How to Find the Best Medicare Part D Rx plan

medicarerx2019 Medicare Part D Rx plans can really help you fight the cost of prescription drugs.  In most cases the costs of prescriptions are decreased by up to 75% and sometime higher.

OPEN ENROLLMENT  –  These prescription plans are considered Medicare Advantage plans which have “open-enrollment periods.”  The most common is the Annual open enrollment period running from October 15 through December 7 of each year.

This is the time all Medicare members are able to view, compare and change Part D Plans.  Any changes will be effective January 1.

Enrollment Opportunities:

  • Initial Enrollment Period (IEP) when a person first becomes eligible for Medicare, they have three months to enroll in a Medicare Part D plan, from the time their Medicare coverage starts.  After this three month window closes, they will be locked out until the next open enrollment.
  • Annual Enrollment Period (AEP) – This is the time each year you are able to change Part D companies or stay with the same plan.  The AEP starts each year on October 15 and ends December 7, for an effective date of January 1st.
  • Special Enrollment Period (SEP) If you are exiting an employer health insurance plan, or if you have moved outside of the plans service area, both allows a two month open enrollment period for you to choose and enroll in a Part D plan.

Another common “special enrollment period (SEP)” is if a person who is currently is enroll in a Part D plan, but moves their residence outside the the Part D plan or company service area.  Or, if a Medicare Advantage plan does not renew or offer coverage the next year.  These situations also allows a two month open enrollment period to find a new plan in your county of residence.

ALSO – If you if you move into, reside in, or move out of a qualified institutional facility: a skilled nursing facility, nursing home, psychiatric hospital or unit, Intermediate Care Facility for the Mentally Retarded—ICF/MR, rehabilitation hospital or unit, long-term care hospital, or swing-bed hospital.  These all provide SEP opportunities anytime of the year.

Where to Compare Part D Plans:

One of the best places to compare all of the Medicare Part D plans in your county is the Medicare website.  There will typically be 25 to 30 plans available in your county.

Be sure to compare all plans because each plan and company will provide a different level of coverage for your prescription list.

Choosing the right Part D plan will benefit you greatly when paying for your meds throughout the year.  On the other hand, choosing the wrong plan may cost you hundreds and potentially thousands of dollars more.

Unfortunately the Medicare website isn’t an easy site to navigate.  When entering your meds, dosage and frequency you need to be very accurate, and double check your entries.  If you are not familiar with the website mistakes can be made, altering the results.

2019 Part D Coverage Details …

Private insurance companies are the only place to purchase a Part D Rx plan.  And most follow a “Standard Benefit Plan Outline” which is as follows:

  • Initial deductible ($415) – Some plans may have an annual deductible, while others do not have any deductible at all, allowing “first dollar coverage.”  After the deductible is met the Plan pays 75% and you pay 25% of the covered costs until the total prescription costs meet the initial Coverage Limit.
  • Initial Coverage Limit ($3,820) – Once you satisfy a deductible, then you will most likely have copays for each of your prescription drugs.  This coverage limit extends to the point where the total retail cost of the medication(s) reach $3,750.
  • Coverage Gap “Donut Hole”  ($3,820 – $5,100) – Next is the “Coverage Gap” (Donut Hole) this part of the plan is when you have your retail costs of your prescriptions reach a total of $3,820.  At this point you will pay 56% of your “Generic” drugs and the 65% of your “Brand” drugs, until your total prescription retail price cost reaches $5,000.  You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.
  • Catastrophic Coverage ($5,100) – After the Donut Hole you enter the “Catastrophic Coverage” portion of your plan.  This is when a person has spent more than $5,000 in prescription costs.  At this time, they will be protected by the Catastrophic Coverage which typically covers 95% of their drug costs for the balance of the year.

Looking for a Medicare Supplement or Medicare Advantage?  Click Here.

“I do not sell Part D plans but I’m happy to help you with your search.  I help my clients every year go through their Part D options, so feel free to call or email anytime.”

