medicarepartd Archives - Health Directions

A TOP TEN TO CHEER ABOUT: The 2026 Prescriptions Medications with Negotiated Prices

April 9, 2026

The Medicare Drug Price Negotiation Program (created by the Inflation Reduction Act of 2022) has allowed Medicare to negotiate drug prices directly with manufacturers. Starting on January 1 of this year, this has meant lower out-of-pocket costs for essential prescriptions.

The first list of negotiated drugs for people with Part D coverage treats common and serious health conditions, such as heart disease, diabetes, arthritis, and cancer. They were chosen because of their widespread use, high costs, and lack of competition.

The 2026 list includes:

Eliquis for preventing blood clots
Jardiance for diabetes and heart failure
Xarelto for blood clots and heart disease risk
Januvia for diabetes treatment
Farxiga for diabetes, heart failure, and chronic kidney disease
Entresto for heart failure
Enbrel for rheumatoid arthritis & psoriasis
Imbruvica for blood cancers
Stelara for auto-immune conditions
Insulin products Fiasp/Fiasp FlexTouch / Fiasp PenFill and NovoLog/NovoLog FlexPen/NovoLog PenFill

Negotiated pricing will lead to significant savings and better access for all Americans. Each year, more high-cost drugs will be selected, with the next set of negotiated prices taking effect in 2027. If you have questions about the impact on your Medicare spending or decision-making, don’t hesitate to contact us!

Resources: cms.gov; medicarerights.org

Looking Ahead: Updates to 2024 Medicare Advantage Program and Part D Payment Policies

May 6, 2023

In an effort to ensure that Medicare Advantage and Part D drug programs remain strong, fair and viable, the Centers for Medicare & Medicaid Services (CMS) has ruled on commonsense updates for next year. Some abbreviated highlights:

Medicare Advantage

Guidelines are clarified to ensure equal access to medically necessary care as with Traditional Medicare.

When coverage criteria are not fully established, organizations may create internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature made publicly available.

To promote more transparent, clinically-based decisions, circumstances are explicitly stated under which plans may apply internal coverage criteria when making medical necessity decisions.

Part D

Cost-sharing will be eliminated for beneficiaries in the catastrophic phase of coverage.

The Low-Income Subsidy program (LIS) will be expanded.

Plans must not apply the deductible to any Part D-covered insulin product and must charge no more than $35 per month’s supply in the initial coverage phase and the coverage gap phase.

The annual growth in the Base Beneficiary Premium will be capped at 6 percent.

We will continue to provide updates as rulings change that could impact your existing overage or future Medicare decisions.

Source: cms.gov

DATES AND DEADLINES – NOW’S THE TIME TO DECIDE — WITH HEALTH DIRECTIONS’ GUIDANCE!

February 24, 2021

Take a look below for a summary of what can (and cannot) be done during the current enrollment period. As always, we are here to inform your decision-making and everything that follows.

Medicare Advantage

Through March 31, 2021

If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage); you cannot switch from Original Medicare to a Medicare Advantage Plan
You can drop your Medicare Advantage Plan and return to Original Medicare; you’ll also be able to join a Medicare Prescription Drug Plan

General Enrollment Period

Through March 31, 2021

If you didn’t sign up for Part A and or Part B (for which you pay monthly premiums) during your Initial Enrollment Period, you can sign up for Medicare
Coverage takes effect July 1
Late enrollment penalties may apply
Individuals who enroll in Medicare Parts A and B during this period then have three months (April through June) to enroll in a Part D plan to supplement their coverage or to enroll in a Medicare Advantage plan

You Can Do That? Helping our Clients Get Money Back from the Government

October 21, 2019

It is very satisfying for us at Health Directions to know we have enrolled our clients in the right policies at the right costs. It’s especially rewarding when we can use our expertise to solve problems… and save a client money on their monthly Medicare premium as a result!

This was the case recently when long-time clients were retiring and concerned about the over $1,000 total monthly Medicare Part B and Part D permanent premium surcharges they were paying as a high-income earning couple. They were busy planning for their upcoming retirement and doing everything possible to manage expenses for the future. The prospect of dealing with the Social Security Administration (SSA) to advise the proper party of their change in circumstances and request an adjustment to the surcharge was overwhelming.

The paperwork… the waiting… the wondering if they submitted the right documents…

This is where we stepped in. With our vast experience with SSA, Health Directions compiled everything required to eliminate the income-adjusted premium, and successfully got it permanently reversed. The happy clients didn’t even have to wait for open enrollment. That’s money in their pocket to use on other important things!

In Connecticut, our population of working, high-income seniors is comparatively large versus other states and is expected to continue to rise over the next decades. We hope to be able to help other clients reduce their healthcare expenditures when they retire too!

Medicare Advantage

Part D

Medicare Advantage

Through March 31, 2021

General Enrollment Period

Through March 31, 2021

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