Ciriaco Gelera, Medicare Insurance Broker
Ciriaco Gelera
Keystone RCM
Medicare Broker Licensed in CA, FL, NJ and NY
Contact Details
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Location
Jersey City, NJ
Ciriaco Can Help With:
About Me
Hello, I'm Ciriaco, your neighborhood Medicare insurance advisor. My expertise lies in the realm of Medicare, and my mission is to assist you in identifying the perfect plan tailored to your unique requirements and financial capacity. Allow me to navigate the array of plans available from both nationally and locally esteemed companies on your behalf. And don't worry, my services are provided free of charge! Contact me to discover your Medicare insurance alternatives and don't forget to mention that you discovered me on Medicare Agents Hub!
Q&A with Ciriaco Gelera
I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?
Answer: The Inflation Reduction Act (IRA) did cap Medicare Part D insulin costs at $35 per month, but there is a critical catch: the cap only applies to insulins that are actively covered on your specific plan’s formulary.
If you have been on the exact same Part D plan for years, here is almost certainly what happened:
Why Your Price Spiked?
1 - Insurance carriers update their formularies (their list of covered drugs) every single year. They frequently negotiate new contracts with pharmaceutical manufacturers, which means they will drop certain brands of insulin and replace them with competitors.
2 - If your specific brand of insulin was removed from your plan's formulary for this calendar year, it is no longer protected by the IRA's $35 cap. Because it is now considered an "off-formulary" or uncovered drug, you are being charged the full retail price.
What You Can Do Right Now!
1. File a Formulary Exception: Your doctor can file an exception request with your Part D carrier. They will need to state that the insulins currently covered on the plan's formulary are not medically appropriate for you, or that you have had adverse reactions to them in the past. If the carrier approves the exception, your insulin will be covered and the $35 cap will apply.
2. Check State Assistance Programs: Programs like PAAD (Pharmaceutical Assistance to the Aged and Disabled) or Senior Gold in New Jersey are excellent safety nets for situations exactly like this. If you qualify based on income, these programs drastically reduce your pharmacy copays. More importantly, qualifying for PAAD grants you a Special Enrollment Period (SEP). This allows you to immediately switch to a different Part D plan that does cover your specific insulin right now, completely bypassing the wait for the Annual Enrollment Period in the fall.
Needs help? Reach out!
What's the difference in copays vs deductibles?
Answer: Both are "out-of-pocket" costs you pay for healthcare, but they happen at different times and for different reasons. The Copay is A Fixed Fee per Visit while The Deductible is Your "Entry Fee" for the Year.
I exercise regularly and maintain a healthy lifestyle. Does Medicare offer any incentives or additional benefits for preventive health behaviors?
Answer: Yes, Original Medicare covers many preventive services (like screenings, shots, wellness visits) at no cost, but Medicare Advantage (Part C) plans often provide extra rewards & incentives (gift cards, fitness items) for healthy behaviors like flu shots, completing health assessments, or using gyms, while Original Medicare doesn't give direct financial rewards but encourages prevention through covered services.
Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
Answer: Medicare Advantage plans offer more benefits:
1. The bundled vision, dental, hearing, and wellness benefits.
2. The out of pocket cap which the annual maximum limits your financial risk for a serious illness
3. Lower premium which many plans have a low or $0 monthly premium (though you still need to pay your Part B premium.
4. Convenience of having all your Medical, Hospital, and often Prescription Drug Coverage in one plan.
Original Medicare (Part A & Part B) offers nationwide flexibility, but you must add Part D (Prescription Drugs) and potentially a Medigap policy for more complete coverage.
What do you enjoy most about working with Medicare clients?
Answer: The deep satisfaction of providing clarity about the complex of Medicare, and financial security during their life's most confusing transition.
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
Answer: To boil the decision down to key trade-offs (Cost, Choice, and Coverage) and then personalize the choice base on their answers.
What are the reasons why I should work with a Medicare agent?
Answer: Very beneficial because Medicare Agent act as your personal guide through the very complex world of Medicare plans. Top reasons why you should working with one are as follows: Expertise and Simplification, personalized and unbiased plan comparison, Cost savings potential, and ongoing support.
What is one Medicare trend that you believe is having a positive impact on Medicare affordability? How is it making a difference?
Answer: Is the increasing of generic drugs. Generic drugs are therapeutically equivalent to their brand-name counterparts but are typically sold at much lower prices.