Making The Most Of You Medicare Coverage For 2009-2010

There are many Federal, State and Local programs and subsidies available for Seniors and Medicare eligible beneficiaries. Through my experience over the last few years I have noticed that many people either do not realize or simply do not know how to qualify or enroll in these programs. I have made it my personal mission to make sure that everyone that is eligible for help receives it. Obviously I only have the power to assist those that contact us and ask for help. 

Here Are A Few Examples:

  1. Medicare Savings Programs: There are actually 4 levels of Medicaid subsidies. Many Seniors will apply for full Medicaid and when they are turned down they simply suffer, scrimp and save to pay the bills. I have spoken to several of these folks and they did in fact qualify for another level of Medicaid called SLIMB. This subsidy will pay the Medicare PART B premium which was $96.40 in 2009. Now that is a nice savings!! But they do not tell people this. They make you figure it out for yourself
  2. Part D Low Income Subsidy: This is a subsidy that will pay for your Part D premiums, cover you through the dreaded “doughnut hole” and even reduce your co-pays. You can apply for this right online!! Go to and follow the links to the Medicare section. If you can’t find it or need help visit and ask for help or call the toll free number.
  3. State Sponsored Medicare Subsidies: If you don’t qualify for one of the Federal programs don’t give up! Many States have special programs with higher income thresholds. For example NY State has a program called EPIC and a single Senior 65 or older can make $35,000 per year or less ($50,000) for married couples AND YOU STILL QUALIFY!!  North and South Carolina have similar programs (the income levels may be different) and many other states have programs as well.

These are just a few examples. My point is that with proper planning and knowledge of the system, healthcare can actually be manageable for Seniors. Unfortunately the government does not do a very good job of communicating this to the public. I have searched for programs in all 50 states and have had great success. Some states do not have their own programs but most do. When a person does not qualify for a state or Federal program you may still be able to cut costs by strategically choosing the correct insurance plan.

If you need assistance in finding a program in your state you can call the toll free health insurance helpline at 1-877-300-2214


Medicare Part D Plans For 2010

There are quite a few proposed changes for 2010 Medicare Part D prescription drug plans.  I will be watching for the final decisions over the next weeks and months. I will post the information as it becomes available. Today I am posting the proposed changes in the Part D deductible and the proposed “doughnut hole information”. There has been some additional developments. A deal has been struck with the prescription drug companies to help soften the blow to those entering the “doughnut hole”. The proposal will reduce the cost from 100% while in the “doughnut hole” to 50% in 2010. Keep in mind that this could always change. When I receive official documentation from the Centers for Medicare And Medicaid Services (CMS) I will post it immediately.

CMS Part D 2010 Standard Benefit Model Plan Details

Here are the highlights for the CMS defined Standard Benefit Plans for 2009 and 2010. This “Standard Benefit Plan” is the minimum allowable plan to be offered.

Once again: these are the proposed numbers and the official numbers are supposed to be released on October 1, 2009. Also keep in mind that this information is for plans offering the MINIMUM coverage. There will be many plans available that offer More coverage than the minimum plan. Be sure to look for the best deals. Or vsit our website to request plan specifics and the best deals in your county

  • Initial Deductible:
    from $295 in 2009 to $310* in 2010
  • Initial Coverage Limit:
    from $2,700 in 2009 to $2,830* in 2010
  • Out-of-Pocket Threshold:
    from $4,350 in 2009 to $4,550* in 2010
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
    from $2.40 for generics and $6.00 for other drugs in 2009 to $2.50 for generic or preferred drug that is a multi-source drug and $6.30* for all other drugs in 2010
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    from $2.40 for generics and $6.00 for other drugs in 2009 to $2.50 for generic or preferred drug that is a multi-source drug and $6.30* for all other drugs in 2010

Changes In Private Fee For Service (PFFS) Medicare Plans For 2010

Many private fee for service Medicare plans will be pulling out of the market in 2010. This is due to the budget cuts and new regulations put in place by our Federal Government.

However, there is no need to panic, since there are many great alternatives available. Many of the larger companies are gearing up to offer Preferred Provider Organization Plans (PPO) for 2010. A PPO plan has a network of providers to choose from but also allows the patient to use an out of network provider as an option. Using an out of network provider however, will usually cost the patient more. This is usually done in the form of a higher copayment (a pre-set fee) or co-insurance (a percentage of the bill).

By choosing the correct plan, a consumer can literally save thousands of dollars per year. Here Are just a few tips for choosing a good plan.

  • Make A list of your regular doctors and specialists and find out which plans they accept.
  • Make sure a plan has a set Copayment rather than Coinsurance (if possible)
  • Be sure to compare the hospital copayments of the various plans (some can be very expensive)
  • Determine if hospital copays are per day or per stay
  • Be sure to find out if you need a Regional or Local PPO plan to fit your specific needs

You will usually have an easier time of it if you get advice from a licensed insurance broker but you will want to make sure the broker offers more than one company to choose from (otherwise they may be more of a salesman rather than an advisor).

Medicare Plans For 2010

Welcome to the new Medicare Plans Blog. I have decided to start this to help educate and assist seniors and those on SSI disability to understand the different parts of Medicare.  I have a full staff that specializes in assisting Medicare eligible beneficiaries understand and choose plans that will be the most economical for each specific situation. We also assist in finding the appropriate government programs if necessary. There are many changes each year and 2010 is no exception. I will be posting relevant information and changes on a regular basis. We also have a website located at