4 Ways to Navigate Medicare

Medicare is not the easiest system to understand let alone to navigate. Here is a few quick facts to make sure you are setting yourself up for major success.

1 If you are currently covered by group employer insurance, you can defer receiving Medicare as long as you want. Once again, this is ONLY if you are covered by employer insurance.

2 Individuals turning 65 years old have six months for the initial enrollment period where underwriting is not a requirement in the process of Medicare. Even though we all love underwriting, this time period allow the process to run even smoother.

3 The initial period is the 3 months prior to your birthday, your actual birthday, and the 3 month post your 65^th birthday. It may seem like a long time now, but those 6 months will pass you if you are not paying attention.

4 If you recently stop receiving employer insurance and over 65 years old, you have a 8 month period after your insurance was discontinued called the Special enrollment period. For example, if your insurance was discontinued in May your special enrollment period will end in December.

Making Medicare Simple and Easy

If you ever wanted a personal assistant, especially with the confusing world of Medicare, My Medicare.gov is an amazing tool! My Medicare.gov is a free, secure, online portal that manages your personalized information regarding Medicare benefits and services. It is very simple to set-up, and can be used to check information about your coverage, enrollment status and Medicare claims.

You can make getting all the necessary information about your coverage, prescription drugs, and health records easy for your doctor and any doctor you may need in the future. You never know when you’ll need to see a doctor while traveling. As you may know, not every doctor has your personal list of medications. This tool allows you to have everything you need at your finger tips.

According to sources at eHealth Medicare, your personal information is protected by the CMS. The CMS is the Centers for Medicare & Medicaid Services, The CMS has many guidelines such as, what type of information is being used, who is collecting the information, and how are they using the information collected. This amazing tool has many other functions for your disposal, so give it try!

Leave a comment, and let us know what would you use My Medicare.gov for?

For more information, click the link below https://www.mymedicare.gov/

6 Things You Should Do Before Medicare AEP Begins Oct. 15

It’s that time of year again, the Annual Election Period (AEP) is upon us. If you’ve been a Medicare recipient prior to this year, then you are all too familiar with the implications of AEP. If this is your first enrollment season, then you’re about to experience what can be a frustrating and stressful time as a Medicare enrollee.

During the Medicare AEP, beneficiaries are able to alter their coverage under specific programs such as Medicare Advantage and Part D Prescription Drug plans. Often times, people make the mistake of thinking this is also the only time to change Medicare supplement plans, however those can be changed anytime throughout the year. The main things to focus on during AEP are switching from or to a Medicare Advantage plan, and entering into or changing your prescription drug plans.

You may be wondering why it is necessary to monitor these plans during the AEP, and the simple answer is that these plans change in coverage and price every year. If you don’t change or do anything to your existing plans, they will likely be much different in price and/or coverage as you enter into the next year. In many cases, the change can be significant. That’s why it’s always worth having your Medicare advisor analyze your existing plans and medications to ensure you’re still in the most cost-effective plan every year during AEP. Don’t wait, you could end up locked into a plan with a much higher premium or with holes in your coverage if you miss the AEP window (October 15^th through December 7^th).

In an effort to curb the stress and confusion that comes from Medicare AEP season, we’ve developed a list of 6 things that you should do to prepare.

Confirm your eligibility. This is pretty obvious, but you must be eligible to enroll in Medicare plans. If you’re unsure of your eligibility, consult this article from the US Department of Health & Human Services website: http://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html

Analyze your existing coverage thoroughly. Take some time to consider your past year of coverage. Weigh the pros and cons of the specific plan you’re in, the company/carrier of the plan, the total expenses (including prescription meds) of the year. Consider aspects like how quickly your claims were paid, if your doctor had any trouble with your insurance at any point, and if the out of pocket expenses were worth the healthcare you received.

Make note of any changes in medication or health that could impact your plans. After you’ve done a thorough self-analysis of your past coverage, make sure to note any looming changes that could be upcoming in your health. For example, if your doctor suggested a new medication or treatment that wasn’t previously needed when you set up your original plan. Write this all out and give your coverage an overall satisfaction rating for the year. This will help determine what the next move for you should be, and will make you aware of what you need most out of your healthcare coverage.

Compare prices of plan options for the coming year. There are MANY plans, programs, and carriers to choose from. When it comes time to select your coverage for the upcoming year, it’s essential to decide what type of Medicare beneficiary you are. Are you someone who would prefer to pay a little more on a monthly basis in exchange for peace of mind that you won’t have any unexpected expenses? Or would you rather pay a lower monthly premium and take the risk that your coverage may require high out-of-pocket expenses should you have a health issue? If you can answer this question for yourself, you’ll give a better starting point to determine what plan/program is a better fit and how much you will spend on said plan.

Make a list of your current medications, dosages, and frequency. After analyzing the entirety of your coverage, the next step would be to write down every medication you take, the dosage, frequency, and brand. This list is going to guide your Part D plan selection.

After completing steps 1-5, set an appointment with a Medicare advisor. After you’ve done the previous five steps, you have painted yourself a pretty thorough picture of your healthcare needs. Now it’s time to take this information to your Medicare advisor, so they can analyze and help you select the best coverage at the best price. Completing steps 1-5 prior to your call or appointment will make the process go much faster and smoother for you. *Helpful Tip: Always work with a non-captive Medicare advisor. They have access to all the plans and companies, not just one of them. This ensures you are in the best plan at the best price.

Remember, in order to ease the confusion, contact a Medicare representative to help make this AEP much smoother. If you don’t have a dedicated agent or aren’t sure, our toll-free Medicare hotline is open for questions, comments, concerns for anyone in the United States who needs consult on their Medicare plans/coverage at (888)-404-5049.

10 Things You Might Not Know About Medicare in the US

We’ve said it before, and we’ll say it again, Medicare is confusing. Which is why we dedicate our lives to helping seniors PREPARE for Medicare before they enroll. Knowledge is power! So with that being said, here is a list of 10 things that you probably don’t know about Medicare, and some of them may surprise you!

Medicare covers more than just senior citizens. Medicare is designed for the aging population, but under certain circumstances, people under the age of 65 can be enrolled. If you have a qualifying disability or End Stage Renal Disease (ESRD), you can get covered under Medicare.
Baby boomers are aging into Medicare at a rate of 10,000 per day. Back when Medicare was first designed, people weren’t living nearly as long as they are today. Add that to the baby boomer generation who are rapidly aging into Medicare at a rate of 10,000 people PER DAY, and you can see how Medicare is quickly going to get into trouble.
Enrollment can happen outside of AEP. There is a common misconception surrounding Medicare that you can’t change your plans unless it’s during the Annual Election Period (AEP) from October 15-December 7. While this is true for Medicare Advantage (Part C) and Prescription Drug Plans (Part D), you can change from Medicare supplement plan to plan anytime you want. There are always “special election periods” and change of status that can warrant a change outside of AEP as well.
Each part of Medicare covers something different. While the parts of Medicare can be the most confusing part, it’s all for good reason. Each part of Medicare means something different and works differently. Part A is for your hospital care, Part B is for healthcare outside of the hospital such as routine doctors’ visits and preventive care, Part C is Medicare Advantage, and entirely different program from original Medicare altogether, and Part D is the prescription drug plan. Every part works differently to make one whole picture.
How much Medicare actually pays out. Medicare supplemental insurance was created to fill in the coverage gaps left behind by original Medicare. Did you know that traditional Medicare only covers 80% of the Medicare-APPROVED costs? That means, YOU as the enrollee are responsible for that other 20%. This is where Medicare supplement insurance comes in. It covers your 20% if you keep up with your monthly premiums, and can save you a ton.
A “non-participating” doctor still takes Medicare. Despite what the status title of “non-participating” doctors suggests, doctors under this status DO accept Medicare. They just don’t accept it at the amount that Medicare pays, meaning these doctors reserve the right to charge the patient additional money on top of what Medicare approves. While it seems confusing, don’t be too alarmed if your doctor becomes a “non-participator”- it just means that they reserve the right to charge you 15% more than Medicare approves. This is typically only found with specialty doctors/treatments.
Waiting to enroll in Part D can cost you FOR LIFE. Once you’ve reached Medicare enrollment time, you also have to enroll in your Part D drug plan. If you don’t, you have to wait until the following AEP, AND Medicare charges a fee every month for the rest of the time you’re on Medicare (aka, the rest of your LIFE!) While the fee is minor, it can add up depending on your lifespan. 1% of the national average in premiums in what you pay PER month, so 12% per year, lasting forever.
Medicare doesn’t cover everything. If you’ve been to your doctor for a physical and you WEREN’T charged for it, your doctor didn’t file it properly. Physicals and some other procedures aren’t covered under Medicare. While Medicare paired with a supplement covers almost everything, and mostly the big stuff, it doesn’t cover everything.
Medicare doesn’t work outside the USA. Getting ready for a big vacation to Europe? Make sure you understand before you go that your traditional Medicare coverage doesn’t apply out of the country. If you have a Medicare supplement, you’re covered. However, traditional Medicare without a supplement or Medicare Advantage does NOT work outside the United States.
On average, with Medicare you get WAY more than you pay for. While your Medicare premiums and co-pays do add up, compared to the average amount of usage, you are saving a TON. Medicare may not be perfect, but it is still possibly the greatest government healthcare coverage known to us. Take advantage of it by preparing yourself properly with a supplement so you don’t get stuck with huge bills, but rather a predictable monthly premium.

