaches, chills, and fatigue. Some people may also have vomiting and diarrhea.

Prescribed antiviral drugs can make your flu milder or shorten the time you are sick and may also reduce the risk of serious complications. Studies have shown that antiviral drugs work best for treatment when they are started within 2 days of getting sick but starting them later can still be helpful. ³ If you are experiencing flu-like symptoms, talk with your doctor to see if antiviral prescriptions may be right for you.

Cover yourself

Since the flu and other respiratory illness are usually spread via droplets made when people cough, sneeze, or talk – it is crucial that you cover your mouth and nose when coughing or sneezing. Additionally, avoid using your hands whenever possible and opt for a tissue or your elbow. COVID-19, RSV, and whopping cough are other examples of respiratory illnesses that can be spread by cough, sneezing, or unclean hands.

Wearing a mask is another great way to prevent the contraction and spread of respiratory illnesses. Public health and clinical laboratories estimated about 38 million people were sick with the flu during the 2019-2020 season. However, the agency reported a mere 2,038 flu cases during the season from Sept. 27, 2020, to April 24, 2021, according to the CDC. ⁴ Experts believe that the social distancing, mask wearing, hand washing, and stay at home prevention measures that were implemented to fight COVID-19, rendered the 2020-2021 flu season virtually nonexistent. As annoying or inconvenient as these measures where, there is no denying that they significantly reduced the spread of the flu.

Get vaccinated

The single best way to prevent seasonal influenza is to get vaccinated every year. Everyone ages 6 months and older is eligible to get a flu vaccine and it is especially important for those who are a higher risk of developing serious flu complications. Higher risk individuals include young children, pregnant people, people with certain chronic conditions like asthma, diabetes, or heart and lung disease, and people ages 65 years and older.

Timing also matters when it comes to getting your flu vaccine. It takes two weeks to be fully protected after receiving your vaccine, so it is best to get it prior to any holiday traveling or celebrations. Additionally, vaccine effectiveness isn’t permanent – which is why we must get the vaccine every year – so it is best to avoid getting it too early so you can be protected throughout the duration of flu season, which typically ends around April. The CDC recommends getting your flu vaccine by the end of October.

Keep clean

This applies to yourself, your home, and your office. Washing your hands with soap and warm water or using an alcohol-based hand rub are the best ways to keep your hands clean. Unclean heads are a leading cause of spread, as flu germs are easily transmissible through touch and can last on surfaces up to 24 hours. You should avoid touching your eyes, nose, and mouth whenever possible, and routinely clean and sanitize frequently touched objects such as doorknobs, keyboards, and phones.

By implementing these simple, preventative actions into your daily life, you set yourself apart and reduce your risk of exposure, and transmission, of the flu. If we all do our part, we can keep the flu from spreading and protect not only ourselves, but our friends, family, and coworkers. For questions or more information, please contact our team today.

Sources:

¹ https://www.cdc.gov/flu/about/disease/spread.htm

² https://www.mayoclinic.org/diseases-conditions/flu/expert-answers/infectious-disease/faq-20057907

³ https://www.cdc.gov/flu/prevent/prevention.htm

⁴ https://www.usatoday.com/story/news/health/2021/05/10/flu-cases-historically-low-during-covid-what-expect-fall/7088318002/

https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm