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Medicare Plans

Are You Ready for Medicare Open Enrollment?

by Carol Marak
written by Carol Marak

It’s Medicare open enrollment period starting October 15 and through December 7, 2019. Your chance to change coverage (Medicare plans) if you want.

Medicare Part C plans, known as Medicare Advantage plans are private health insurance plans, mainly HMOs and PPOs, for people enrolled in Medicare. If you enroll in a Medicare Advantage plan, you still have Medicare, but you get all of your Medicare-covered benefits through a private plan.

Most Medicare Advantage plans also cover prescription drugs and may cover other services, like vision, dental, and hearing. If you have Part A and Part B and are covered under the Original Medicare program, then you do not need to sign up for a Medicare Advantage plan during Open Enrollment unless you want to get your Medicare benefits through a private plan.

Medicare Advantage plans restrict the health care providers that enrollees see (provider networks) whereas beneficiaries in the Original Medicare may see any doctor that accepts Medicare, without needing prior authorization or a referral from their primary care doctor.

Start Your Research

Now is the time to research and make preliminary calls to get an idea of what changes (if any) need to be made to your Medicare coverage. Gathering information now will prevent you from making knee-jerk decisions at the end of enrollment. Here are six steps to take:

  • Become familiar with each part of Medicare, Part A, Part B, Part C, and Part D. This glossary explains terms in the Medicare program, https://www.medicare.gov/glossary/.
  • If you have a Medicare Advantage Plan (Part C), are you happy with it? Be sure to read all mail from the carrier which arrives in September and October. Look for any changes to monthly premiums, deductibles, copays and provider groups.
  • If you have a Medicare Supplemental Insurance policy (Medigap), check for any changes or monthly premium increases. Some beneficiaries switch from Medigap to a Part C (Medicare Advantage Plan) at this time of year.
  • If you’ve spent a lot of money out-of-pocket on hospital visits and doctor’s appointments because you don’t have a Supplemental insurance plan or Medicare Advantage Plan, add up expenses to know if a more coverage would help save money. Or check with Medicaid, a state Medicare Savings Program, the “Extra Help” program, or the local State Health Insurance Assistance Program (SHIP).
  • Get up-to-date information on your health status. Is your annual visit with the primary care physician coming up? Will you need to see a specialist? Make a list of all your prescription medications. If any are brand name, ask the pharmacist if there are generic equivalent. If not, ask your insurance plan Part C or Part D for an exception if the expensive brand-name medication isn’t part of the drug formulary.
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Medicare Plans

Medicare Open Enrollment 2019: What You Should Know

by Guest Blogger
written by Guest Blogger

What: Medicare Annual Enrollment Period (AEP)
Also known as the Annual Election Period or Medicare Open Enrollment

When: October 15 through December 7, 2019

Medicare beneficiaries have one guaranteed chance to make changes to their Medicare enrollment each year — the Medicare Annual Enrollment Period from October 15th through December 7th. During this period, you can:

  • Enroll in a Medicare Advantage Plan
  • Enroll in a Part D Prescription Drug Plan
  • Drop a Part C or D Plan

Understanding the Medicare Parts

Original Medicare — Parts A & B

Original Medicare, the coverage offered by the federal government, includes coverage for some hospital services, as well as preventative and medically necessary care. It does not include coverage for prescription drugs, vision, dental, and a number of other categories. You only have to enroll in this coverage once, when you are initially eligible by turning 65or through having a disability, end-stage renal disease, or ALS.

Medicare Advantage — Part C

Medicare Advantage Plansare offered by private insurance companies that are contracted with the federal government. These plans include the same coverage as Original Medicare, and many plans also offer additional benefits like vision, dental, hearing, fitness, and wellness. Some also offer prescription drug coverage, which is critical for many people.

Prescription Drug Plans — Part D

Individuals who are enrolled in just Original Medicare or a Part C plan without prescription drug coverage may also enroll in a Part D plan, which offers only prescription drug coverage.

Changing Plans During AEP

The Medicare Annual Enrollment Periodis a great time to find out what new Medicare plans or benefits might be offered in your area. If you’re covered by Original Medicare only, you may be able to gain benefits like vision, dental, hearing, fitness, and prescription drug coverage by enrolling in a Medicare Advantage Plan. Some of those plans may be available with $0 premiums, copays, and deductibles, making it possible to get more benefits at no additional cost.

If you’re already enrolled in a Medicare Advantage Plan, the Annual Enrollment Period is an opportunity to find out what other Medicare Advantage Plans are available in your area. Plan benefits change each year, so there may be a plan that’s now better suited to you.

New Medicare Advantage Benefits in 2020

Due to updated regulations in 2019 from the Centers for Medicare and Medicaid Services (CMS), insurance providers can now offer a wider range of benefits with Medicare Advantage plans in 2020, including things like:

  • Home helpers/in-home support
  • Transportation
  • Meal delivery
  • Safety/assistive devices
  • Day center visits
  • Fitness membership

 

Several of these additions improve coverage for long-term care and at-home support, which have long been areas where there was little or no Medicare coverage. Review the Medicare Advantage plans in your area to discover if these benefits are available for you.

AEP and Dual Eligibility

Some Medicare beneficiaries are also eligible for Medicaid through their states. These individuals are considered dual eligible and may be qualified for additional assistance with Medicare costs, such as premiums and prescription drugs.

Individuals who are dual eligible can also enroll in Medicare Advantage plans called Special Needs Plans (SNPs). If you are uncertain about your Medicaid eligibility, the Annual Enrollment Period is a good time to look at Medicaid information in your state and make sure you’re not missing out on benefits or assistance you could be receiving.

Medicare Annual Enrollment Period Resources

Medicare AEP Toolkit

You can learn more about this enrollment period with easyMedicare.com’s Annual Enrollment Period Toolkit. This convenient online resource includes information on how to prepare for AEP, a guide to this enrollment period, and answers to frequently asked questions.

Online Enrollment Portal

You can easily enroll in a Medicare Advantage plan during the Annual Enrollment Period using the Medicare Online Enrollment Portal. Use your zip code to search for plans in your area, choose plans to compare side-by-side, and then follow the guided process to enroll in the plan of your choice.

The portal includes plans from a number of top carriers, like Humana, United Healthcare (UHC), and WellCare. It is available 24/7 — no waiting on hold or trying to schedule a callback from an agent. The site is designed with high-contrast adjustable text for your ease of use. It is also equipped with SSL encryption to protect your personal information.

Summary

The Medicare Annual Enrollment Period occurs October 15 through December 7. This enrollment period is critical to your healthcare coverage for 2020 and you may be able to save money, receive additional assistance, or gain new benefits by enrolling in a Medicare Advantage plan during this time. The Medicare AEP Toolkit is a resource for additional information about taking advantage of this enrollment period. You can easily enroll in a Medicare Advantage plan through the Medicare Online Enrollment Portal.

By the easyMedicare.com Team

easyMedicare.com is an independent digital insurance marketplace providing individuals the ability to purchase Medicare insurance from the comfort of their homes. The company has proudly served tens of thousands of people across the United States.

 

 

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Do All Doctors Accept Medigap
Medigap

Do All Doctors Accept Medigap

by Garrett Ball
written by Garrett Ball

If you are turning 65 and comparing Medicare Supplement or Medigap plans, you will probably ask “do all doctors accept Medigap plans?“. This is one of the most common questions for people turning 65 – it can seem complex, but the answer is actually very straight-forward. Do All Doctors Accept Medigap
Put simply, when it comes to accepting Medigap plans, it all depends on if your doctor accepts Medicare itself. Medigap plans “follow” Medicare. So, if a doctor or hospital takes Medicare, they will accept your Medigap plan. It does not matter which company or plan you have since Medigap plans themselves do NOT have networks. Do All Doctors Accept Medigap
If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
This is not the case, obviously, with many other types of insurance which rely heavily on network arrangements to determine which doctors you can/can not see. For example, under-65 individual plans, group plans, and Medicare Advantage plans all typically use a PPO or HMO network of providers.

What If My Doctor Does Not Accept Medicare Assignment?

There is a difference in accepting Medicare and accepting Medicare assignment. Medicare “assignment” is the terminology that essentially means whether or not a doctor accepts the Medicare payment as payment in full. Medicare has a pre-defined payment schedule for each service or procedure. This is the amount that they will pay to a provider for a certain service or procedure, and it is based on where you are located (varies by location).
Most providers DO accept Medicare assignment (most estimates show that around 95-96% of doctors do accept assignment nationally). This means they accept the terms and conditions (and amounts) on the Medicare payment schedule.
If a physician does not accept assignment, however, he or she can charge up to 15% above the Medicare payment schedule. This is called a “Part B Excess charge”. This is typically billed to you after the doctor visit. There are a few states that have prohibited the charging of these excess charges, including CT, MA, MN, NY, OH, PA, RI and VT (as of early 2017). In those states, doctors can not charge above the Medicare payment schedule if they are going to accept Medicare patients.
Even when doctors do charge excess charges, many of the standardized Medigap plans cover these Part B Excess charges, including Plans F and G. Plan N is the most common plan among the plans that do not cover Part B excess charges.

Why Won’t My Doctor Accept My Medicare Supplement Plan?

We often get this question in January and February of each year. Inevitably, what has happened is the person is in a Medicare Advantage plan that they are mistakenly calling a Medicare Supplement. The Advantage plans all have networks and are typically PPOs or HMOs. Those networks change each year – sometimes even in the middle of a year – and if your doctor is not in network with the specific plan you have, you may have to find a new doctor.
This is one of many reasons why it is crucial to understand the differences in Medigap plans and Medicare Advantage plans.

Do All Doctors Accept Medigap Plans: The Bottom Line

So in summary, do all doctors accept Medigap plans? The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare. Do All Doctors Accept Medigap
Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

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Understanding Medicare through Supplemental Insurance
Medicare Plans

Understanding Medicare through Supplemental Insurance

by Jeff Dailey
written by Jeff Dailey

Americans don’t celebrate it as a holiday, but July 30 is an important historical date in the United States. It was on this day in 1965 that President Lyndon Johnson signed Medicare into law, introducing a national health insurance program for citizens aged 65 and older. Understanding Medicare through Supplemental Insurance
In its first year of availability, more than 19 million Americans enrolled in the program. Medicare has since expanded to include individuals who are permanently disabled and those who suffer from kidney failure. This year the number of enrollees is expected to reach 57 million, according to the Centers for Medicare and Medicaid Services (CMS). As the Baby Boomer generation continues to leave the workforce, that number will continue to increase. In fact, Becker’s Hospital Review projects that 19.1 million more people will enroll in the program over the next 11 years. Understanding Medicare through Supplemental Insurance
That’s why it’s important for people approaching retirement to consider Medicare Supplement insurance. A Medicare Supplement policy can help patients cover some of the costs related to medical treatment that aren’t paid by Medicare. Understanding Medicare through Supplemental Insurance
But, before investing in Medicare Supplement insurance, consumers have to do their homework. They should review the 2016 Medicare and You guide published by CMS to find the latest updates to the Medicare program, and also research insurance companies. Not all companies are the same, and there are five things that people should consider before they decide which company to go with:

Insurance Company Ranking

There are many insurance companies that sell Medicare Supplement insurance in the United States today. Fortunately, there are third party organizations like Standard & Poor’s and A.M. Best that rate these insurance organizations for financial strength. These ratings are important to consider when choosing your coverage, as they rate an insurance company’s credit worthiness and its ability to pay its claims.

Experienced agents Understanding Medicare through Supplemental Insurance

When buying Medicare Supplement insurance, be sure to work with an agent who is knowledgeable and experienced in selling the ten standardized Medicare supplement plans.
Medicare is a complicated topic and consumers have so many other issues to think about after retiring from a lifetime of work that working with an agent has its advantages.
The majority of insurance companies will educate and provide training to their agents to ensure that they know the product and insurance laws before they allow them to sell. These insurance companies make sure that their agents stay updated on the annual changes the government makes to the Medicare program, which helps them to work with customers to find the insurance policy(ies) that is right for them.

Pre-existing conditions

Not all Medicare Supplemental insurance programs cover pre-existing conditions. Before reading through a policy, a number of seniors sign up for insurance, only to realize later that they aren’t covered for a second heart attack, or for hospital stays due to recurring back problems during the preexisting condition limitation period.
All companies that sell Medicare Supplement policies cover all pre-existing conditions during an insured’s open enrollment period, which is six months from their Medicare Part B effective date—so start researching your options right away and be sure to connect with a knowledgeable sales person well within those first 180 days. But, some will issue the policy beyond the open enrollment period with a pre-existing condition clause attached. If you are like most consumers, and don’t want to worry about what might not be covered at the time of a claim due to a pre-existing condition, then it is important to choose a company that does not issue policies with pre-existing clauses.

Multiple plan options

Medicare Supplement insurance isn’t a one-size-fits-all solution. There are four parts to Medicare:
Understanding Medicare through Supplemental Insurance
• Part A, covering in-hospital care
• Part B covering medical services and preventative care
• Part C, Medicare Advantage which is a combination of the first two
• Part D, medical prescriptions
There are 10 standardized Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N). Find a provider that can talk with you about what plans they offer in your state, and who can talk you through what will work best for your specific situation.

Customer’s Choice Understanding Medicare through Supplemental

Technology has changed the way the business of insurance is done. Today’s seniors are more tech savvy than previous generations, with Pew Research data showing that 61 percent of people over the age of 65 go online. Seniors expect and want to buy insurance the way they want to buy it – whether it’s purchasing online, over the phone, or face-to-face. When researching insurance companies, find one that will work with you the way you want. Understanding Medicare through Supplemental Insurance
Millions of Americans are helped by the Medicare program each year, but supplemental insurance plays a critical role in helping policyholders to cover expenses they would otherwise have to pay. You worked your whole life to be in a position to enjoy your retirement. Don’t let the exorbitant medical expenses from an unexpected injury or illness prevents you from doing that. Research how supplemental insurance can help you, and find an informed agent who can help you select coverage that is right for you. Understanding Medicare through Supplemental Insurance
By Kevin Murray and John Fauzey, Combined Insurance
Kevin Murray is Vice President, Combined Affinity Markets and John Fauzey is VP, Director of Senior Sales at Combined Insurance. Understanding Medicare through Supplemental Insurance
 

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Medicare Plans

Medigap Supplement Plan

by Kimberly Johnson
written by Kimberly Johnson

If you want to stay in original Medicare, you may want to look into your options for supplement plan coverage. Without such coverage, your out-of-pocket costs could be high if you require medical care. Supplement plan insurance helps pay the deductibles and coinsurance costs that original Medicare does not cover.
You may be able to get supplement plan insurance from a former employer or union. If not, you can buy Medicare supplement plan insurance (Medigap) directly from an insurance company.
If you want to buy a Medicare supplement plan insurance policy, known as Medigap, you must decide which benefit package to buy and which insurer to use. Before making a decision, you should clearly understand what benefits are covered and how to compare plans.
There are 10 different standardized Medigap Supplement plan, labeled A-N. Not all plans are available in all areas. Each Medigap Supplement Plan pays for a particular set of benefits.
The cost of your Medigap Supplement Plan policy depends on the type of Medigap Supplement Plan you choose, the company from which you buy it, and the cost of Medigap Supplement Plan in the state where you live. Once you have chosen the plan you want, it pays to shop around. Plans with the same letter name offer the same benefits, but the premiums vary from company to company. If you buy your Medigap Supplement Plan policy during your open enrollment period or other federally mandated times, your premium cannot vary based on your health status.
No insurance policy fills gaps in coverage for Medicare HMOs or any of the other Medicare private health plans. Should you select an HMO, PPO, or other type of plan, you should budget for any costs that the plan doesn’t cover. Many have a cap on the annual out-of-pocket costs that you are required to pay.

