Maximizing Your Benefits

Maximizing Your Benefits

Happy New Year to all our valued clients! We wish you good health for the upcoming year, and hopefully a little fun as well! 

By now, you all have received information on your 2020 benefit plans. Some of our clients have a Medicare Supplement plan and a stand-alone prescription drug plan (PDP). The others have a Medicare Advantage plan that includes prescription drug (MAPD). In any case, we want all of you to maximize your benefits so that you get the most out of your plan. 

First, whether you have a stand-alone PDP or your prescription plan is part of your MAPD plan, you should familiarize yourself with the benefits. Each prescription drug plan has 5 tier levels and usually tiers 1 and 2 have the lowest cost or copay as they are generic medications. If possible, and appropriate, using generics will save you money on your medications. Also, if a generic is the right fit for you, try and use a “preferred” pharmacy. Each plan has a set of preferred pharmacies. They are listed on the plan’s website, you can call the plan using the customer service number on the back of your ID card or call us and we will assist you. But by using a preferred pharmacy, you will get a lower copay on your medications then if you use a non-preferred pharmacy, so it is important to know which pharmacies are preferred. A tier 1 generic medication at a preferred pharmacy is often a $0 copay or a very low copay. 

Second, we always tell our clients to take advantage of the free gym membership, if offered by your plan. Most of the plans have Silver Sneakers which is accepted at many gyms. You can check on the web at to find a gym near you. Most of the MAPD plans have Silver Sneakers and some of the Medicare Supplement plans do as well. Check your plan to see if you have this benefit. If so, it is a great way to stay active and there is no cost. 

If you have a Medicare Advantage plan, the plans offer many other benefits that you should familiarize yourself with. Some of the plans have a benefit called “Over the Counter” (OTC) where you can order various health items out of catalog that the plan furnishes to you. These items typically include vitamins, aspirin, band aids, toothpaste, cough and cold remedies and other health related supplies that you would normally purchase in a drug store without a prescription. Please check your plan and see if you have this benefit. Most of the plans have what is called a “use it or lose it benefit” approach with OTC. For example, if you get a $25 per month benefit, then you must use that each month and cannot carry over that amount to the next month. For that reason, we urge our clients to take advantage of that benefit each month. 

Some plans also include other benefits such as, transportation benefits that provide rides to doctor appointments, hearing aid allowances, dental allowances and vision service allowances. You should really familiarize yourself with all your additional benefits to make sure you are getting the most out of your plan. 

Finally, most of the MAPD plans are either HMO’s or PPO’s so if possible, try and find an in-network provider in order to get the lowest copay amount. In an HMO plan, if you voluntarily go out of network, your services may not be covered. In a PPO plan, you will almost always pay a higher copayment for services when you go out of network. 

We hope these tips are helpful and please do not hesitate to contact us if you have any questions or issues. 

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