Medical

Doctors	Eyes	Medicare
Drugstores	Humana	Medicare Advantage
Dental	Ornish	Medicare Supplemental

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Doctors

Chiropractor
- Dr. Roger Clifford, D.C. (05/19)
  - 4222 Trinity Mills Rd, Suite #106
  - (972) 934-1660
  - Mon-Thurs: 8:00 am - 1:00 pm, and 3:00 pm - 6:00 pm
  - Medicfusion Patient Login (10/16)
Dentist (Prosthodontist)
- Dentistry for Adults (P. Andrew Benson) (09/19)
  - 6300 W Parker, Suite 223, Plano, TX 75093
  - Medical Office Bldg 2, closest to Midway Road (use parking lot C)
  - 972-981-8653
  - Hours: Mon: 9-5; Tue-Thu: 8-5: Fri: 8-2 (occasionally until 5 pm)
  - We will attempt to maximize your insurance benefits
  - Major credit cards
  - Email: drbenson@denistryforadults.com
  - Dr. Benson is board certified
  - Dental technician (Larry Costin, The Lab Guy)
    - 2828 W Parker, Plano, TX (Parker & Independence)
    - Larry selects the custom shade for your teeth
- Cook Periodontics (Periodontics & Dental Implants) (01/23)
  - Jeremiah B. Cook
  - Phone:469-888-4315
  - Hours: Mon-Thu: 7:30am-4:00pm; Fri-Sun: Closed
  - 5858 Main St, Suite 260, Frisco, TX 75034
  - Trip #1:
    - DNT north to Main St
    - Main St East one block to World Cup Way
    - North on World Cup Way
    - Turn (right) into parking lot north of the building
    - Office is in the center building
    - Building is next door to Toyota Stadium
Eye Doctors
- Ophthalmologists
  - Dr. Kimberly Warren (cataract surgery; 55 years old) (07/24)
    - Key-Whitman Eye Center (07/24)
    - 3060 Communications Pkway Ste 205, Plano, TX 75093
      - (972) 769-2020
      - Mon-Fri: 8:00am-5:00pm
      - NE corner of Wedgewood Dr and Communications Pkway
      - Actually ONE block north of Wedgewood Dr
      - SE corner of Parker & Communications Pkway
      - Actually TWO block south of Parker
      - In the same building as the Texas Heath Neurosurgery & Spine
    - 11445 Dallas Pkwy, Ste 240, Frisco, TX 75033; (214) 220-3937
  - Dr. Lewis Frazee (74 years old) (07/24)
    - Dr. Lewis Jacob Frazee @ northtexaseyecenter.com (07/24)
    - Accepting patients
    - Fri, July 26th 8am; Plano office; 10-15 min early (Frazee)
    - North Texas Eye Center
    - Phone: 972-867-7777
    - 751 Hebron Pkwy, Ste 230, Lewisville, TX 75057
      - Mon-Fri: 8:00am-5:00pm
      - NE corner of Hebron and Lakepointe Dr (just E of 35E)
    - 4100 W 15th, Ste 210, Plano, TX 75093
      - Mon-Fri: 8:00am-5:00pm; Sat: 8:00am-12 noon
      - 972-867-7777
    - Dr. Ellen Ngo (07/24)
    - Dr. James Passmore (07/24)
      - Dr. Ellen Ngo @ northtexaseyecenter.com (07/24)
  - Dr. Marvin Hsiao @ leeeyesurgery.com/ (02/20)
    - GREAT expericence!
    - He removed a scar on the cornea (old wound)
    - He diagnosed cornea edema, and suggested salt eye drops
  - Eye Surgery Center of North Dallas (02/20)
- Glasses Prescriptions
  - How to Read Your Eye Prescription @ warbyparker.com (08/23)
  - Eyeglass Prescription Positive Cylinder Conversion @ aclens.com (08/23)
    - Ophthalmologists write astigmatism prescriptions with positive (+) cylinders
    - Most eyeglass labs cut lenses in the negative (-)
  - Optical Transposition Calculator @ chadwichoptical.com (08/23)
    - SPH CYL AXIS: +1.00 +0.50 180 ==> 2.50 +0.75 80
  - Effective Power (08/23)
  - Diopter Radius Curvature Calculator @ chadwickoptical.com (08/23)
  - Aniseikonia Calculator @ chadwichoptical.com (08/23)
  - Sagitta Calculator (08/23)
- TransVision Eye Care (08/23)
  - 18181 Midway Road, Suite 100, Dallas, TX 75287 (SW corner Midway & Frankford)
  - 972-662-2020
  - Mon, Tue, Thu, Fri: 9:00 am - 5:00 pm; Wed, Sat: 9:00 am - 2:00 pm
  - Huey Tran, OD
  - Has been serving North Dallas for more than 15 years
  - Dr. Huey Tran also enjoys fitting contact lenses for everyone,
    especially those hard-to-fit patients
  - Accepts VSP
  - Patient Forms (08/23)
  - TransVision Eye Care @ yelp.com (08/23)
  - TransVision Eye Care @ reviews.birdeye.com (08/23)
- Our Doctors @ myeyedr.com (08/23)
  - MyEyeDr. Locations near me (08/23)
  - MyEyeDr. @ Trinity Mill Rd (08/23)
    - 2810 E. Trinity Mills Road, Suite 173, Carrollton, Tx
    - 972-416-1270
    - Mon-Fri: 9:00 am - 6:00 pm
    - Sat: 8:00 am - 2:00 pm
    - Dr. Victoria Tran (graduated as valedictorian in 2019)
    - Dr. Philip Stiles (64 years old)
  - MyEyeDr. in Hebron Parkway (08/23)
    - Book an appointment @ Hebron Parkway (08/23)
    - 3012 E. Hebron Pkway, Suite 100, Carrollton, TX
    - 972-307-5000
    - Opens at 9:00 am Monday (not open on Saturday)
    - Dr. Chris(topher) H. Peterson (47 years old; MyEyeDr since Jan 2020)
      - Dr. Christopher H. Peterson @ eyedoctor.io (08/23)
      - Graduated from University Of Houston - College Of Optometry in 2006
    - Dr. Timothy Leach (keratoconus, glaucoma)
    - Dr. Mary Ann Peck (practiced for over 33 years; 66 years old)
  - MyEyeDr. in Plano - Midway Rd (08/23)
    - 3405 Midway Rd, Suite 421, Plano, TX
    - 972-801-2727
    - Opens at 8:00 am Saturday
    - Dr. Morgan Schultz (graduated in 2019 with Summa Cum Laude; sounds good)
    - Dr. Amritha Toppae (age 31)
  - 2313 W. Parker Rd, Plano, TX 75023
    - 972-612-2015
    - Dr. Brian Rast
    - Dr. Parisa Foroutan (bilingual in both English and Farsi; trained in San Antonio)
    - Dr. Bilal Ismail (glaucoma; intense light pulse therapy)
    - Dr. Johnson Ly
  - MyEyeDr. in Prestonwood (08/23)
    - 5495 Belt Line Rd, Suite 160, Dallas, TX
    - 972-980-1773
    - Opens at 8:00 am Saturday
- Donna Haas @ trinityvision.net (03/22)
  - 2765 E. Trinity Mills Road #405
  - Carrollton, TX 75006
  - (NW Corner of Trinity Mills and Marsh)
  - (972) 818-3937
  - Hours: Mon-Thu: 9am-5pm; Fri: 9am-2pm
Podiatrist
- Kellvan Cheng @ elitefootankle.com (08/19)
  - 4222 Trinity Mills Road, Suite 112, Dallas, TX 75287
  - South side of Trinity Mills, east of Westgrove (same building as Chiropractor)
  - 214-710-1028
  - Mon-Fri: 8:00 - 5:00
  - Tuesday, August 20th @ 10:30 am (left big toe, partial nail removal)
  - Friday, October 18th @ 9:30 am (left big toe, total nail removal)
  - Tuesday, November 5th @ 9:15 am (status check)
  - Tuesday, November 19th @ 9:15 am (right big toe and pinky, nail removal)
  - (status check)
  - GREAT doctor!