It’s true; Medicare is complex. But it’s one of the best working healthcare systems out there, and if used properly it can save enrollees a ton of money in their health care and keep them healthier, longer.

What is the Difference Between Medicare Part A and B?

Ever wondered what all the different parts of Medicare actually mean? There are many terms and ideas associated with Medicare that are constantly thrown around, but do you truly know what they mean? Our blog is aiming to answer some of the common and consistent Medicare questions so that you can better understand the industry, and furthermore, your coverage.

So let’s dive in today with the basics: defining the two primary parts of original Medicare, Part A and Part B. We’ll get into Part C & D on another day.

Okay, so let’s start with the more basic Medicare Part A.

Medicare Part A

This is your hospital insurance. Any inpatient hospital stays, care received in a skilled nursing facility, hospice care, and some health care are covered under Medicare Part A. This is pretty straight forward; however, it can be more complex depending on your healthcare status and provider. Often times “under observation” can be a troublesome status for a patient covered under Medicare to have, because it can cause trouble with coverage. That’s a story for another day though, so for now, just remember that “Medicare Part A covers your stay” (in most cases).

Medicare Part B

Okay, so this is your actual health insurance coverage. This covers two types of medical services:

Preventive medical services such as flu shots, illness screenings, and the like, are considered preventive services. The lines here can become a bit blurred, but essentially, any sort of screenings or lab work that is done in an attempt to prevent major illness is considered preventive. Additionally, coverage can extend to necessary durable equipment like walkers or wheelchairs, when a diagnosis requires that.
Necessary treatment is covered when patients require treatment and care to treat conditions or illnesses. Included in this category are x-rays, lab work, outpatient services, and doctors visits that are necessary per your condition.

For part B, just remember it either helps prevent illness with preventive care coverage or treats an illness or condition.

If you don’t have a Medicare supplement plan in addition to your original Medicare coverage, then you are responsible for paying a deductible annually, as well as 20% of the Medicare-approved amount with participating providers. This 20% can really add up quickly, especially if you are being treated for a serious illness. This is why in most cases it makes sense to have a Medicare supplement plan to back up your original Medicare.

Well that in a nutshell is Medicare Part A and B. Stay tuned for more Medicare news, tips, and facts by following our blog or social channels.

The Medicare Crossroads

The Medicare Crossroads: Do I Buy a Medicare Advantage or Medicare Supplement Plan?

Ah, the legendary question that every senior encounters nearing their 65^th birthday and thereafter. Not only does each program have hundreds and hundreds of companies and plans to choose from, but the rules, networks, and coverage details can be extremely difficult to grasp.

Entering Medicare is a confusing, intimidating, and even vulnerable time, mostly because there are so many predatory insurance companies and salespeople vying for your dime. If you want to make the best Medicare decision possible that will support you when you need it and not break your bank account in the meantime, it’s critical for you to stay informed about all your options. Like, for example, did you know that if you enroll into a Medicare Advantage plan, you are thereby dis-enrolling from original Medicare. They are two completely separate entities.

Let us help you on your journey as you navigate your way through the Medicare knowledge to be known. Here is our pros and cons breakdown of both Medicare Supplement (or Medigap) plans and Medicare Advantage plans.

