LowCostCaHealth.com

10/02/2025

For those concerrned

During a government shutdown, only programs deemed essential for protecting life and property are kept operational.

Here's what's typically open and closed during a government shutdown: http://www.wcvb.com/article/government-shutdown-open-closed-programs/68120120

09/09/2025

We have received several questions from clients regarding whether they can pay us a fee to review and enroll them in the now non-commissionable Medicare Advantage (MA) or Prescription Drug Plans (PDP).

We want to make this absolutely clear: federal regulations prohibit agents from directly charging any fee to beneficiaries for marketing, consulting, or enrollment services involving MA or PDP plans, even if the plan does not pay a commission.

Federal Regulation: 42 CFR § 423.2274(c)(8) requires Part D sponsors to “ensure beneficiaries are not charged marketing consulting fees when considering enrollment in Part D Plans.” The same prohibition applies under Medicare Advantage regulations. Federal law preempts state law in this area. Even if a state permits Certified Insurance Consultants or Registered Investment Advisors to charge fees for other products, they may not do so for MA or PDP plans.

All compensation must come directly from plan sponsors and must comply with CMS regulations. Charging beneficiaries directly for these services places the agent at risk of regulatory enforcement and plan contract termination.

This means that we no longer are compensated for assisting with Medicare Drug plan reviews. We are also not compensated for some of the Medicare Advantage Plans.

We are offering free of charge specific zoom events and two in person events at our office to show you how to find and enroll in the best drug plan for you this open enrollment.

Go to https://www.lowcostcahealth.com/2026-aep-events/ When there is a zoom time listed, click on the zoom link to join in. Be on your computer or the largest screen you have and have a comprehensive list of any medications you currently take for best results.

05/04/2025

The boys had one of their best weekends. QT get 1 or 2 double Qs a year. Never have we ever had 2 in one weekend. Booyah got 2 master Fast legs and an excellent Standard leg..

01/27/2025

Dear valued clients,

We appreciate the opportunity to assist you with your Medicare plans each year. As professional agents we try hard to provide you with the information you need to make informed decisions about plans and options. Often in the media agents and brokers are NOT portrayed in very good light. Also, the Centers for Medicare and Medicaid Services (CMS) the branch of the government that oversees Individual and Medicare does not distinguish between Agents and Brokers like us and the call centers that I know drive you crazy with unwanted calls.

If you value, the ability to work with our agency we would like you to tell your legislators why we are important to you. We would appreciate it so much if you could take a few minutes to complete this short 5 question survey (see link below). The professional Association that we belong to the National Association of Benefit and Insurance Professionals (NABIP) will be forwarding the information from surveys to CMS and your legislators.

Thank you in advance for your time. We appreciate you!

Client Survey link
https://www.votervoice.net/NABIP/Surveys/11551/Respond

The last thing I will say, THANK YOU. Thank you for reading this far. Thank you for helping. Pam

Medicare beneficiaries, we need your help!The National Association of Benefits and Insurance Professionals (NABIP) represents over 100,000 licensed health insurance agents, brokers, general agents, consultants, and employee benefits specialists...

12/19/2024

If you value, the ability to work with our agency we would like you to tell your legislators why we are important to you.
We would appreciate it so much if you could take a few minutes to complete this short 5 question survey (see link below). The professional Association that we belong to the National Association of Benefit and Insurance Professionals (NABIP) will be forwarding the information from surveys to CMS and your legislators.

Thank you in advance for your time. We appreciate you! If you have already completed the survey, Thank-You. This is the start to how we affect change!

09/13/2024

Your Prescription or Medicare Advantage Plans are changing for 2025

It’s important to review your Medicare Advantage or Part D plan every AEP because, as we’ve talked about, plans and coverages can change each year. This year, it’s especially important to conduct your review because potentially disruptive changes are coming in 2025, courtesy of the Inflation Reduction Act, that may significantly alter the makeup of your Part D prescription drug coverage.

Here are some key Inflation Reduction Act changes:
• Insulin available at $35 per covered prescription (took effect in 2024)
• Annual out-of-pocket maximum reduced to $2,000 from $8,000
• Expansion of low-income subsidy program to 150% of the federal poverty level
• Plus, several important changes to the structure within Part D, including elimination of the coverage gap

Many of these changes will have positive impacts for you as the consumer. However, experts are predicting we could see substantial adjustments to products released in 2025, which could affect pricing, formularies and benefits.

That’s why I’m urging all my clients to pay special attention to their carrier’s Annual Notice of Change (ANOC) letter when it arrives in the mail this September. Once you review your ANOC letter, please contact me to schedule a no-cost, no-obligation appointment to review your coverage. This is the best way to ensure you remain in a suitable plan going forward into 2025.

I look forward to helping you!