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Drug Stores, etc

Information
- Thyroid USP Porcine Now Available (as of Dec 14, 2022) @ pccarx.com (09/24)
- Thyroid Porcine @ drugs.com (09/24)
  - Brands include: APur Thyroid, Armour Thyroid, Bio-Throid,
    Nature-Throid, Niva Thyroid, NP Thyroid, Westhroid, WP Thyroid
- Armour Thyroid @ pharmacy.amazon.com (09/24)
  - 60 mg (1 grain); 1 tablet; 30 days; $33.22 (with prime)
- Armour Thyroid @ rxabbvie.com (09/24)
  - Armour Thyroid is derived from porcine thyroid glands
  - It is not approved by the FDA
  - Desicated Thyroid Extract (DTE) is called Armour Thyroid, NP Thyroid,
    Nature-Thyroid, and Natural Thyroid
- Armour Thyroid @ pushhealth.com (09/24)
- Naturopathic Doctors
  - Renewed Vitality (thyroid doctor) Dr. Spurlock (09/24)
  - Naturopathic.org (09/24)
    - Dr. Kimberly Wilson (09/24)
Retail Drugstores
- Armour Thyroid @ goodrx.com (60mg tablets; 90 tablets; $99.00) (09/24)
- CVS Pharmacy #7440 (05/23)
  - 17410 Marsh Lane (and Trinity Mills), Dallas, TX
  - 972-306-4931
  - Pharmacy hours: M-F 10-8 (closed 1:30-2:00); Sat 10-6; Sun 11-6
- CVS Pharmacy #7623
  - 4610 Frankford Rd, Dallas, Tx (east of DNT)
  - 972-732-6197
  - Pharmacy Mon-Sun: open 24 hours (closed 1:30-2:00 pm daily for lunch)
Compounding Online
- CSF Pharmacy (NJ) (09/24)
  - Thyroid Porcine 60mg; 90 caps; $79.95 + $4.95 shipping
- Empower Pharmacy.com (Houston, TX) (09/24)
  - Refuse to quote a price without a precription
- ReviveRX.com (09/24)
  - 888-689-2271
  - Houston, TX
  - Thyroid Porcine 60mg; 90 caps @ $101.25; 180 caps @ $202.50
  - Request Presription (09/24)
- Glendale Pharmacy (NP Thyroid) (09/24)
Compounding Drugstores
- Plano, TX
  - Abrams Royal, Plano (09/24)
    - P: 972-599-7700
    - Mon-Fri: 9am-6pm | Sat-Sun: Closed
    - Thyroid Porcine: 30 caps @ 60mg: $43.28; 90 caps for $129.84
  - Texas Star Pharmacy (09/24)
    - 3033 W Parker Rd, Suite 100, Plano, TX
    - Located at Parker & Independence
    - 972-519-8475
    - M-F: 9:00am-6:30pm; Sat: 9:00am-1:00pm
    - Can handle Thyroid Porcine
    - Refuse to quote a price without a precription
  - Spring Creek Pharmacy
    - 4666 McDermott Rd, Ste 200, Plano, TX 75024
- Dallas, TX
  - A&M Drugstore (09/24)
    - 15340 Dallas Pkway, Suite 2630, Dallas, TX 75248
    - Northbound DNT & South of Arapaho (east side)
    - 214-377-8066
    - Mon-Fri: 9am-5pm
    - aandmdrugstore@gmail.com
    - Can compound Thyroid Porcine; 30 @ $48.00; 90 @ $90.00; 100 @ $91-92
    - Can compound 90 caps for much less money; talk to Mel
  - Doughertys Pharmacy (good comments) (09/24)
    - New Patients: 214-833-6729
    - info@doughertys.com
    - 12835 Preston Rd, Ste 202, Dallas, TX
    - SW corner of 635 & Preston
    - Yes, they can compound Thyroid Porcine
    - 30 caps: $74.99; 60 caps: $104.99; 90 caps: $134.99
- Lewisville, TX
  - Forumalation Compounding Center @ pharma1rx.com (09/24)
    - Retail arm of the Formulation Compounding Center
    - 469-301-7621
    - Closed at 5pm?
  - Formulation Compounding Center @ formulationrx.com (09/24)
    - 1511 Justin Rd, Lewisville, TX 75077
    - 469-946-6690
    - The compounding pharmacy location
    - Closed at 5pm?