No Cost Help … there is no charge for my services.  The insurance companies provide a fee for me to help with coverage options, enrollment and service.

John Conner

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8 Tips to Help You Find the Right Medicare Supplement

How do you find the right Medicare Supplement Plan, when there are so many options out there? Here are some tips to help you better understand.

The Medicare Open-Enrollment starts October 15, please call for details in your area.

8 Tips:

1. When you first become eligible for Medicare A and B … this is the first available time when you can enroll in a Medicare Plan.  And during this time you will be flooded with every company mailer, advertising piece and brochure.  They will start filling your mailbox about 4 months prior to you turning 65.  These piles of fancy marketing material typically tries to push you into that companies most profitable Medicare plan, which is usually one of their Medicare HMO’s.  Be sure to take your time, ask questions, look at different plan and policy options, so you end up with a policy that best fits your needs.

With all of this you will want to do a little homework or call an independent agent like myself.  One who is not going to push one company on you, but rather show the different company rates and discuss the differences between a Medicare Supplement, Medicare Advantage and Part D Rx plans.

2.  If you are exiting an “employer health insurance” policy … you have a 2-month open enrollment period which allows you to enroll into any Medicare plan available to you in your area.  Again, be sure to check many of the popular companies and comprehensive plans.

3.  The Medicare website is not necessarily the best place to check what Medicare Supplement companies and plans are available in your zip code. It typically will not provide current premiums and what plans the company is offering.

4.  Compare the different company premiums …  There may be quite a difference when comparing.  Since all Medicare Supplement policies are Federally standardized, there is no reason to pay more for the same type of policy. Federally standardized means; all Medicare Supplement plans provide the same benefits.  For example, Plan F, provides the exact same benefits and pays for the same services as any other Plan F nationwide.  So when looking at benefits, company A’s Plan F, will be exactly the same as company B’s Plan F, or, company A’s Plan N is the same as company B’s Plan N.

Here is a basic Medicare Supplement coverage outline, showing which each Medigap plan covers:

Medicare Supplement Plan Chart 2016

5.  If you currently have a Medicare Advantage HMO or PPO … and wish to move to a Medicare Supplement policy, you can try to move anytime of the year.  Although there are a few things to keep in mind.  If you dis-enroll or cancel your Medicare Advantage plan mid-year (outside of open enrollment) you will also be cancelling your Medicare Part D coverage and will not be eligible for a new plan until the next January 1.  Also when applying for the new Medicare Supplement policy, you will need to answer the health and prescription questions on the enrollment form.  The company will then review your application and base their decision on your current and past health status.  The policy may be declined because of health status, or will be approved.  Cancelling a Medicare Advantage plan mid-year can be a bit tricky, so call me and we can take a look at your options.

6.  If your Medicare Advantage plan non-renews … (or if you move out of the service area … This is an easy one.  You will have 2 months to enroll into any available Medicare Supplement, Medicare Part D Rx or Medicare Advantage plan.  This is a small open-enrollment you can take advantage of and enroll (guaranteed) into any plan available in your county.

7.  California Birthday Rule … This Medicare Supplement rule allows anyone who resides in California and who currently has a Medicare Supplement policy in force to switch companies to a plan with similar benefits or less. This is a guaranteed enrollment, you don’t need to answer any health or prescription questions on the new enrollment form.  Every company has a little different interpretation of this rule, but generally; from your birthday and up to 30 days past, you can enroll in a new companies plan without medical underwriting.  This is a great opportunity for you to save by switching companies.

8.  Look for company discounts … some of the current discounts are; Spouse discount. This is when both enroll in the same company and plan, the discounts range from 5% up to 12% depending on the company.  Monthly bank debit discount is another one. For those who like or don’t mind their monthly premiums being deducted automatically from a bank or savings account, several companies offer a $2 or $3 per month discount.  Then there is the “New to Medicare” which both Anthem and also Blue Shield are offering.  This is for anyone who is new to Medicare and enrolls in one of these two companies Medicare Supplement plans, they will receive a $15 (Blue Shield) or $20 (Anthem) monthly discount for the first 12 months they are on Medicare.