Pamela Fugitt-Hetrick

09/12/2024

News those of you on Medicare can use...
For 2025
New Medicare Prescription Payment Plan
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A Patient’s Guide
Medicare patients in the Part D prescription drug program often face significant out-of-pocket costs early in the year while trying to meet their deductible. A new program, the Medicare Prescription Payment Plan, will help make prescription drug costs more manageable for patients.
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What is the Medicare Prescription Payment Plan?
The program has two main benefits for seniors:
Patients’ out-of-pocket costs will be capped at $2,000 a year.
Patients can spread their prescription costs evenly across 12 monthly payments.
The program is for patients enrolled in the Medicare Part D program.
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How will the program work?
• Each month the patient will make his or her monthly payment to the Part D sponsor, instead of paying the pharmacy.
If patients accrue additional costs throughout the year, their payments may adjust. But their annual total will not exceed $2,000.
The Medicare Prescription Payment Plan can make out-of-pocket costs more manageable, allowing patients to focus on what matters to them.
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How can I opt in?
Patients can opt in to the Medicare Prescription Payment Plan directly with their Part D sponsor during open enrollment season, which begins October 15, 2024.
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When can a patient opt in to the program?
October 15, 2024: Enrollment opens
January 1, 2025: Medicare Prescription Payment Plan begins
After initial enrollment opens on October 15, 2024, Medicare Part D patients may opt in at any point during the year.
The Alliance for Patient Access is a national network of policy-minded health care providers advocating for patient-centered care.

Pamela Fugitt-Hetrick

08/20/2024

Oh, the most major changes to Medicare Drug and Advantage plans since they were invented is coming soon. DO NOT IGNORE the notices you will be receiving from your plans in September. Submit your information if you want to get into the que for free help navigating these changes. No plan details can be discussed till 11/1 per Medicare requirements.

08/01/2024

Hi there,

You are invited to a Zoom webinar.
When: Aug 7, 2024 03:00 PM Pacific Time (US and Canada)
Topic: Annual Medicare Open Enrollment 2025. What you NEED to know
Register in advance for this webinar:
https://us02web.zoom.us/webinar/register/WN_WpCZRP8fQW2iBAO9iY9ZuQ

After registering, you will receive a confirmation email containing information about joining the webinar.

The Inflation Reduction Act put in motion changes to Medicare Prescription plans and Medicare Advantage plans that include prescription coverage. For some, these changes will be great. As with all things, for some if will have pain points. EVERYONE needs to review their drug and advantage plans betw...

07/01/2024

Changes Due to the Inflation Reduction Act

The Inflation Reduction Act of 2022 introduced significant changes to Medicare Part D, focusing on reducing prescription drug costs for enrollees. Here are the biggest changes:

1. Out-of-Pocket Spending Cap: Starting in 2025, Medicare Part D will implement a $2,000 cap on out-of-pocket spending for prescription drugs. This cap will be adjusted annually based on the growth rate of per capita Part D costs, significantly reducing the financial burden for beneficiaries who require high-cost medications.

2. Elimination of the Coverage Gap: Also known as the "donut hole," the coverage gap phase where beneficiaries faced higher costs for their medications will be eliminated in 2025. This will simplify the benefit structure and reduce out-of-pocket expenses for enrollees.

3. Insulin and Vaccines: Since 2023, the cost of insulin has been capped at $35 per month, and adult vaccines recommended by the Advisory Committee on Immunization Practices (such as the shingles vaccine) are provided without cost-sharing.

4. Changes in Catastrophic Coverage: In 2024, the 5% coinsurance requirement for catastrophic coverage will be eliminated, shifting a larger share of costs to Part D plans. By 2025, Part D plans will cover 60% of drug costs in the catastrophic phase, with pharmaceutical manufacturers providing a 20% discount on brand-name drugs.

5. Low-Income Subsidy (LIS) Program Expansion: Starting in 2024, eligibility for full benefits under the Part D LIS program will extend to individuals with incomes up to 150% of the federal poverty level, enhancing access to reduced drug costs for more low-income beneficiaries.

6. Manufacturer Discount Program: In 2025, the current Coverage Gap Discount Program will be replaced by the Manufacturer Discount Program. Drug manufacturers will provide a 10% discount on brand-name drugs during the initial coverage phase and a 20% discount in the catastrophic phase, increasing their financial contributions to the program.

These changes aim to make prescription drugs more affordable for Medicare beneficiaries while redistributing costs among the federal government, insurance plans, and pharmaceutical companies.

We will not have final plans information to share with clients and referrals until October 1st. We strive to get you as much information as we legally can now to keep you updated. This is not the year to "set it and forget it" on your drug plans and or Medicare Advantage plans. Be in the know and work with us at no charge.
DCD Financial & Insurance Services
www.lowcostcahealth.com

10/10/2023

Covered California has your information that you put into the system from the past. Is your current situation different? Don't get hung out to dry because you didn't update your information. Update now!