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5 Programs that Lower Medicare Costs
Medicare Plans

5 Programs that Lower Medicare Costs

by Kimberly Johnson
written by Kimberly Johnson

5 Programs that Lower Medicare Costs

Even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. There are five federal programs that lower your costs for care even if you do not qualify for Medicaid: 5 Programs that Lower Medicare Costs
  1. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.
  2. Medicare Savings Programs: Depending on your income, these programs help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, vary somewhat by state. You should apply through your local Medicaid office.
  3. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, which pays for some or all of the cost of your drug coverage, so long as your income is under $1471 (individual) or $1991 (couple) and your assets are below $13,070 (individual) or $26,120 (couple). You get this automatically if you have Medicaid or a Medicare Savings Program. Some states have State Pharmaceutical Assistance Programsthat provide even more assistance.
  4. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and serve underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
  5. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. For information on Medicaid, click here. To learn more about these programs, free local resources, and other programs that could help, contact your State Health Insurance Program. To contact your state Medicaid office, click here.

Written by Diane Archer
Huffington Post

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Budgeting Long Term Care
Health Insurance

Budgeting Long Term Care

by Kimberly Johnson
written by Kimberly Johnson

Budgeting Long Term Care

Budgeting Long Term CareLong-term care costs are an x-factor many people simply do not think about when budgeting their retirement. The odds you’ll need some form of long-term care, however, are surprisingly high. According to longtermcare.gov, 70% of people turning 65 should expect to use some type of long-term care in their golden years. Budgeting Long Term Care
As calculated by Genworth financial, a semi-private room in a nursing home for 2015 cost an average of $80,300. When it comes to finances, seniors are generally on a fixed income, so how can a senior account for such an exorbitant cost? Well, if you plan ahead, there are a few options worth considering.

Medicaid:

While Medicaid is a great option, it’s not applicable to everyone. They have very strict financial and medical rules. Each state has individual guidelines, so check out this guide for your state’s limits and restrictions. Generally, Medicaid allows $2,199 a month in income and $2,000 in assets. The medical portion is determined by whether or not an individual needs care at the nursing home level. If you do qualify, you will not have out-of-pocket costs, but you must choose a care home that has an agreement with the state.

Qualified Income Trust:

If you do not qualify for Medicaid because your income is too high, you can open what is called a qualified income trust, income only trust, or Miller trust. Some states allow you to simply spend the extra money down towards medical care, while others make you create the Miller Trust. It depends whether your state is an income cap state or a medically needy state. Qualified income trusts allow a person to qualify for Medicaid even if their income is beyond the limit, usually around $2,000 per month. For example, if you make $2,600 a month and your state’s limit is $2,000, all money under $2,000 will go towards care, the state will keep the excess, and you will still qualify to receive Medicaid benefits.
Essentially, the creation of a qualified income trust is the state’s way of getting paid back for care and living expenses. The problem with medical spend-down or a qualified income trust is that, for the most part, all income goes towards care, leaving little behind for loved ones. If you’re not concerned with leaving a legacy, this is a great option because the cost of care will be taken care of; placing no financial burden on loved ones.

Reverse Mortgage:

Within the last few years, reverse mortgages have slowly gained in popularity. While not complex, this type of loan doesn’t work for everyone. A reverse mortgage is a loan borrowed against a house’s equity. Rather than making monthly payments, as you would with a normal mortgage, the bank reversely pays the homeowner each month. Essentially, the bank is slowly buying the house. If the borrower moves into a care home or dies, then the bank takes ownership of the home. If a homeowner is pretty healthy and wants some more money for retirement or in-home care, then this could be a decent option. If you are trying to leave your house behind for loved ones then this choice will not work. See a detailed list of pros and cons here.