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Dental

Delta Dental (05/24)
- DPO Premium Plan (for two): $84.50/mo
  - Annual deductible of $50
  - Annual maximum of $2,000
  - 11,920 network dentists
- DPO Basic Plan (for two): $39.84/mo
  - Annual deductible of $50
  - Annual maximum of $1,000
  - 11,920 network dentists
- DeltaCare USA TXA70 (for two): $25.00/mo
  - Payment made in one payment of $300; $10 enrollment fee
  - No annual deductible or annual maximum
  - 189 Primary Care Facilities
    - West Plano Modern Dentistry and Orthodontics
    - Westgrove Dental Care Facility

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Eyes

Eye Glasses
- Eyemart Express (05/24)
  - 13800 Senlac Dr, Ste 200, Farmers Branch, TX 75234
  - Hours: Mon-Fri 9 AM - 5:30 PM
  - Phone: (972) 488-2016
  - Military discount: 20% off
  - VSP Claims -- Out Of Network
Vision Insurance
- Best Vision Insurance Companies of May 2024 @ usatoday.com (05/24)
- VSP Insurance Plans @ vsp.com (05/24)
  - Enhanced plan: $56.90/mo for both of us ($682.80/year)
    - $150 frame allowance
    - Exam copay: $15
    - Basic lens copay: $25
    - Scratch resistant: $0
    - Anti-glare: $15
  - Easy Options plan: $47.41/mo
  - Standard plan: $26.80/mo (for both of us) (Visionworks)
- Humana Vision PLUS Plan @ humana.com (05/24)
  - Humana Vision Plus: $14.99/month for one person
  - Humana Vision PLUS Plan (PDF) (05/24)
- EyeMed Quote (2 people) (05/24)

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Humana

Medicare & You 2025
- Medicare & Your 2025 @ medicare.gov (10/24)
  - Yearly out-of-pocket drug costs will be capped at $2,000
  - Part B premium should be $185 (5.9% increase)
- Medicare Premiums 2025: Projected IRMAA for Parts B and D @ kiplinger.com (10/24)
  - IRMAA will be based on Line 11 of your tax return (Adjusted Gross Income)
  - These figures change annually with inflation, and have a two-year lag time
  - The 2025 IRMAA will be based on our 2023 tax return
  - Here are the numbers for 2025 (filing jointly)
    
    Income Part b Part D
    
    >$0 and <$212,100 $0 $0
    
    >$212,100 and <$265,000 $71.90 $13.30
    
    >$265,000 and <$332,000 $179.90 $34.30
    
    >$332,000 and <$398,000 $287.80 $55.40
HumanaChoice H5216-358 (PPO) - 2024 Choice
- HumananChoice H5216-358 (2024) @ ehealthmedicareplans.com (10/24)
  - Out-of-pocket maximum: in-network ($7,500); out-of-network ($12,850)
- Medicare Advantage Plans (2024) @ ehealthmedicareplans.com (10/24)
- Coverage will end on December 31, 2024
Humana (PPO) - 2025 Choice
- Plans @ plans.humana.com (10/24)
- HumanaChoice Giveback H5216-431 (PPO)
  - Call 1-800-421-7858 (5am-8pm) to sign up
    - Joshua Joseph: 877-256-1640 x1382785
  - THIS PLAN IS ONLY FOUND ON THE HUMANA WEBSITE
  - This plan includes enhanced dental benefits when you enroll on our site.
    It also adds money back to your Social Security check with the Part B
    giveback program.
  - Giveback will be up to $74.00 per month
  - Change in cost will be -$14.00 (larger giveback) and +$10.30 (Part B increase)
  - Change in cost/month will be -$7.40 (for household)
  - Maximum out-of-pocket: in-network ($8,300.00); out-of-network ($13,850)
  - Dr. Frazee & Dr. Clifford are in network ($55 copay)
  - Dr. Cook is not in network (50% coinsurance)
  - Summary of Benefits (10/24)

