Why its important to review your Medicare plan every year

1. Why is it important to review
your Medicare plan each year?
Not reviewing your plan can cost you both money
and benefits

2. Carriers make
changes to
their plans
each year
Add/remove benefits
Benefits
Increase/decrease rates
Rates
Change formularies
Formulary
Add/remove/change drug tier levels
Drug Tier
Levels
Increase/decrease copays
Copays
Increase/decrease Max Out of Pocket (MOOP)
Max out of
pocket limit
Change Drug Stage Limits per CMS guidelines
Drug Stage
Limits

3. Result of
Not
Comparing
Plans
You may pay more than you
need to
You may be losing out on
benefits
You could get more benefits by
changing plans even within the
same carrier

4. What
should you
be looking
at when
comparing
plans?
Network (HMO/PPO)
Premium
Deductible (Medical/Prescription)
Max out of pocket (MOOP)
Inpatient Hospital Costs
PCP/Specialist copays

5. What
should you
be looking
at when
comparing
plans?
Prescription Copay
Dental Benefit
Vision Benefit
Hearing Benefit
OTC allowance
Fitness Benefit

6. What is an HMO?
An HMO (Health Maintenance Organization) is a network of contracted doctors,
health care providers, and hospitals that have agreed to contract with a carrier at a
particular rate.
• In most cases you are required to select a PCP (Primary Care Physician) who will
coordinate your care across all specialties.
• You may need a referral to see a specialist. Some plans have eased this restriction,
but you want to know before scheduling an appointment with a specialist.
• It is important to STAY IN NETWORK with an HMO plan. Out of network visits are
not covered unless preauthorized by the carrier.

7. What is a PPO?
• A PPO (Preferred Provider Organization) is usually a larger network of
contracted doctors, healthcare providers, and hospitals that have agreed to
contract with a carrier for a particular rate, however, this plan allows you to
see OUT OF NETWORK providers at an increased cost (copay or
coinsurance)
• These plans don’t always require you to select a PCP (Primary Care
Provider) but may recommend it.
• These plans don’t usually require a referral to see a specialist, however,
you will pay less if the specialist is in the PPO network.

8. What is Max
out of Pocket
(MOOP)?
This is the most you pay
for copays, coinsurance
and other costs for
medical services for the
year.
• Premiums and drug copays DO
NOT count toward your max out
of pocket.

9. Inpatient
Hospital Costs
It is very important to understand when you are inpatient and when you
are in observation.
• You are Inpatient once you are formally ADMITTED into the hospital by
a physician. Once ADMITTED Part A will be activated and daily charges
will apply.
• Up until you are formally admitted into the hospital, even if you are in a
room, you are in OBSERVATION which falls under PART B. You will not
be charged “daily charges” until you are formally ADMITTED.
• Daily charges can vary by carrier and plan. The amount and the number
of days should be taken into consideration.
• A plan may look like they have a lower inpatient hospital cost, but are
they?
Example: A carrier charges $250.00 per day for the first 7 days. Another
carrier charges $350.00 per day for the first 4 days. If you are in the
hospital for 8 days you will pay $1,750 under carrier A, but $1,400 under
carrier B. However, if you are in the hospital for 3 days, carrier A charges
$750 where carrier B will charge $1,050.

10. Prescription
Drug Tier
Levels
Most carriers use the same Tier levels but be sure to compare.
• Tier 1: Preferred Generic (lowest costing generics)-lowest
copay
• Tier 2: Generic- slightly higher copay
• Tier 3: Preferred Brand- higher copay
• Tier 4: Non-Preferred Brand- high copay and sometime
percentage
• Tier 5: Specialty Tier-highest cost and always a percentage
It is best to have a set copay for Tiers 1, 2, 3, and 4.
You may never be prescribed a Tier 5 drug but the lower the
percentage the better, just in case.

11. OTC
Allowance
(Over the
Counter)
An added benefit where the carrier gives you a dollar amount each
quarter that can be used to purchase over the counter (OTC) items such
as vitamins, band-aids, cough and cold meds, etc. Typically, eligible items
are those items you will find in the aisles in front of a retail pharmacy.
Normally use it or lose it, however, some carriers may roll this amount
over until the end of the year when any unused dollars will expire.
Use your credit! Think outside of the box. Even if you can’t use
everything, think of loved ones, grandbabies, friend and neighbors.
Its your benefit…you all of it each quarter/year.

12. Why use an Independent Broker to
help you compare available plans?
• An independent broker contracts with all major carriers so
that, when they compare plans, they are comparing ALL
plans and not just the plans one carrier offers.
Using an illustration: Let’s say you wear size 5 pant. You look
at a store but all they have is size 7. If you buy the size 7,
you’ll have pants, but the fit will be wrong, and you’ll be
uncomfortable. Same thing for a plan. If you go directly to a
carrier to review plans all they have is THEIR plan (size 7).
They can’t show you the size 5 you wear. An independent
broker can fit you into the size YOU WEAR versus fitting you
into the size THEY OFFER.

13. Why an Independent Broker who
is also a Licensed Pharmacist?
• A licensed Pharmacist provides value because they have a level of
expertise other brokers don’t have.
• A licensed Pharmacist is familiar with the healthcare system and how it
operates.
• A licensed Pharmacist is familiar with drug Tier levels, Prior Authorizations,
Quantity Limits, Lock-In Situations and can provide guidance in areas other
brokers (Independent or with a carrier) can’t.
I operate the only Insurance Agency in the country that partners with agents
who are not only Independent Insurance Brokers, but who are also LICENSED
PHARMACISTS.
I am licensed in Life, Accident, and Health Insurance in TN, MS, AL, GA, SC,
MD, MI, and MN.
I am licensed in Pharmacy in TN, MS, and OH.

14. Plan Review Process
• Determine benefits from your current plan using enclosed
worksheet
• Email Norma a list of your current doctors and medications,
your zip code, county, and the best way to reach you
(norma@yourmedicarepharmacist.com)
• Norma will review ALL available plans and determine which
plans to further examine against your current plan.
• If I determine you would benefit from a change in plan, we
will schedule an appointment to make that change
between October 15, 2021 and December 7, 2021 with the
plan taking effect Jan 1, 2022.

15. I want to be
your Agent of
Record
Johnson Healthcare Advisors
Norma Johnson
Located in Spring Hill, TN
931-777-9801
My service is at NO COST TO YOU! I am paid
by the carrier if ,and when, I enroll you into a
plan. I will become your Agent of Record and
be with you every step of the way going
forward.