We’ll start with Medicare Advantage.

PROS

Medicare Advantage monthly premiums are fairly inexpensive. Some can cost $0 per month.
Part D drug plans are typically included. (*Note: This is a pro for convenience, not efficiency.)
Sometimes they include fitness memberships or other extra incentives.

CONS

Small and intricate medical networks determine your available medical providers. In many cases, you have to change your doctor to become “in-network” before your plan will cover claims.
You run the risk of VERY high out-of-pocket costs (OPCs) if you don’t remain perfectly healthy.
If your OPCs get too high due to illness or injury, you are unable to enter back into original Medicare and can get stuck paying the high OPCs forever.
Limited nationwide coverage due to network restrictions. Traveling becomes an issue because your insurance is usually not applicable at remote medical facilities. (*Note: The Mayo Clinic is one of those major hospitals that will NOT take Medicare Advantage plans.)

Medicare Advantage plans may be cheap, but as my mother always told me “you get what you pay for.” This is true with Medicare Advantage, or as we call it in our office Medicare DIS-Advantage. The cons almost ALWAYS outweigh the pros when it comes to a Medicare Advantage plan.

Next, the Medicare Supplement or “Medigap” plan.

PROS

Depending on your plan, almost everything is covered. Out-of-pocket costs (OPCs) are relatively low or non-existent.
Anytime you become eligible, you can enroll in a supplement plan, not just during the Annual Election Period (AEP).
Coverage is more predictable and easier to understand.
You can keep your doctor! Chances are, he or she accepts original Medicare and your corresponding supplement plan.
Almost always accepted when you travel nationwide.

CONS

Medicare supplement plans are more expensive than Medicare Advantage plans.

As you can see, Medicare supplement plans do cost more, however the coverage they provide is exemplary.

Let’s create an example. Two best friends, Jane and Beth, each chose coverage recommended to them by their insurance agents three months prior to their 65^th birthdays. Jane was enrolled into a Plan G Medicare Supplement plan from Banker’s Fidelity at $183.47 per month. Beth decided to dis-enroll from original Medicare and enroll into a Humana Medicare Advantage plan at only $37 per month. As they compare their enrollments, Beth gloats about how much money she is saving for her coverage. Jane does wonder why her plan is so much more than Beth’s, but she trusts her advisor and believes in her decision.

Later that year, Jane discovers she has a rare form of curable cancer, and Beth also learns she has progressing heart disease. Both women are in and out of doctors’ and specialists’ offices. While Jane gets to keep seeing the doctors she knows and trusts during this scary time, Beth’s plan requires her to visit only in-network doctors and specialists, some who mandate traveling far from home.

A few months later, the women start receiving their doctors’ bills and statements. Beth is shocked and terrified to discover that she already owes thousands, and it’s continuing to add up. Her out-of-pocket maximum will eventually kick in, but it’s a high number. Beth is not only worried about the future of her health, but also her financial future.

Jane, on the other hand, doesn’t owe anything other than her premium. She can rest assured because the money she pays every month in premium protects her from unexpected costs and expenses. While she’s moving towards recovery of her health she can rest easy knowing her Medigap coverage will insulate her pocketbook.

Unbiased and Factual Medicare Presentations Available Year Round

Senior Health Medicare Presentations Overview

Unbiased and useful information is what viewers of our Medicare presentations can expect, always. With almost two decades of experience in Medicare, our presenters are the best of the best and can help you feel secure and informed when it comes to your Medicare insurance. If you’re a part of a group, association, retiree club, or credit union, this is a great FREE way to provide more benefits to your members.

On-Site Medicare Workshops

If your group is located in the state of Michigan, or in the bordering states like Ohio or Indiana, we would be happy to hold an on-site Medicare workshop at your location or a location of your choice. We provide the lunch and the information, and your members benefit.

Virtual “Webinar-style” Medicare Workshops

Same information just presented virtually for those on-the-go or out of our region. Great way to get a feel for our presenters and style before committing to an in-person workshop. Also a great way to get the same valuable information on your time and schedule.

