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Tag: Part D

  • Helping a Parent With Medicare: A Caregiver’s Toolkit

    Helping a Parent With Medicare: A Caregiver’s Toolkit

    A lot of Medicare decisions are not made by one person alone. They are made at a kitchen table, with a son or daughter reading the fine print, keeping track of the prescriptions, and making the phone calls. If you are helping a parent with Medicare this fall, a little preparation can make the process calmer for both of you.

    The Window

    The Medicare Annual Enrollment Period runs from October 15 through December 7. During that window, people with Medicare can generally change their Medicare Advantage or Part D prescription drug coverage, and any changes take effect January 1. If no change is made, coverage generally continues into the new year — under next year’s costs and rules.

    Step One: Get Permission in Writing

    This is the step most families discover too late. By law, 1-800-MEDICARE cannot share your parent’s personal health information with you unless your parent has given permission in writing first.

    The form is called the Authorization to Disclose Personal Health Information, also known as CMS-10106. Your parent can complete it online through their Medicare.gov account, or print, sign, and mail it. Medicare’s guidance indicates that an online submission generally takes effect sooner than a mailed form. Your parent can limit what you may see and can revoke the permission at any time.

    Medicare Advantage and Part D plans have their own authorization forms, so ask each plan for theirs as well.

    Step Two: Gather the Paperwork

    Before you sit down to review options, collect:

    • Your parent’s red, white, and blue Medicare card and any plan ID cards
    • The Annual Notice of Change from their current plan, which explains what is different for next year
    • A current list of every prescription, with dose and how often it is taken
    • A list of doctors, specialists, and the pharmacy your parent uses

    With those in one place, a comparison takes far less time.

    Step Three: Know What Changes for 2027

    Some changes apply to everyone with Part D coverage. For 2027, the standard Part D deductible rises to $700, and the annual out-of-pocket limit on covered prescription drugs rises to $2,400. A plan’s own deductible and costs may be lower; the plan’s Annual Notice of Change will show what applies.

    Premiums, drug lists, and provider networks also change from year to year. A plan that fit well this year is not automatically the right fit for next year.

    Step Four: Let Your Parent Lead

    Your role is to help your parent understand the choices — not to make the choice for them. Ask what matters most to them: keeping a particular doctor, predictable costs, or coverage for travel. Write down their answers. If your parent has trouble making or communicating decisions, legal documents such as a power of attorney may be needed; that is a question for an attorney.

    A Familiar Scenario

    Linda manages her father’s medications and noticed one of his prescriptions was listed differently in his plan’s Annual Notice of Change. Because her father had already submitted the authorization form, she was able to call with him, ask questions, and set up a review before December 7. He made his decision with all the information in front of him.

    We’re Here To Help!

    We are happy to talk with you and your parent together, by phone or in an online meeting, to walk through the options for 2027. Bring your list, bring your questions, and bring your parent’s priorities. Reach out before December 7 so there is time to make any changes for January 1. Call us at 818-253-1736 or use the contact form on our website.

    We do not offer every plan available in your area. Currently we represent 7 organizations which offer 35 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

  • Medicare Annual Enrollment Help in Los Angeles: 3 Things to Check by December 7

    Medicare Annual Enrollment Help in Los Angeles: 3 Things to Check by December 7

    Every fall, most people with Medicare Advantage or a Part D drug plan do the same thing: nothing. Their coverage rolls into the new year automatically, and for many of them that works out fine.

    The trouble is that plans change every year, and staying put only works if the plan you are staying in still fits. The Annual Enrollment Period is your yearly chance to check. If you live in Los Angeles or Burbank, we can go through these checks with you by phone or online meeting before the December 7 deadline.

    The Dates

    The Medicare Annual Enrollment Period runs from October 15 through December 7. During that window you can switch Medicare Advantage plans, move between Original Medicare and Medicare Advantage, or join, switch, or drop a Part D drug plan.

    Changes you make generally take effect January 1. After December 7 your options narrow considerably, so the useful time to review is now — before the window opens, not in its final week.

    Step One: Read the Annual Notice of Change

    If you are in a Medicare Advantage or Part D plan, your plan is required to send you an Annual Notice of Change each fall, generally by the end of September. It lists what is changing for the coming year.

    This document is easy to set aside because it looks like routine plan mail. It is the single most useful thing you will receive all year.

    Look specifically for changes to premiums, deductibles, and copays; changes to which drugs are covered and at what tier; and changes to the provider or pharmacy network. If you cannot find your notice, contact your plan and ask for it.

    Step Two: Check Your Doctors

    Medicare Advantage plans generally use provider networks, and those networks can change from one year to the next. A doctor who was in network this year is not guaranteed to be in network next year.

    Make a short list of the doctors, specialists, and hospitals you actually use, and confirm each one against the plan’s network for the coming year. Your plan’s provider directory is a starting point, but calling the doctor’s office to confirm directly is worth the extra few minutes.

    Step Three: Check Your Prescriptions

    Drug plans publish a formulary — the list of covered drugs — and it can change each year. A medication can be dropped, moved to a different cost tier, or given new requirements such as prior authorization.

    Write down every prescription you take, including dosage, and check each one against next year’s formulary. Confirm that your usual pharmacy remains in the plan’s preferred network as well, since that can affect what you pay.

    The Medicare Plan Finder at Medicare.gov lets you enter your medications and compare how different plans would cover them.

    If Nothing Changed For You

    If your doctors are still in network, your prescriptions are still covered on similar terms, and your costs are reasonable, staying in your current plan may be exactly the right answer.

    The point is not to change plans. The point is for staying put to be a choice you made rather than one that was made for you.

    A Familiar Scenario

    Someone has taken the same medication for years with a predictable copay. Their Annual Notice of Change arrives in September and goes into a drawer. In January, the first refill costs several times what it did in December — the drug moved to a higher tier.

    The information was in the notice all along. It simply was not read until it was too late to act on it.

    We’re Here To Help!

    If you would like help working through your Annual Notice of Change, or checking your doctors and prescriptions before December 7, give us a call. Reviewing it early leaves time to act on what you find.

    This article is general information about the Medicare Annual Enrollment Period. Plan details, costs, and networks vary and change each year; confirm current information with your plan, at Medicare.gov, or by calling 1-800-MEDICARE.

    We do not offer every plan available in your area. Currently we represent 7 organizations which offer 35 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.