Medicare

Medicare insurance. Medicare Advantage Plans. Part C. Medigap. Supplement plans.

Texas: Friday Health Plans Bails; Another ~230K Enrollees Will Have To Pick A Different Day Of The Week

It was just four days ago that Bright Healthcare, which had been aggressively expanding their individual market coverage area footprint as recently as a year ago, suddenly announced that they were doing a complete 180 and instead pulling out of virtually the entire individual & small group markets nationally starting in January 2023.

This shouldn’t have been as much of a surprise as people thought, however; Bright had already announced back in April of this year that they were pulling out of five states, and healthcare analyst Ari Gottlieb had written an impressively-researched post about the warning signs surrounding Bright’s plight back in August, which I expanded upon here at the time.

In any event, Tuesday’s announcement by Bright that they were pulling out the other nine states they’re currently operating in means that nearly a million ACA individual market enrollees will either be automatically shifted to different insurance policies via different carriers or they’ll have to log into their accounts and actively pick a different policy themselves. This represents upwards of 8% of all on-exchange individual market enrollees nationally, including an estimated ~262,000 in Texas alone.

Scan the QR code to get more information

 Let us help you today

WE’RE AVAILABLE BY EMAIL (SUPPORT@EPROASSOCIATES.COM) OR BY PHONE (1-888-500-2578).

aetna medicare solution

WOW! Great news: Formulary enhancements for 2023

Starting in 2023, many of the top medications taken by Aetna Medicare members will be on a lower drug tier, Tiers 1 and 2. In fact, nearly 300 drugs are moving to a lower drug tier.

 

This includes drugs for asthma, depression, anxiety, and more. And many drugs for high blood pressure and high cholesterol are already on Tiers 1 and 2.

What’s the big deal?

These formulary updates may help members save on prescription costs.

For example, some of the Tier 3 drugs moving to Tier 2 include:

  • a) ALBUTEROL SULFATE HFA (asthma, COPD)
  • b) ESCITALOPRAM OXALATE (depression, anxiety)
  • c) CELECOXIB (pain relief, inflammation)
  • d) BUPROPION HYDROCHLORIDE ER (XL) (depression, smoking cessation)

Other fun facts

  • a) We’ve down-tiered nearly 300 drugs across each of our formularies: B2:         294; B4/B4+: 279; B5: 278 
  • b) Improved the volume of Tier 1 and 2 drugs on our MAPD formularies by           45% (compared with 2022) 
  • c) Nearly 8 in 10 members will continue to have access to $0/$0 Tier 1 and         2 copay structure 
  • d) Added ~10 new drugs to MAPD formularies including popular drugs such      as:
    •      i) Eligard (prostate cancer)
    •      ii) Gemtesa (overactive bladder)
    •      iii) Lantus (diabetes)*
    •      iiiv) Toujeo (diabetes)*
    •      v) Truxima (biosimilar, rheumatoid arthritis)
    •  

 *Drug already on B5+ in 2022

What you need to know about the Inflation Reduction Act (IRA)

President Biden’s signing of the Inflation Reduction Act (IRA) marks the beginning of implementing many years of substantial change to the Medicare Part B and Part D programs.

How does the IRA impact 2023 Medicare Advantage plans (MAPD) and Prescription Drug Plans (PDP)?
 
1. It limits the member cost-share on covered insulins to $35. 
  • a) This means members won’t pay more than $35 for a one-month supply of each insulin product covered by their plan, no matter what cost-sharing tier it’s on, even if their plan has a deductible that hasn’t been met. 
  •  
  • b) While some members already benefit from plans that offer $35 insulin, this legislation ensures that all seniors who use insulin benefit from this out-of-pocket cost limit.
  •  
  • c) Members receiving LIS will continue to pay the CMS statutory maximum cost share for insulin, which is less than $35.
  •  
  • d) In Florida, some 2023 Aetna MAPD plans will offer select insulins for a $0 cost share at preferred pharmacies and a $20 copay at standard pharmacies. On these plans, other covered insulins will be available for the $35 IRA copay.
  •  
  • e) In addition, the 2023 SmartSaver PDP (which is non-commissionable for new sales), available in all 50 states, offers covered insulin for a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies.
 

2. It eliminates member costs and improves access for Part D vaccines.

  • a) Our 2023 plans will cover most Part D vaccines for a $0 cost share, even if a plan has a deductible that hasn’t been met.
 
What information will members receive?
Member materials are being updated in accordance with CMS guidance to ensure members are properly informed of the changes.

 

How will insulin and vaccine benefits be displayed on Medicare Plan Finder?

Beginning October 1, the Medicare Plan Finder site (www.medicare.gov) will reflect Part D sponsors’ insulin and vaccine benefits and cost sharing as they were submitted in their 2023 bid and formulary submissions, prior to IRA being enacted. However, new insulin and vaccine drug footnotes and other help features will be displayed to explain the benefit changes resulting from the IRA.Because of this, CMS is granting a Special Enrollment Period (SEP) for Exceptional Circumstances to allow beneficiaries to add, drop, or change their Part D coverage if they find a better option after the 2022 Annual Enrollment Period (AEP) and through the end of 2023. This SEP will be available for all beneficiaries who use a covered insulin product and begins on December 8th, 2022, and ends on December 31, 2023. Beneficiaries may use this SEP one time during this period. To utilize this SEP, beneficiaries must call 1-800-MEDICARE so a customer service representative can process the enrollment change; they cannot use a broker for this SEP. Consistent with current policy, when Part D enrollees change plans mid-year, their True Out-of-Pocket (TrOOP) costs carry over from one plan to the next.