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Dr. Ornish

Ornish.com (05/24)
UnDo It! @ amazon.com ($5.03) (05/24)
Basic Principles
- There’s a growing scientific and medical consensus that lifestyle changes
  can prevent and reverse chronic diseases
- When it comes to lifestyle changes, slow and steady does not win the race
- The underlying causes of chronic illness can be found in, and removed from,
  our modern lifestyles
- A plant-based diet is one of the pillars of maintaining long-term health
- Plant-based foods provide health-boosting substances, while meats and refined
  carbs do the opposite
- Exercise makes you healthier, happier and smarter
- Stress is dangerous but also preventable
- Strong social connections are a fundamental part of a healthy life

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Medicare

Contact Medicare
- Call 1-800-633-4227
- Sign Up for Part B Only @ ssa.gov (06/24)
  - Call 1-800-772-1213
  - Medicare Part B Online Application @ secure.ssa.gov (06/24)
  - Lower IRMAA @ ssa.gov (05/24)
- Dallas SSA
  - 10824 N. CENTRAL EXPWY, DALLAS, TX 75231
  - Southeast corner of I-75 and Royal Lane
  - Phone: 1-800-772-1213
  - Fax: 1-833-515-0513
  - Hours: M-F 9:00am-4:00pm
  - Offices are busiest on Monday, the morning after a Federal holiday,
    and the first week of the month
- Manage Your Medicare Benefits @ ssa.gov (06/24)
  - You'll sign up for Part A and Part B through Social Security.
  - Once enrolled, you'll manage your benefit plans through Medicare.
    - View/pay your Medicare bill
    - Get the Medicare handbook
    - Compare and choose Medicare Advantage and prescription drug plans
- How to Check Your Medicare Application Status Online @ medicreinsuranceaz.com (06/24)
  - How to check the status of your Medicare application
    - Through your online Medicare account
    - Online through your Social Security account
    - Calling the Social Security Administration at 1-800-772-1213
    - Visit your local Social Security office branch
  - Check Enrollment Page on your Online Medicare Account
    - Medicare.gov (06/24)
    - Click "Log in/create an account" in the top right
    - Create an account if you don't already have one
    - Log in to your account
    - Click the "Check enrollment" page
    - You should see the status of your application and any other information
      about your benefits
  - Check your application on your online Social Security Account
    - SSA.gov (06/24)
    - Click "Check application or appeal status" in the top central banner
    - Sign in or follow the steps to create an account
    - Select "Your benefit application"
    - Click on "View Details"
Information
- You can Appeal a Medicare Premium Surcharge @ kiplinger.com (05/24)
  - Seniors who enroll in a Medicare Advantage plan that includes drug coverage
    are also subject to a surcharge
  - For purposes of calculating the surcharge, MAGI consists of your adjusted gross
    income
  - The most common life change that leads to a reconsideration of the surcharge is
    retirement
  - Social Security recalculates your income every year (but with a two-year lag)
  - If a drop in income is due to retirement, include a copy of the tax return
    for the year your income declined, along with a letter from your former employer
    stating that you've retired.
  - You can mail or fax the form and supporting documents to your local Social Security
    office, or take it there in person
  - Medicare beneficiaries contesting their IRMAA typically visit a Social Security
    office to file an appeal or supply supporting documents
- When Does Medicare Coverage Start @ medicare.gov (05/24)
  - Special Enrollment Period (IF you have coverage from an employer) OR
  - 8 months after coverage ends for Parts A and B
  - 63 days after coverage ends for Parts C and D
  - You will pay STIFF PENALTIES if you enroll late
- Avoid Late Enrollment Penalties @ medicare.gov (08/24)
  - You may be able to ask for a "reconsideration"
  - Your drug plan will send you information about how to request a reconsideration
  - You must complete the form, and send it within 60 days from the letter's date
  - Also send any proof that supports your case, like a copy of your notice of
    creditable prescription drug coverage from an employer
  - In general, Medicare's contractor makes a reconsideration decision within 90 days
  - By law, the late enrollment penalty is part of the premium, so you must pay the
    premium even if you don't agree with it
  - You must also pay the penalty even if you've asked for a reconsideration
  - IF Medicare's contractor decides that your late enrollment penalty is correct,
    the Medicare contractor will send you a letter explaining the decision, and you