A few links for you:

Questions?  Call or email anytime.

John Conner

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Silver Sneakers and Blue Shield Medicare Supplement

Blue Shield of California offers the SilverSneakers Fitness Program to members of the Blue Shield Medicare Supplement plans throughout California.  The current Medigap subscribers can join the Silver Sneakers program at no additional cost and enjoy fitness, fun and friends with the award-winning program.

Designed exclusively for individuals on medicare and taught by certified instructors, offers an innovative blend of physical activity, healthy lifestyle direction and social opportunities to Medicare-eligible individuals.  Studies have found individuals who participate in Silver Sneakers have a significantly lower risk of depression and require fewer admissions to the hospital.

Silver Sneakers … You can use as many facilities as you like!  Work out with cardio and weight equipment, access pools or take group exercise classes taught by instructors trained specifically in senior fitness.

Did you know  This award winning fitness program gives members a fitness club membership and access to more than 13,000 participating locations across the country, including 24 Hour Fitness, YMCAs and many others.  Best of all, it’s at no extra cost to you.

Aetna   Anthem   Blue Shield   Health Net   UnitedHealthcare

Silver SneakersMembers have access to a wide variety of benefits, including:  A basic fitness membership at any participating location around the country, with access to all amenities usually included with a basic membership.

  • A trained adviser at each fitness location to introduce you to Silver Sneakers, show you around the location and help you get started.
  • Silver Sneakers classes.
  • Silver Sneakers Steps, for members without convenient access to a location.
  • ACT NOW for Fitness … to help you track your health progress.
  • Health education seminars and other events.

Blue Shield Medicare Supplement plan members who reside 15 miles or further from a participating  Silver Sneakers location have access to the Silver Sneakers Steps program.  Members count the steps they take daily while engaging in activities they enjoy such as walking, dancing, playing with the grand kids or working in the yard.

Silver Sneakers Steps members receive a kit that includes a step counter, exercise bands, an exercise DVD, exercise illustration cards and a drawstring bag to store their Steps program tools.

How do I enroll in Silver Sneakers Enrolling is easy.  Take your health ID card to a Silver Sneakers participating fitness location and the friendly staff will take care of the rest.  It usually takes less then 30 minutes.

Am I limited to using just one fitness location?  No.  You are welcome to use any of the more than 13,000 participating locations nationwide.  After you enroll, you will receive a listing of participating locations near you, amenities, addresses, and phone numbers. Or, you can go here: 

No Cost Help … there is no charge for my services.  The insurance companies provide a fee for me to help you with coverage options, enrollment and service.


John Conner

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Medicare Supplement Plans California

Medicare Supplement plans in California.  The most popular plans are currently Plans F, G and N.


  • Plan F = 100% hospital coverage – 100% outpatient.
  • Plan G = 100% hospital coverage – $185 outpatient deductible then 100%.
  • Plan N = 100% hospital – $185 outpatient deductible then $20 Dr visit copays.

CALIFORNIA BIRTHDAY RULE … This rule allows you to switch companies each year on the month of your birthday, without having to answer any medical questions.  This move is guaranteed as long the move is to a plan with equal or less benefits.  All Medicare Supplement companies in California must follow this birthday rule.

You need to know the difference between the different Medicare Supplement (Medigap) plans.  Medigap plans are insurance policies sold by private insurance companies that are designed specifically to fill in the gaps left by Medicare.

Medicare Supplement plans help pay for some of the Medicare deductibles and coinsurance which you would be responsible for.  Each plan; A, C, D, F, G, N and M are some of the available California Medigap plans.  Each offers different benefits and all are priced medicare-provides-no-coverage-outside-the-us-1differently.

Each company sets their own rates, so please compare the different rates in your area.  Prices vary drastically.  Also be sure to check the new Medicare Supplement plans M and N.  They offer some unique benefits.  Plan F continues to be the plan of choice for most Medicare beneficiaries because of the comprehensive benefits.

