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Medicare Expands Part B Immunosuppressive Drug Benefit for People with Kidney Transplants

The tree (kidney) is a 3D illustration of the medical environmental concept.

As of January 1, 2023, kidney transplant recipients who meet certain criteria can qualify for lifetime Medicare coverage for immunosuppressive drugs, regardless of age. This is great news! The new benefit is called Medicare Part B Immunosuppressive Drug (Part B-ID) and has a monthly premium of $97.10 in 2023. It only covers immunosuppressive drugs and no other items or services.

In the past, people on Medicare due to kidney failure, or end stage renal disease (ESRD) were eligible for 36 months of Medicare coverage after a successful kidney transplant. This coverage was crucial in large part for the payment of the hugely expensive immunosuppressive drugs necessary to prevent rejection of the transplanted kidney and keep it functioning well. Yet, unless a person was otherwise eligible for Medicare due to age or disability, this essential coverage would end in 36 months. This loss of coverage caused people huge financial strain, costing $10,000-$17,000 a year for the medication, often leading people to ration or stop taking the medications entirely, either of which greatly increased the risk of the transplant failing and the patient returning to dialysis. Many others did not even try to get a transplant for fear of not being able to afford their immunosuppressive drugs 36 months after their transplant.

Now this has thankfully changed. Read more for details on eligibility, how to enroll and more.

Understanding New Rules Regarding Insulin Costs & Rights to Switch Plans

Bottle of insulin injection with a syringe on black table and stainless steel background.

One of the many good provisions in the Inflation Reduction Act of 2022 (IRA) is the cap on out-of-pocket costs for all insulin drugs. The IRA limits out-of-pocket costs to no more than $35 per 30-day insulin prescription under all Medicare drug prescription plans. Plans also cannot charge a deductible for insulin. This means that a 60-day supply would be no more than $70, etc. And for those enrolled in Part D’s Extra Help, they will continue to pay their lower co-pay amounts.

Starting July 1, 2023 the same $35 cap per 30-day supply will apply for insulin used in traditional insulin pumps (covered by Medicare Part B).

These are significant cost-saving changes that will have a positive impact on many. Yet, as mentioned in an earlier article, this positive change is not reflected in Medicare Plan Finder’s drug cost estimates as the law took effect too late to be updated. As a result, when people researched their insulin drugs costs on the Plan Finder during Medicare’s Open Enrollment, the old, out-of-date, most-likely higher copays that plans were going to charge for insulin drugs still appeared. And these numbers won’t change until plans submit their next annual bid cycle with their Plan Benefit Package in spring/summer of 2023 to display the information for the 2024 plan year.

Therefore, if you or someone you know realize you made a wrong plan choice based on inaccurate insulin copay costs, you can call 1-800-Medicare and ask for a Special Enrollment Period (SEP) to change plans. The opportunity to ask for a SEP runs from December 8, 2022 through December 2023. You can use this SEP one time to enroll in a new plan.

For help in understanding your insulin coverage and costs, and choosing a plan which plan best meets your needs at the lowest cost is you’re using a SEP, contact your local Health Insurance Counseling and Advocacy Program (HICAP) (or your local SHIP if you’re another state) for free and unbiased assistance.

Read more.

Free At-Home COVID-19 Tests Available Again

Coronavirus Covid-19 home testing kit with swab and test tube

Good news! As part of the Biden Administration’s winter preparedness plan, the White House announced a new limited round of free at-home COVID-19 tests for the winter. Households can now order either standard at-home tests or tests that are more accessible for people who are blind or have low vision. The more accessible tests, the Ellume COVID home tests, work with a smartphone app to provide audio step-by-step instructions for administering the test and audio test results. Shipping for both types of tests is free.Older adults and people with disabilities who need support ordering the free at-home tests can contact the Eldercare Locator (800-677-1116) or the Disability Information and Access Line (DIAL, 888-677-1199).  Staff are available to assist you from 8 AM to 9 PM ET Monday through Friday. They can help you learn more about testing options, including by connecting you to accessible instructions and helping with test administration.

Medicare coverage for at-home COVID-19 tests

In addition to the tests available at covid.gov/tests, Medicare continues to cover up to 8 over-the-counter COVID-19 tests per month, including the Ellume tests. This coverage includes people with Medicare Advantage plans. You can call 1-800-MEDICARE (1-800-633-4227) with any questions, or visit Medicare.gov for more information.

Read online.

Paul Davis Will Be At West Valley Food and Wine Oasis

Your favorite Chamber of Commerce fundraiser is back!
Serving up FUN, FOOD and Fine Pours!!!