Choose from a list of intriguing topics like:

“Medicare 101: An Overview of the Medicare Benefit”
“Medicare Advantage versus Medicare Supplement”
“How the Affordable Care Act Will Effect Medicare in the Next 5 Years”
“How to Recognize and Avoid Medicare Scams”
“Understanding the Difference Between Part A and Part B”
“Part D Prescription Plans Made Clear”
“How to Choose the Right Medicare Supplement Plan”
And more! We can customize topics based on audience interest.

Our presentation calendar fills up quickly, so book your spot today! We recommend late summer/early fall time slots to make the best impact on your members right before the Annual Enrollment Period (AEP).

Call Cortney to set up your FREE Medicare presentation at (517) 304-3484 or email her at cpeters@seniorhealthmedicare.com

3 Things Medicare Buyers Should Stop Doing Right Now

The undeniable truth about our Medicare system is that the entire process is daunting. There are so many different terms and phrases; the supplemental plans, the “Advantage” plans, the Part D options. And enough acronyms to drive a sane person completely bonkers.

Add to that the growing number of insurance agents pounding on your door or filling your inbox, the pile of confusing mail awaiting you, and the government “experts” constantly modifying plans and procedures- now, you’re in trouble.

If you take ownership of Medicare knowledge, these pitfalls won’t affect you. In order to be the most educated Medicare buyer, you just have to stop doing these 3 things right now. What happens if you don’t? You waste money and time.

Stop buying insurance from agents.

Despite any claims otherwise, most insurance sales people tend to play favorites with carriers and products. In many cases the commission rates, incentive trips, and sales leads provided to the agent all contribute to the favoritism. On top of that bias, the Medicare landscape changes indefinitely; carriers in the Medicare realm usually enter the market at a great price, then are followed by substantial increases. Agents aren’t always giving the best advice, and you should really seek an advisor over an agent any day.

Make sure that the agent you are working with has access to a multitude of carriers (they’re called many names like “non-captive”, “independent” or “non-exclusive”) and definitely avoid “captive” agents, who work exclusively for one carrier.

Always ask, “What other carriers offer the same plan in my area?” We have literally seen scenarios where one carrier pays close to $300 more commission than another…for the same exact plan! In most cases, carriers who pay less commission to the agent have had more stable rates with smaller increases.

Don’t take the “easy” way out.

Most agents love to sell Medigap plan “F”, but it’s usually not the best plan for you. The honest truth is that because commission is a percentage of the premium you pay, plan F pays the agent the most. Plus, it’s the only plan that pays both Medicare part A and B deductibles, and all Part B co-insurance, which makes it very attractive. If you are in “open enrollment”, or can qualify for coverage, plan G is almost always the way to go.

Here’s why: Plan G requires you to pay the Part B deductible of $140 per year, but pays everything else the same as plan F. Most plan F premiums are far more than its friend plan G, but only for the convenience factor. Would you pay $300 more per year just to have a $140 deductible paid on the insurance companies’ behalf?

Here’s the other big secret about plan F: It has larger and more frequent rate increases than the other plans. Because Plan F is used for the “Guaranteed Issue” privilege, (for those who have lost coverage from somewhere else), Plan F almost always has more claims due to the absence of medical underwriting. The sicker the pool of people, the more the rates go up. When you apply for a plan G…you’ll know that everyone, except those who just turned 65, had to qualify based on their health. Healthier people=lower rates.

Stop buying into marketing tactics and sales clichés.

Here’s a short list of some of the most popular sales pitches used to convince a person to enroll, followed by the real interpretation:

“The customer service is great and they pay claims really fast.” Tell us something we don’t know. Every sneaky agent uses this line, and they usually know darn well it’s out of their control. A good Medigap plan pays everything automatically that Medicare approves, and most clients will NEVER have to work with the carrier except for premium payment changes or a billing address change, etc. What’s more…it’s not as if the Medigap carrier is paying you, they are paying the doctor or the hospital. So whether they pay the claim in 2 days or 2 weeks is completely irrelevant to you. Don’t fall for this one!

“This carrier hasn’t had a rate increase in years!” Bad sign. A carrier who hasn’t taken a rate increase in more than 2 years is probably long overdue for one, and you’ll be along for the ride when it happens. It is far smarter to enroll in a plan that has just recently adjusted its rate, as the chances of you experiencing a large bump in price are far less. Little increases are fine, and necessary based on the claims activity. But huge ones are usually the result of a carrier trying to “buy” the business by maintaining a lower rate until it hits the number of clients it wants; then treating those “lucky” recipients to a whopping increase.

