Closing Your Medicare Coverage Gaps
Did you recently purchase a new health care plan, or are you reevaluating your existing plan? You may have noticed by now that your Medicare plan does not cover all of your health care needs.
If you only have basic Medicare, your plan only covers hospital treatments and doctor visits. If you have Medicare Supplements, your plan covers hospital treatments, doctor visits, and copayments and deductibles. If you have Medicare Advantage, your plan probably includes additional items like prescription drug coverage, dental and vision benefits, and physical fitness incentives.
Your prescription drug coverage can also leave you in the Donut Hole!
Thankfully, we can help you close your coverage gaps. This is how:
Ancillary Products
Even if you have Medicare Advantage, your Medicare plan is missing items like final expense coverage, life insurance, and more! If you don’t have Medicare Advantage, your Medicare plan definitely does not have items like dental, vision, and hearing insurance. These are all items that you can buy separately to give yourself additional coverage!
Dental, vision, and hearing policies are a great place to start, but you’ll really want to consider your other health care needs. Are you at a high risk for a stroke or heart attack? Do you have a family history of cancer development? If so, you may want to consider adding on a cancer, heart attack, or stroke policy.
Individual hospital indemnity policies are a great way to protect yourself for the event that you need to spend a long period of time in the hospital, and final expense policies are a great way to ensure that your family does not have to shell out thousands of dollars to pay for your burial expenses and any outstanding bills at the time of your death.
Extra Help
Thousands of seniors who qualify for Extra Help don’t even know it! We want to help you figure out if you’re missing out on great Medicare savings. If you qualify for Extra Help, otherwise known as LIS (Low-Income Subsidies), you can get help paying for prescription drug premiums, deductibles, coinsurance, and copayments.
Additionally, you can have an SEP, or Special Enrollment Period. This means that you’ll be able to change or add a plan outside of the Annual Enrollment Period (once per quarter during the first three quarters of the year).
LIS can also help you pay for late enrollment fees and cover you when you fall into the Donut Hole (the gap we mentioned earlier). Any Medicare beneficiary who has LIS does not have to worry about the Donut Hole coverage gap!
Find more information on LIS here.
Meet An Agent
Thankfully, we can help you with all of this! Our Medicare Health Benefits agents can come directly to your home, so you don’t even have to go anywhere. We’ll send them your way so they can help you pick the best plan from the best carrier for your individual needs. Our agents can also help you apply for LIS!
To get started, set up an appointment by giving us a call at 1-844-431-1832.
How Medicare and Retiree Coverage Work Together
How Medicare and Retiree Coverage Work Together
Does your employer offer retiree health care coverage? Even if you have a retiree plan, you still need to enroll in Medicare. Medicare and retiree coverage are not the same thing.
Your Medicare coverage will always come first. Your retiree coverage will work as extra coverage to backup your Medicare plan – kind of like a Medicare Supplement plan. While retiree coverage is not a Medicare Supplement plan, it is very similar. It can cover things like copayments and deductibles, or even extra hospital stay days. All retiree plans are different, though, so look over your plan and call your agent to find out what it covers.
Do You Have Coverage?
Not every employer offers retiree coverage. Since it isn’t required, your employer (or former employer) can cancel or change your retiree plan at any time. It’s safest for you to have Medicare as well. Plus, if you don’t enroll in Medicare when you first become eligible, you will face a penalty fee. Some retiree plans automatically stop when you turn 65 and become eligible for Medicare.
If your employer does not offer retiree coverage, retiring or losing your job gives you a SEP. A Special Enrollment Period means that you don’t have to wait for AEP, the Annual Enrollment Period, to buy coverage. You will have 60 days from your last day of work to enroll in a marketplace health plan. After those 60 days are over, you’ll have to wait until AEP (October 15 – December 7) to buy a marketplace plan, at which point you will be charged a penalty fee for having a lapse in coverage.
How To Enroll In Medicare
To get started with Medicare, speak with an agent! One of our licensed and highly qualified agents can help you sort out your options and pick the best plan for your needs. Our agents offer bias-free assistance because they are licensed with multiple carriers. We truly want you to have health care and coverage that works for you.
To set up a free appointment, call 1-844-431-1832.
Understanding The Benefits Of Medicare Supplements
Understanding The Benefits Of Medicare Supplements
Medicare Supplement, or Med Supp plans, are designed to help you pay for your Medicare. Original Medicare is comprised of two parts: Part A, hospital care, and Part B, medical care. Some seniors opt to purchase a Medicare Advantage plan, which adds perks like prescription drug coverage, dental coverage, and more, but Medicare Advantage can be pricey. You may be better off with a Medicare Supplement plan.
Med Supp plans are called Medigap because they help to close the gap between your coverage and your out-of-pocket costs. They don’t provide any extra benefits like Medicare Advantage plans do. However, they will help you pay for copayments, coinsurance, and deductibles.