    must pay the penalty.
Part A
- Pays for hospital stays
- Deductible is $1,632 in 2024
Part B
- Sign up for Part B only
  - Sign Up for Part B Only @ ssa.gov (05/24)
  - Form CMS 40B Application for Enrollment in Medicare Part B (pdf) (05/24)
- Medicare premiums for 2024
  - Medicare Premiums 2024: IRMAA for Parts B and D @ kiplinger.com (05/24)
    - Earning < $206,000: Part B (+$0.00); Part D (+$0.00)
    - Earning < $258,000: Part B (+$69.90); Part D (+$12.90)
    - Earning < $322,000: Part B (+$174.70); Part D (+$33.30)
    - Earning < $386,000: Part B (+$279.50); Part D (+$53.80)
    - You should submit a Medicare IRMAA Life-Changing Event Form (PDF)
  - 2024 Medicare Parts B Premiums and Deductibles @ cms.gov (05/24)
    - Medical insurance component of the Medicare program
    - Pays for doctor's office visits, medical equipment, and outpatient procedures
    - Deductible is $240 in 2024
    - BASE Monthly premium is $174.70 for 2024
  - Premiums for high earners
    - High earners may pay significantly more
    - Medicare uses your Modified Adjusted Gross Income to determine your premiums
    - Earning < $206,000: $174.70
    - Earning < $258,000: $244.60
    - Earning < $322,000: $349.40
    - Earning < $386,000: $454.20
    - Earning < $750,000: $559.00
  - Medicare Premiums @ ssa.gov (06/24)
    - Use Form Medicare Income-Related Monthly Adjustment Amount -
      Life-Changing Event to report a major life-changing event
    - If your income has gone down, you may also use Form SSA-44 to request a
      reduction in your income-related monthly adjustment amount
    - The fastest and easiest way to file an appeal of your income-related monthly
      adjustment amounts is online
  - Appealing a Higher Part B or Part D Premium (IRMAA) @ medicareinteractive.org (06/24)
- How to pay for Part A & Part B Premiums
  - How to Pay Part A & Part B Premiums @ medicare.gov (06/24)
    - Most people don't get a premium bill from Medicare because they get
      their Medicare Part B (Medical Insurance) premium deducted automatically
      from their Social Security benefit payment
    - If you pay for Part B only, you will get a bill every three months
    - If you applied for Medicare to start in August, you'll receive a bill
      in July for your August, September, and October Part B premiums
    - If you also pay for Part A or a Part D IRMAA surcharge, the bill you
      receive in July will be for August's premium
    - If you pay for Part D IRMAA, you will get a bill every month
    - All Medicare bills are due on the 25th of the month
    - You are always paying your premiums in advance (Medicare A, B, C, and D)
    - Social Security benefits are paid in ARREARS (the benefit check you
      receive is for the previous month). Medicare premiums are paid in
      ADVANCE of coverage.
  - Medicare Premium Bill (CMS-500)@ medicare.gov (06/24)
    - It is a bill for people who pay Medicare directly for their Part A premium,
      Part B premium, and/or Part D IRMAA
    - Your bill will arrive around the 10th of the month
Part D
- Medicare Care Part D - Prescripton Plans @ ehealthinsurance.com (05/24)
- Medicare Part D Plans @ ehealthmedicareplans.com (05/24)
- How to Get Prescription Drug Coverage @ medicare.gov (05/24)
  - There are two ways to get Medicare drug coverage
    - Medicare drug plan
    - Medicare Advantage Plan (Part C)
  - 6 Tips for Choosing Medicare Drug Coverage @ medicare.gov (05/24)
- 2024 Projected Medicare Part D Premium @ cms.gov (05/24)
- If you go 63 days without drug coverage, you will pay a late enrollment penalty
- Average nationwide monthly premium for 2024 is $55.50
- Highest deductible is $415; lowest deductible is $0
- Medicare uses your Modified Adjusted Gross Income to determine extra cost of your premiums
  - Earning < $206,000: $55.50 + $0.00
  - Earning < $258,000: $55.50 + $12.90
  - Earning < $322,000: $55.50 + $33.30
  - Earning < $386,000: $55.50 + $53.80
  - Earning < $750,000: $55.50 + $81.00
- Monthly Premium for Drug Plans @ medicare.gov (06/24)
  - Most people only pay their Part D premium
  - If you have a higher income, you might pay more for your Medicare drug coverage
  - You'll also have to pay this extra amount (Part D-IRMAA) if you're in a
    Medicare Advantage Plan that includes drug coverage
  - Social Security will contact you if you have to pay Part D IRMAA, based on
    your income
  - You pay your Part D IRMAA directly to Medicare, not to your Advantage plan
  - How to Pay Part A and Part B (and D) Premiums @ medicare.gov (06/24)
    - All Medicare bills are due on the 25th of the month
- Coverage gap (the "Donut Hole")
  - Medicare Donut Hole @ smartasset.com (05/24)