“This company also offers the Part D benefit, so you can have both plans with same carrier.” Run away from this line-giver as fast as you can. It makes no sense to even consider a Medicare supplement plan based on the Part D benefit. Any responsible agent would offer to run a complete prescription drug analysis before recommending a part D. The best one for you is the one that has the least out of pocket costs for that year, and it rarely ends up being the same company as your Medigap policy. You could end up overpaying WILDLY. A reputable, good company would offer a Part D analysis to determine what medicines you actually take, before trying to determine prescription coverage.

Save Money and Time On Health Insurance with a Non-Captive Provider

Non-captive agents help you get the best coverage at the best price, always.

Okay, so we know insurance is a source of stress and angst for people everywhere. Am I in the right plan? Am I overpaying? Will our coverage be enough if something terrible happens?

If you’ve asked yourself these questions about your health insurance plan, then you are definitely not alone. It’s extremely difficult to navigate the sea of insurance options, plans, prices, and companies- it can be almost impossible to go it alone.

But even if you have someone to help you, how can you be sure that they have your best interest at heart? If you are working with a captive agent, we’d be willing to bet that they usually don’t.
So, what is a captive agent? A captive agent is an insurance salesperson who works for one insurance carrier and, therefore, can only offer products from said carrier, nowhere else. These are your typical big-name insurance companies like Blue Cross Blue Shield, HAP, or Humana. If you’re working with one of these companies, don’t worry, they all offer good products that meet health insurance needs. However, the agents representing these brands can only give you the price and coverage quotes of the products they have access to- which means only one carrier option. Aside from that, sometimes there are incentives given to agents for selling a certain product. This product might not be the best option for you, but if it gets your captive agent on a trip to the Bahamas they won’t tell you that.

This is why we ALWAYS recommend that you select your health insurance plan with the guidance and help of a non-captive advisor. Non-captive providers can select the best coverage for you at the best price from an infinite list of carriers. Not only that, but they can explain thoroughly the details of your plan and stay with you for years to come.

Try calling into find your captive insurance agent at their home office and we can almost guarantee you’ll be pushed through an automated phone system. Select a non-captive provider and you can access them directly anytime you want for questions or help regarding your plan.

Having a non-captive provider not only saves you money, but it saves you time and worry. A non-captive agent is not tied down to one carrier or persuaded by incentives to sell products like captive agents are. They only select the best plan at the best price to suit each client’s individual needs.

Okay, so let’s recap the primary differences between captive and non-captive insurance advisors:

Flexibility– Non-captive agents have the flexibility to select from a wide variety of carriers and plans, not just one. This means they have a much higher chance of finding the perfect coverage/price for you.

Accessibility- Instead of calling into a major corporation and going through the run-around, you can more quickly and easily access your non-captive advisor year round. Get a bill that doesn’t make sense? Give your non-captive advisor a call and they’ll be sure to help.

Dedicated Resource- Even if you aren’t sure you’re ready to buy yet, a non-captive provider will give you information about the plans, health care laws, and policies whenever you need help. Think of your non-captive advisor as a dedicated resource for all insurance questions.

Fluidity- Whereas many captive providers want you to think you’re stuck in your plan, there can sometimes be a way out if rates get to high (especially with Medicare supplement insurance). The ability you have to move if your plan doesn’t work out as well as you thought, is a benefit only offered by non-captive providers.

Freedom- The freedom to live your life without stressing about your health insurance plan and how it affects your bank account, is something that can only be reached with non-captive agents.

For these reasons, we highly recommend you seek a non-captive provider to be your health insurance guide. Your wallet will thank you.

Can I keep my doctor if I switch to a medicare supplement?

Can I keep my doctor if I switch to a medicare supplement?

Yes, at least, most likely. 98% of all doctors in the united states accept medicare. It is the bread and butter of most hospitals because seniors make up the majority of hospitalized patients.

If your doctor accepts medicare, your doctor will take medicare supplements!

Imagine medicare as a road with a bunch of pot holes. Medicare supplements is the tar that the road crews fill the road with. Once it’s added it just becomes part of medicare!

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