The Medicare deductibles continue to rise, the part A deductible is now $1,364 per 60 day benefit period.  This is not a traditional annualized deductible.  There are six potential benefit periods per year, meaning there is a possibility you would be responsible for six, $1,364 deductibles in any given year.  This is why most seniors choose to purchase this insurance option called a Medicare Supplement plan.

Medicare Part D Rx … You will also need to purchase a Medicare Part D Prescription Drug plan.  Most plans are between $20 to $45 per month which provides coverage for your prescription medications.

Enrolling is Easy … Applying is easy; once you are enrolled in Medicare parts A and B, you can enroll into a Medicare Supplement plan with companies such as; Aetna, Anthem, Blue Shield, Health Net and UnitedHealthcare, and compare plans.  Then pick a solid company with low monthly premiums.

Medicare Advantage Plans … Also compare the $0 premium Advantage plans – Anthem MediBlue, Blue Shield 65 Plus and many others which include the Medicare Part D Rx plan  Click here

No Cost Help … there is no charge for my services.  The insurance companies provide a fee for me to help with coverage options, enrollment and service.


John Conner

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Medicare Supplement Plan G in Ohio

Medicare Supplement Plan G is quickly becoming a very popular choice between Medicare Supplement Plans.

Identical to Plan F, except Plan B does not cover the Medicare Part B annual outpatient deductible of $183.  Depending on your current age, Plan G will offer a significantly lower premium than Plan F.

Be sure to compare several companies before choosing.  For example; Aetna, Anthem, Mutual of Omaha,  will most likely be some of the lowest priced Medicare Supplement plans in your area.  The Anthem plans available in Ohio as in most of the other Anthem States (California, Colorado, Connecticut, Indiana, Kentucky, Missouri, Nevada, Ohio, Virginia) are; A, F, G and N.

Ohio Medicare Supplement Plans:

Plans; F and N provide a different level of coverage.  Original Medicare has deductibles and co-insurance for both inpatient and outpatient coverage.  Part A (Inpatient hospital) has a $1,316 ‘benefit-period deductible for each 60 day benefit period.  Medicare Part B (Outpatient) has an annual deductible of $183 and then 20% coinsurance after the deductible is satisfied (Medicare pays 80% you are responsible for 20%).


Original Medicare – The federal health insurance program available to people 65 years of age or older.  Medicare is also available to people with certain disabilities who are under age 65 and also on Medicare.

  • Part A is Hospital Insurance.  This pays for inpatient hospital stays, care in a skilled nursing facility and hospice care.
  • Part B Medical Insurance (Outpatient).  This helps pay for doctors services, outpatient hospital care, durable medical equipment and some medical services not covered by Medicare Part A.
  • Part C – Medicare Advantage Plans (Usually HMO’s and PPO’s).  Only available through private insurers contracted with Medicare.  Medicare Advantage plans are usually County specific, meaning they are available in certain counties.  Premiums can typically range from $0 to $100 per month, although most are in the $50 to $75 range.  A Medicare Advantage plan will take the place of Medicare for your health insurance needs.  Medicare is still in place but merely in the background.
  • Part D is Prescription drug coverage.  Like a Medicare Advantage plan, Medicare Part D is available only from private insurance companies.  Joining a Medicare Part D plan is voluntary, and you pay a monthly premium for the coverage.  You must first have Medicare Parts A and B before enrolling in a Part D Rx plan.

Other Companies …

Anthem – Mutual of OmahaAetna

Enroll …

If you are in a “Guarantee-Issue” period or situation, you do not need to answer any of the “health history” or “prescription” questions on the application.  First you will need to print the appropriate State  Complete the application and fax it to me for processing, I’ll do the rest to make sure you receive your requested effective date and the application process is quick and accurate.  Please feel free to call me and I will walk you through the application.  The application process will usually take 1 to 2 weeks to complete.


John Conner

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