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Medicare Advantage

Good or Bad?
- 10 Reasons Why Medicare Advantage Enrollment is Growing and Why it Matters @ kff.org (07/24)
  - Medicare Advantage enrollment has more than doubled since 2010 and is projected
    to grow from 54% of the eligible population in 2024 to 60% by the end of this decade
  - Medicare will pay Medicare Advantage plans an estimated 123% of the cost of
    similar beneficiaries in traditional Medicare, on average, in 2024
  - People with Medicare are drawn to Medicare Advantage for the extra benefits
  - Medicare Advantage enrollees are required to pay the Medicare Part B premium,
    but unlike beneficiaries in traditional Medicare, they typically do not pay a
    separate premium for additional coverage or for Part D prescription drug premium
    because Medicare Advantage rebate dollars cover these costs
  - Premiums for Part D stand-alone prescription drug plans that supplement traditional
    Medicare are rising rapidly.
  - People with Medicare are attracted to the financial protection that comes with
    an annual out-of-pocket limit that Medicare Advantage plans are required to provide.
  - Beyond financial benefits, people with Medicare are attracted to the simplicity
    and convenience of Medicare Advantage
  - Insurers are marketing Medicare Advantage aggressively
  - Brokers have a financial incentive to encourage enrollment in Medicare Advantage plans
  - A growing share of large employers are shifting their Medicare-age retirees into
    Medicare Advantage plans for both Medicare and supplemental benefits
  - Medicare beneficiaries may be reluctant to switch from Medicare Advantage to
    traditional Medicare if they run the risk of being denied a Medigap policy due to a
    pre-existing condition
  - Beneficiaries may not be familiar with potential tradeoffs in choosing Medicare
    Advantage over traditional Medicare
- Sources of Coverage @ kff.org (07/24)
  - Medicare Advantage enrollment has surpassed 50% of total Medicare enrollment
    as of 2023
- Why are Medicare Advantage Plans Considered Bad @ askchapter.org (07/24)
  - On Original Medicare, you can see any doctor who accepts Medicare (which is
    about 90% of doctors across the US)
  - Medicare Advantage plans, however, have provider networks
  - Unlike Original Medicare, Medicare Advantage plans do have out-of-pocket maximums
  - But when you compare out-of-pocket costs to those paid by Medigap enrollees,
    you might just faint
  - Most Medigap plans don’t have an out-of-pocket max
  - On Plan G, once you've met your Part B deductible (which is $240 in 2024),
    you don't owe anything else for covered services in that year
  - Medicare Advantage plans can require plan holders to get prior authorization
    before receiving a service
  - Original Medicare does not have prior authorization requirements
  - Prior authorization denials are on the rise
  - Advantage plans change each year
  - Original Medicare (Part A and Part B) has its downsides; it doesn't pay about
    20% of costs and there's no out-of-pocket maximums
  - Original Medicare also doesn't cover prescriptions
  - Consider current and future needs
  - Medicare Advantage premiums are lower than Medigap premiums
  - One of the catches with Medigap plans is that you aren't guaranteed acceptance
    into the plans outside of your Medigap Open Enrollment Period, which occurs during
    the first six months that you have Part B coverage
  - If you want a Supplement plan that doesn't require prior authorizations,
    has no network limitations, and significantly reduces your out-of-pocket costs
    as you get older, you should enroll in a Medigap plan when you first sign up for Medicare
- What are the Advantages and Disadvantages of Medicare Advantage Plans @ healthline.com (07/24)
  - Original Medicare only offers two types of coverage: hospital insurance and
    medical insurance. If you want additional coverage, you’ll need to purchase
    Medicare Part D for prescription drug coverage and Medigap for supplemental coverage.
  - With a Medicare Advantage plan, all your coverage options are in one convenient plan.
Basic Information
- Special Enrollment Periods @ medicare.gov (05/24)
  - Starting January 1, 2024, if you sign up for Part A and/or Part B because of an
    exceptional situation, you'll have 2 months to join a Medicare Advantage Plan
    (with or without drug coverage) or a Medicare drug plan (Part D). Your coverage
    will start the first day of the month after the plan gets your request to join.
- You must have Medicare Parts A & B to join a Medicare Advantage plan
- Understanding Medicare Advantage Plans @ medicare.gov (05/24)
  - If you're in a plan that doesn't offer drug coverage, and you don't have a
    Medicare drug plan or other creditable prescription drug coverage, you may have to
    pay a late enrollment penalty if you decide to join a Medicare drug plan later
- Compare Original Medicare & Medicare Advantage @ medicare.gov (05/24)
- Medicare Advantage Plans @ medicare.gov (05/24)
  - HMO = must use doctors in network
  - HMOPOS (HMO Point of Service) = MAY allow you to get some services out of network,
    for a higher copay
  - PPO (Preferred Provider Organizations)
    - You can generally go to out-of-network providers, but you'll pay more
    - You can use any doctor or hospital that accepts Medicare
    - You don't have to choose a primary care doctor
    - You don't need a referral to use a specialist
  - Compare Types of Medicare Advantage Plans @ medicare.gov (05/24)
- Medicare Part C @ smartasset.com (05/24)
- Compare Types of Medicare Advantage Plans @ medicare.gov (05/24)
Joining a Plan
- CMS Medicare Online Enrollment Center @ medicare.gov (06/24)
- Joining a Plan @ medicare.gov (06/24)
  - You need your Medicare Number and Part A and/or Part B coverage start dates
  - Starting Jan 2024, if you sign up for Part B during a SEP, you'll have 2 months
    to join a plan
  - Coverage usually begins the first of the month after the plan gets your request
  - Talk to a trusted agent or broker
  - Contact the plan to join -- call them or visit their website
    - Request an Apointment with a Licensed Humana Sales Agent @ plans.humana.com (06/24)
    - Plans @ humana.com (06/24)
    - Select "Enroll" for the plan you want to join
- HumanaChoice (PPO) H5216-358 ($60 giveback)
  - Summary of Benefits @ humana-medicare.com (06/24)
  - Provider Directory @ finder.humana.com (06/24)
  - Pharmacy Finder @ finder.humana.com (06/24)
  - List of Covered Drugs for Medicare @ humana.com (06/24)
  - Your 2024 Evidence of Coverage @ humana-medicare.com (06/24)
  - 2024 Medicare Star Ratings @ humana-medicare.com (06/24)
- HumanaChoice (PPO) H5216-352 ($0 giveback)
  - Your 2024 Evidence of Coverage @ humana-medicare.com (06/24)
Our Doctors
- Find a Doctor @ humana.com (06/24)
- Personal doctors
  - Dr. Roger Clifford, chiropractor (in network H5216-358)
  - Dr. P. Andrew Benson, prosthodontist (not in database or network)
  - Dr. Jeremiah B. Cook, periodontist (not in network)
  - Dr. Lewis Frazee, ophthalmologist (in network H5216-358)
  - Dr. Donna Haas, optomitrist (not in network)
  - Dr. Marvin Hsiao, cornea (in network)
  - Dr. Kellvan Cheng, podiatrist (in network at another location)

Specific Plans @ ehealthmedicareplans.com

Medicare Advantage Plans @ eHealthmedicareplans.com (05/24)