Long-term Care Insurance:

If you are young and thinking ahead, one way to afford long-term care is to purchase a long-term care insurance plan while you are still healthy. A healthy 55 year old can find an affordable policy that provides adequate coverage. Once a life change occurs, such as a stroke or a fall, it becomes nearly impossible to qualify for long-term care insurance. Long-term care insurance pays for long-term care in the event that the policyholder needs it.
As mentioned above, Medicaid long-term care has a very strict qualification process, but many states offer what is called a long-term care insurance partnership. For example, if the policy covers $350,000 worth of care and that money is spent through, the policyholder can now apply for Medicaid with $350,000 worth of assets exempted during the qualification process. This is perfect for people who want to leave a legacy behind, but also need to qualify for Medicaid.
 
Max Gottlieb is the content manager of Senior Planning and ALTCS in Phoenix, Arizona. While not affiliated with any long-term care insurance provider or Reverse Mortgage brokers, Senior Planning receives many questions on these subjects. Senior Planning and ALTCS give free assistance to seniors and their families, helping them navigate the often-complicated process of finding benefits or care.
 
 

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Understanding Medicare through Supplemental Insurance
Medicare Plans

Fewer Doctors Taking Medicare Patients

by Jeff Dailey
written by Jeff Dailey

Fewer Doctors Taking Medicare Patients

 

Fewer Doctors Taking Medicare patientsIn a recent discussion with one of my doctors, he and I spent a few minutes discussing the ongoing changes and challenges facing physicians who practice medicine today, and more importantly the impact on new doctors just starting to practice. Fewer Doctors Taking Medicare patients

Many of today’s doctors leave medical school with a great deal of debt accrued during the pursuit of a medical degree, and few new graduates can afford to go into a sole private practice. A majority of recent graduates join a group or a hospital to avoid the costs of office rent, equipment purchases, liability insurance, staff costs and the monthly expenses involved in opening a new business.

Medicine used to be a patient-centered and was often a very lucrative career. But with hundreds of government regulations, and new reporting requirements increasing virtually geometrically in the past decade plus the impact of reduced reimbursements from private insurance and Medicare, it’s a whole new world of medicine.

Here’s one of the unintended consequences that has made the practice of medicine not only less enjoyable for many doctors, but will affect a number of boomers. While it might not impact everyone now turning 65 and becoming eligible for Medicare, it will add some challenges to doing so for some.

If you don’t already have a primary physician or might require a specialist, you may be surprised to learn when seeking a doctor, that a growing number won’t expand the current size of their current practice with new Medicare patients. So while you may soon be eligible for Medicare, you might struggle to find a doctor who will accept new Medicare patients.

The Kaiser Family Foundation conducted a research survey and found that 21 percent, or about one in five, physicians are not accepting new Medicare patients and 14 percent are not willing to take privately insured patients. Some physicians may or may not accept traditional Medicare patients that provide payments to those doctors based upon a fee schedule dictated by the government. Other physicians may not be willing to accept Medicare Advantage plans where paid fees are negotiated with private insurers, plans like the AARP United HealthCare, Humana and Blue Cross/Shield “Advantage” plans.

What this means to those of us that live in western North Carolina is that it might be a very good idea to make sure that your current physician, if you have one, will continue to see you when you become a Medicare patient and will accept the Medicare plan you choose. Not all doctors will accept all plans, especially certain Medicare Advantage plans.

If you’re going to become eligible for Medicare in the coming months, get in front of this potential problem. By doing that you’ll know that the doctor you have or choose will accept the plan you wish to select or help guide you in the selection of a plan that includes him or her.

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of Caring for a Loved One with Alzheimer’s Disease, available as a Kindle book on Amazon.com. His podcasts can be heard weekly at www.seniorlifestyles.net.

 

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