16th Annual West Valley Food & Wine Oasis
Wednesday, October 19th 2022 at 5:30 PM
22006 Erwin Avenue, Woodland Hills
Luxurious Jaguar / Land Rover Show Room

BUY YOUR TICKETS TODAY! Save $10 when you prepay.

Online pre-pay link closes at midnight on October 17th.
CLICK HERE
Guest Parking will be ample at the Warner Center Promenade and surrounding area.

Check out the video here!

Thank you in advance for understanding our no refund policy.
Chamber of Commerce Members ~ $50 each
Non-Members are welcome and appreciated ~ $75 each.
Party Pack~ ($250 Member Price/ $375 Non-Member price) Pay for 5 and get 6!
“At Door” pricing begins on October 18th add $10

Be present without being present:
~Purchase tickets for clients/friends/family/colleagues
~Donate to the Silent Auction
(Deadline for silent auction items Friday, October 7th)

Call Felicia or pay online. Phone: 818 -347-4737
E-mail guests name (s) to felicia@woodlandhillscc.net to reserve their spot.
Checks payable to

WV~WC Chamber of Commerce PO Box 1, Woodland Hills, CA 91365-0001

Thank you for your Support. We look forward to seeing you at the
West Valley Food & Wine Oasis!

Join Us 10-19-22 – Facey Presents Paul Davis Workshop on Medicare Health Plans

Let Facey help you understand your Medicare options.

Come to this free Zoom workshop. Listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

October 19 at 10:00 am: Click on the link to register:
https://tinyurl.com/PaulDavis-10-19-22

November 29 at 10:00 am: Click on the link to register for August 11:
https://tinyurl.com/PaulDavis-11-29-22

Join Us 7-26-22 – Facey Presents Paul Davis Workshop on Medicare Health Plans

Let Facey help you understand your Medicare options.

Come to this free Zoom workshop. Listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

July 26: Click on the link to register for July 26: https://tinyurl.com/dymf84mh

August 11: Click on the link to register for August 11: https://tinyurl.com/hfaczvvz

Stop Wasting Money. Get a Reality Check on Your Medicare Supplement Plans

Paul Davis

By Paul Davis

It’s time to shop for your Medicare supplement plan. How do you do this, what do you need to know and how much time will it take? The answer is simple. You don’t have to do anything, we do it for you.

What are Medicare Supplement Plans? Insurance that allows you to see any Medicare contracted provider in the U.S. without a referral. We regularly save people more than $1000 a year on their Medicare supplement plans. If you’re like many people, you may have signed up for a plan 10, 15 or even 20 years ago and have never bothered to shop for a better deal, or what I like to call “a reality check.”

How much money are you wasting on plans that don’t suit your needs?

If you’re lucky enough to have gotten on a Plan J or I, which has not been sold since 2010, you are on the most robust standardized Medicare supplement plan that ever existed. Plan J and I have an at-home recovery benefit that does not exist on current plans. We had hundreds of clients on this plan but not one that ever used this benefit. How much extra are you paying annually for this benefit, and is it worth it?

That’s where we come in. Here’s a brief explanation of the plans.

Since 2010, Plan F has replaced Plan J and I as the most robust plan available. It is still available to those who turned 65 before Jan. 1, 2020. But if your 65th birthday or Medicare eligibility is after that date, you are not eligible for this plan. There are no new young 65 year olds enrolling to dilute the pools. Consequently, we have seen significant price hikes on Plan F.

Plan G is the one we are moving our clients to. The only difference between Plans F and G is that with G you are responsible for the Part B deductible. That one-time deductible is $233 this year and will index up annually. If we save someone $100/mo. in their premium and they need to absorb this deductible, they are ahead by almost $1000. Over the past few years, we have seen more companies emerge with Plan G offerings and offer competitive pricing on them.

All the plans mentioned use the EXACT SAME NETWORK of providers and pay the exact same benefits (other than the deductible and recovery benefit).

For a Los Angeles County reality price check, go to https://pdinsure.com/medicare-supplement-price.

In California, we have a “birthday rule” which guarantees the right of existing Medicare supplement plan subscribers to change to any carrier’s similar or lesser Medicare supplement plan within 60 days of their birthday — with no health questions.

Now through February 28, both Blue Shield of California and AARP/UHC have open enrollments going. You can transfer to these carriers Medicare supplement plans from any present plan with NO HEALTH QUESTIONS.

Paul Davis of Paul Davis Insurance Services is an independent insurance agent licensed for more than 37 years, CA license 0669770, 0M47932, with a focus on Medicare plans for more than 12 years. Paul was recently appointed to the National Association of Health Underwriters Medicare Advisory Group. His practice is entirely devoted to this market segment. More information is available at https://pdinsure.com/, or contact Paul at 818-888-0880 or via email paul@pdinsure.com.