Plan	H5216-352	H5216-358	H1278 013 (AARP)
Giveback	$0	$60	$0
$Max in-network	$5,800	$7,500	$6,300
$Max out-network	$9,550	$12,850	$9,550
Primary Dr in-network	$0	$0	$0
Primary Dr out-network	$25	$25	$25
Specialist in-network	$35	$45	$0-$35
Specialist out-network	$65	$65	$65
Dental	$2,000	$1,500	$1,000
Glasses	$200	$150	$250
Eye Exams	$75	$75	$0 for 1 visit
Hearing	Covered	Covered	Covered
Chiropractor in-network	$20	$15	$15
Chiropractor out-network	$20	50%	65%
Hospital Deductible	$0	$0	$0
Hospital Stay	Unlimited	Unlimited	Unlimited
Hospital Stay in-network	Days 1-5: $290	Days 1-7: $320	Days 1-6: $325
Ambulatory Surgery Center in	$0-$255	$0-$250	$0-$275
Ambulatory Surgery Center out	40%-45%	40%-45%	40%
Diagnostic Tests in-network	$0-$90	$0-$175	$50
Lab Tests in-network	$0-$55	$0-$55	$0
Drug Deductible	$0	$395	$260
Drug Donut Hole	$5,030-$8,000	$5,030-$8,000	$5,030-$8,000

HumanaChoice H5216-352 (Local PPO) (05/24)
- Part B give back: none
- Out-of-pocket maximum: in-network: $5,800; any provider: $9,550
- Prescription drugs
  - Tier 1 (preferred generic): $0 (30-day supply)
  - Tier 2 (generic): $5.00 (30-day supply)
  - Tier 3 (preferred brand): $45.00 (30-day supply)
  - Tier 4 (non-preferred brand): $99.00 (30-day supply)
  - Deductible: $0
- Dental: $2,000 allowance every year
- Vision: eyewear: $200/year; eye exams: $75/year
- Specialist visit: in-network: $35 copay; out-of-network: $65 copay
- Eyeglasses: in-network: $0; out-of-network: $0
- Yearly dental exam; two free cleanings/year; dental X-rays once every 5 years
- Annual eye exams; glaucoma screenings; diabetic eye exams
- HER940 mandatory supplemental hearing benefit
- DEN374 medicare-covered dental
- VIS692 mandatory supplemental vision benefit
- Summary of Benefits (PDF) (05/24)
HumanaChoice H5216-358-0 (Local PPO) (05/24)
- Non-members: 1-800-833-2364; Members: 1-800-457-4708
- Humana sales agent: 1-800-967-1591
- Schedule an appointment: 1-866-991-2293
- Request Appointment @ plans.humama.com (08/24)
- Website: Plan website (08/24)
- Part B give back: up to $60 every month
  - Part B Giveback Benefit @ humana.com (06/24)
- Out-of-pocket maximum: in-network: $7,500; any provider: $12,850
- Prescription drug
  - Tier 1 (preferred generic): $0 (30-day supply)
  - Tier 2 (generic): $5.00 (30-day supply)
  - Tier 3 (preferred brand): $47.00 (30-day supply)
  - Tier 4 (non-preferred brand): $100.00 (30-day supply)
  - Deductible: $395 (Tier 3, 4, and 5)
- Pharmacy Plan:
- Dental: $1,500 allowance every year
- Vision: eyewear: $150/year; eye exams: $75/year
- Specialist visit: in-network: $45 copay; out-of-network: $65 copay
- Eyeglasses: in-network: $0; out-of-network: $0
- Yearly dental exam; two free cleanings/year; dental X-rays once every 5 years
- Annual eye exams; glaucoma screenings; diabetic eye exams
- DEN365 mandatory supplemental dental benefit
- VIS751 mandatory supplemental vision benefit
  - Eyewear (post cataract surgery) $0 copay (in network); $0 copay (out of network)
- HER937 mandatory supplemental hearing benefit
- Summary of Benefits (PDF) (05/24)
- 2024 Evidence of Coverage @ ehealthmedicareplans.com (06/24)
- Humana Medicare Plan Documents @ plandocs.humana.com (06/24)
- Find a Doctor @ humana.com (06/24)
- Humana Dental Medicare Network
  - Humana.com > Find a doctor > Dentist icon >
    From the Distance drop down select the preferred distance >
    Enter Zip code > All Dental Networks > HumanaDental Medicare
- Humana Medicare Insight Network (Vision)
  - The provider locator for the Humana Medicare Insight Network for
    routine vision can be found at Humana.com > Find a Doctor >
    select the Vision Care icon > select Medicare >
    select Medicare Advantage plans
  - Network: Insight Network @ humana.com (06/24)
  - LensCrafters is a PLUS Provider (glasses) - $150 allowance
  - Out of network provider (glasses): $100 allowance
AARP Medicare Advantage from UHC TX-0005 - H1278 013 (05/24)
- Part B give back: none
- Out-of-pocket maximum: in-network: $6,300; any provider: $9,550
- Prescription drug deductible: $260

