By Patricia L. Burris, CFP®, Vice President, Corporate & Retirement Plan Services
Provided by Meld University
If you are already on Medicare, or getting ready to enroll, you want to make sure you take advantage of the benefits offered, without increasing your costs. There may be ways you can lower your out-of-pocket expenses as well.
Benefits available with all Medicare Plans at little or no cost include:
“Welcome to Medicare” Preventive Exam
This exam must be done within the first 12 months you enroll in Medicare Part B. The exam is free if the services your doctor conducts are limited to the review your medical and social health history and discussing preventative services. You may have to pay your Plan’s applicable coinsurance and Part B deductible if your doctor performs additional tests or services during this initial ‘welcome’ exam. The ‘Welcome to Medicare’ exam is especially beneficial for new Medicare recipients who are changing doctors.
Annual Wellness Visit
Once every 12 months Medicare will pay for an annual visit to your doctor, who accepts Medicare’s assignment, to develop or update your personalized prevention plan. This exam may also include preventative services such as flu shots and diabetes, high blood pressure, bone density, colorectal cancer, mammogram and other health screenings.
Medicare Mobile App
You can now use an app on your smart phone to see if a service or procedure your doctor is recommending is covered by Medicare. Simply search for “What’s Covered” or “Medicare” in the App Store or Google Play and download this app.
Once you are on Medicare, there may be ways to lower your out-of-pocket expenses, such as:
The amount of premium you pay for original Medicare Part B (excluding supplemental coverage) and prescription drug coverage is based on your income two years ago. The Part B premium for 2019 is $135.50. However, if your Modified Adjusted Gross Income (adjusted gross income plus tax-exempt interest) in 2017 was over $170,000 for married filing joint taxpayers or over $85,000 for single filers, you will pay an income-related monthly adjusted amount (IRMAA) of up to an additional $325.00 for Part B and up to an additional $77.40 for prescription drug coverage. If you experienced one of the life-changing events listed below since 2017, you can file form SSA-44 with the Social Security Administration to request a change in your IRMAA premium.
- Divorce or Annulment
- Death of Your Spouse
- Work Stoppage
- Work Reduction
- Loss of Income-Producing Property
- Loss of Pension Income
- Employer Settlement Payment
Prescription Drug Costs
In addition to choosing the right drug plan each year, you need to also make sure you are getting your Rx filled at the right pharmacy. All prescription drug plans, whether a Part D stand-alone plan or through a Medicare Advantage Plan, have a network of pharmacies. You need to have your Rx filled through one of these pharmacies, or through mail order, in order for them to be covered by your drug plan. However, what many people don’t realize is that many drug plans have ‘preferred’ pharmacies that have better pricing with lower out-of-pocket expenses. You can determine which pharmacies are considered preferred by your Part D or Medicare Advantage Plan by looking on their website or requesting a Pharmacy Directory.
You should be sure to review your carrier’s list of network and preferred pharmacies each year since they can very easily change from year-to-year. For example, in prior years Medicare subscribers would not have their Rx covered if filled at Walgreens with one of the most popular Medicare Advantage Plans here in the Birmingham area, whereas Wal-Mart was considered a preferred provider. In 2019 Walgreens, Publix and many independent pharmacies are considered preferred providers for this same Medicare Advantage Plan, with Wal-Mart remaining in the network, but not as a preferred provider.
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