What’s coming in 2024?

Additional IRA requirements that will be implemented in 2024 include:

  • 1. $0 cost sharing in the catastrophic phase for Part D
  • 2. Expansion of the low-income subsidy eligibility to 150% of the federal poverty line
 
What additional impacts will IRA have in the future?
Additional IRA requirements will be implemented annually through 2029. We’ll share more information as we approach those implementation dates. 
 
Question?
  If you have any questions about 2023 Aetna Medicare plans, please reach out to your local Aetna Medicare Broker Manager.
 

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates (Aetna). 

SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal.
 
Prior to engaging in the sale of Aetna Medicare products, producers must be ready to sell, which means certified, contracted, licensed in the applicable states, and appointed by Aetna in accordance with state law. As permitted in certain states, Aetna will order appointments after the first sale. This communication is intended for use by brokers only and is not intended for distribution to Medicare beneficiaries. Any publication or distribution of this communication to unauthorized recipients without Aetna’s approval is prohibited.

You are receiving this because you have elected to communicate with Aetna through email. If you no longer wish to receive these particular messages via email, you may unsubscribe at any time. 
 
We are located at 151 Farmington Ave, Hartford, Connecticut 06156. 
 
©2022 Aetna Inc

Scan the QR code to get more information

 Let us help you today

WE’RE AVAILABLE BY EMAIL (SUPPORT@EPROASSOCIATES.COM) OR PHONE (1-888-500-2578).

Great news! CMS announces Medicare Part B premium reductions!

According to an update released by CMS on September 27, 2023: The standard monthly premium for Medicare Part B decreases to $164.90 in 2023, compared to $170.10 in 2022, a decrease of $5.20. The annual deductible for Medicare Part B beneficiaries decreases from $233 to $226 in 2023. The Medicare Part B monthly adjustment amount is income-related and the total premiums for fully insured Part B beneficiaries in 2023 are shown below.

Scan the QR code to get more information

 Let us help you today

WE’RE AVAILABLE BY EMAIL (SUPPORT@EPROASSOCIATES.COM) OR BY PHONE (1-888-500-2578).

Medicare Open Enrollment 2020-2021

The enrollment for drug and health plans for 2021 Medicare has opened! You can register in Medicare plans from October 15th until December 7th, 2020. The plan will be effective starting January 1st, 2021. This is the time to make any necessary changes to your Medicare plans to adjust to your needs for 2021.

what do you need to do

At ePro Associates, we want to make sure that you are able to enroll in Medicare plans with ease. Check your mail to see if you have received any important updates from Medicare or Social Security. If this is your first time enrolling in Medicare, you will receive a Medicare card in the mail. It is important to remember that you must enroll either 3 months prior to the month you turn 65, the month of your 65th birthday, or 3 months after. 

Below is an example of what the Medicare card looks like.

                                 

get personalized help

Choosing a Medicare plan can be complicated and confusing. Feel free to contact our agents at ePro Associates for assistance with choosing a plan! We are here to help our customers find the best plan suited for their needs with an affordable premium. You can contact us by selecting the tab at the top of the page. We will be glad to assist you in any way and make this process easy and understandable. 

Visit our Medicareful page to preview 2021 Medicare Supplemental, Medicare Advantage, and Part D plans!

https://medicareful.com/DerrickZhang

    Medicare Open Enrollment 2020-2021

    Serving the interests of our clients. Personalized support and relationships matter to us. Because we are owned by banks, we are empowered to deliver top-notch support and services able to add on additional cover to protect your valuable items

    Financial Group is a broker-dealer powerhouse that prides itself on an unwavering commitment. Serving the interests of our clients. Personalized support and relationships matter to us.

    It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use

    Serving the interests of our clients. Personalized support and relationships matter to us. Because we are owned by banks, we are empowered to deliver top-notch support and services.

    Duden flows by their place and supplies

    Contrary to popular belief, Lorem Ipsum is not simply random text. It has roots in a piece of classical Latin literature from 45 BC, making it over 2000 years old. Richard McClintock, a Latin professor at Hampden-Sydney College in Virginia, looked up one of the more obscure Latin words, consectetur, from a Lorem Ipsum passage, and going through the cites of the word in classical literature, discovered the undoubtable source. Lorem Ipsum comes from sections 1.10.32 and 1.10.33 of “de Finibus Bonorum et Malorum” (The Extremes of Good and Evil) by Cicero, written in 45 BC. This book is a treatise on the theory of ethics, very popular during the Renaissance. The first line of Lorem Ipsum, “Lorem ipsum dolor sit amet..”, comes from a line in section 1.10.32.

    • Should the home you’re renting be affected by fire
    • Theft or other unforeseen events
    • Renters Insurance will help ensure you don’t
    • Since 1914, the New York Mutual Insurance