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Medicare Supplemental

Supplemental Plans (Medigap)
- Medigap Basics @ medicare.gov (07/24)
  - You get a 6-month "Medigap Open Enrollment" period, which starts the first month
    you have Medicare Part B and you're 65 or older. During this time, you can enroll in
    any Medigap policy and the insurance company can't deny you coverage due to
    pre-existing health problems. After this period, you may not be able to buy a Medigap
    policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time
    enrollment. It doesn't repeat every year, like the Medicare Open Enrollment Period.
  - All Medigap policies are standardized.
  - Policies with the same letter offer the same basic benefits no matter where you
    live or which insurance company you buy the policy from
  - There are 10 different types of Medigap plans offered in most states, which are
    named by letters: A-D, F, G, and K-N
  - Price is the only difference between plans with the same letter that are sold by
    different insurance companies
  - If you have a Medicare Advantage Plan, you can't buy a Medigap policy. If you
    want to switch to Original Medicare and buy a Medigap policy, contact your Medicare
    Advantage Plan to see if you're able to disenroll.
  - If you enroll in Medigap for the first time, it won't include drug coverage.
    If you want prescription drug coverage, you can join a separate Medicare drug plan
    (Part D).
- Compare Plan Benefits @ medicare.gov (07/24)
  - The Medigap policy will only pay your coinsurance after you've paid the
    deductible (unless the Medigap policy also covers your deductible).
- Your Medigap Open Enrollment Period @ medicare.gov (07/24)
- Buying a Medigap Policy @ medicare.gov (07/24)
- Find a Medigap Policy that Works for You @ medicare.gov (07/24)
  - Use AARP United Medical, Blue Cross Blue Shield, AARP (not Aetna or Humana)
  - Use PPO, not HMO
  - For 72 year old female, non smoking
    - Plan A: AARP UnitedHealthcare = $132/mo
    - Plan F (high deductible of $2,800): BlueCross Blueshield = $78/mo
    - Plan G (high deductible):
  - For 81 year old male, non smoking
    - Plan A: AARP UnitedHealthcare = $197/mo
    - Plan F (high deductible of $2,800): BlueCross Blueshield = $114/mo
    - Plan G (high deductible): BlueCross Blueshield = $105/mo
      - Premiums are low for younger buyers, but go up as you get older
        and can eventually become the most expensive.
    - Plan K: AARP United Healthcare = $118/mo
      - Premiums are the same no matter how old you are.
      - Premiums may go up because of inflation and other factors.
- Why are Medicare Advantage Plans Considered Bad @ askchapter.org (07/24)
  - On Original Medicare, you can see any doctor who accepts Medicare (which is
    about 90% of doctors across the US)
  - Medicare Advantage plans, however, have provider networks
  - Unlike Original Medicare, Medicare Advantage plans do have out-of-pocket maximums
  - But when you compare out-of-pocket costs to those paid by Medigap enrollees,
    you might just faint
  - Most Medigap plans don’t have an out-of-pocket max
  - On Plan G, once you've met your Part B deductible (which is $240 in 2024),
    you don't owe anything else for covered services in that year
  - Original Medicare does not have prior authorization requirements
  - Original Medicare (Part A and Part B) has its downsides; it doesn't pay about
    20% of costs and there's no out-of-pocket maximums
  - Original Medicare also doesn't cover prescriptions
  - Medicare Advantage premiums are lower than Medigap premiums
  - One of the catches with Medigap plans is that you aren't guaranteed acceptance
    into the plans outside of your Medigap Open Enrollment Period, which occurs during
    the first six months that you have Part B coverage
  - if you want a Supplement plan that doesn't require prior authorizations,
    has no network limitations, and significantly reduces your out-of-pocket costs
    as you get older, you should enroll in a Medigap plan when you first sign up for Medicare
Add-ons
- Humana MyOption OSB (optional supplemental benefits)
  - Medicare Dental Benefits @ humana.com (05/24)
Pharmacy Savings Cards
- Comparisons
  - Best Prescription Discount Cards @ verywellhealth.com (05/24)
    - Best overall: GoodRx
    - Best for future savings: SingleCare
- GoodRX (05/24)
  - Discount Card (05/24)
    - While the Prescription Savings Card will often help you save at the pharmacy,
      it may not always provide you with the most current listed coupon price
    - To receive the coupon price listed on our website or mobile app, you must
      present the most current online coupon to the pharmacist
  - GoodRx Gold (05/24)
    - Individual plan: $9.99/mo
    - Family plan: $19.99/mo
  - Amoxicillin, 500mg, 21 count
    - CVS pharmacy: retail $11.71; GoodRx: $8.99
    - Kroger: retail: $10.31; GoodRx: $7.30
    - Target: retail: $12.80; GoodRx: $10.41
    - Tom Thumb: retail: $20.38; GoodRx: $10.75; GoodRx Gold: $3.25
    - Walgreens: retail: $14.58; GoodRx: $8.10; GoodRx Gold: $3.10
    - Walmart: $13.86 (1-61 days)
- SingleCare (05/24)
  - Use the card at CVS, Walgreens, Walmart, Kroger, Tom Thumb, etc
  - Save up to 80% on your presciption medications
  - Search prescriptions, choose a free coupon, and show it to your pharmacist
  - Amoxicillin, 500mg, 21 count
    - $4.34: Walgreens, Tom Thumb
    - $4.81: Kroger
    - $8.99: CVS
    - $13.49: Walmart
    - Generic Amoxicillin: $13.38
    - SingleCare Generic Amoxicillin: $8.35
  - You can use SingleCare even if you have Medicare
  - Some pharmacies (Walgreens, Walmart, and CVS) feature signature SingleCare
    cards that will maximize your savings at those pharmacies
    - CVS SingleCare Discount Card (05/24)
    - Kroger SingleCare Discount Card (05/24)
    - Walgreens SingleCare Discount Card (05/24)
    - Walmart SingleCare Discount Card (05/24)

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Bonnie's Links
created by Bonnie Lee Hill,

bonniehill@verizon.net

last modified on October 15, 2024

URL: http://www.bonniehill.net/pages/misc.html

Income	Part b	Part D
>$0 and <$212,100	$0	$0
>$212,100 and <$265,000	$71.90	$13.30
>$265,000 and <$332,000	$179.90	$34.30
>$332,000 and <$398,000	$287.80	$55.40