How Medigap Works
Medigap coverage is arranged by letter. Options are A, B, C, D, F, G, K, L, M, and N. Each letter represents a different amount of coverage, as well as different costs for coinsurance, deductibles, and out-of-pocket limits. The confusing part of this is that Medigap A and Medigap B are not the same as Original Medicare Part A and Original Medicare Part B. Make sure to confirm whether you are discussing Medicare Part A or Medigap Plan A.
The letters apply to every state except for Massachusetts, Minnesota, and Wisconsin. Massachusetts and Minnesota separate their Medigap Plans by only two options, and Wisconsin has one basic plan. Clients will still have options with these plans for different amounts of coverage and costs, but the arrangement is different from the other 47 states (speak to your agent for details).
Medigap Qualifications
To qualify for Medigap, you have to have Original Medicare first. You cannot own both a Medicare Advantage and a Medigap policy, so you’ll need to pick one – but you can switch under certain circumstances. Once you have Original Medicare, all you need to do is pay your premiums and you’ll be eligible. Your spouse may not be automatically eligible because every individual needs to purchase his or her own Medigap policy. Those with a Medicare Savings Account (MSA) are not eligible.
Don’t wait too long to purchase a Medigap plan! Otherwise, you may find yourself excluded or up-charged for pre-existing health conditions. Buy as soon as your eligible.
Buy Now
AEP (the Annual Enrollment Period) runs from October 15 through December 7. Set up an appointment to speak with an agent about Medigap or other changes to your plan by calling 1-844-431-1832.
Holistic and Natural Health Care with Medicare
Holistic and Natural Health Care with Medicare
Medicare provides coverage for services with doctors, pharmacies, and hospitals that have legally agreed to serve Medicare clients. Holistic and natural health care providers are usually not legally equipped to support Medicare. In 2017, if you’re over the age of 65 you have to purchase a Medicare plan. But what if you only use holistic and natural methods and don’t plan on actually using Medicare?
Medicare Is An Investment
If you have Original Medicare, your premiums can be less than $200 per month. That’s a better deal than paying a fee every time you visit a holistic doctor. More importantly, if you have to rush to an emergency room one day, you’ll have to pay the total cost of your visit and care. An emergency medical professional is not going to drive you to your holistic care facility. A Medicare plan will help you pay for any potential emergency.
If you don’t purchase a plan now, you’ll be charged a penalty fee later – so it’s financially smartest to buy a Medicare plan as soon as you turn 65.
What To Buy
If you truly believe that you won’t use your Medicare plan, you’re still better off purchasing a small plan than not having coverage at all. If you prefer, you can enroll in Medicare Part A alone. It will only cover hospital services (no prescription drugs, no doctor’s appointments, no long-term, dental, hearing, or vision care). Additionally, you can enroll in a Medicare Supplement plan, which will help you pay for your coinsurance, copayments, and deductibles.
We’ll take your holistic health care needs into consideration and help you find a plan that best fits YOUR needs. Call today at 1-844-431-1832.
Health Care Around The World
Health Care Around The World
With all of the coming changes to health insurance, are you curious what other countries do for health coverage? Let’s take a look at health care around the world.
The U.K. & The Commonwealth
Essentially everyone in the U.K. has access to free health care. Even visitors receive free emergency care! That comes with a different kind of price, though. As the U.K. tries to cut costs, quality of care decreases.
Australia’s health care system is called Medicare, but it is available for all citizens, not only seniors. It is almost entirely government-funded. 25% comes from the Australian government and 43% comes from the Commonwealth.
France
In France, doctor’s appointments essentially cost one euro, which is currently worth a bit more than one American dollar. Patients pay with a card and receive 100% reimbursement later, minus one euro to help fund nation-wide health care activities. Special care and drugs are reimbursed at about 70%. Also, patients can purchase additional coverage.
Belgium
Belgium has one of the most efficient health care systems worldwide. Care facilities, much like in the U.S., range from privately owned to government-run and non-profits. Citizens can choose whatever facility they want to visit, with no limitations on insurance.
Like in France, all Belgian patients use a care card at all of their appointments. Belgian cards will later provide reimbursement of up to 75%. Charges will come through payroll or a bank account.
Germany
Germany may be most similar to the U.S., since patients pay about 13% of their income to what is essentially health insurance. Uniquely, Germany often bundles accident and long-term insurance with their traditional health care plans. Germans can choose any health care facility they like because they are all federally funded. The unemployed (about a third of the German population) are funded separately.
Sweden
Since the Swedish system is 70% tax-funded, there are 21 regulating councils throughout the country. The councils determine health care, social welfare, and water supplies. There is a small fee for treatments and prescription drugs. Additionally, drug costs cannot surpass the limit of the equivalent of $163 per year.
Our system is fundamentally similar to European systems in some ways. It’s easy to wonder if we may head towards a Universal, U.K.-like system or at least a more centralized Belgian-like system. We could also head in another direction entirely – it’s hard to say. All we know is that right now, your Medicare is safe. For help with changing, upgrading, or purchasing a new plan, call one of our licensed agents today at 1-844-431-1832.
Are You Eligible To Have Your Penalty Fee Waived?
Are You Eligible To Have Your Penalty Fee Waived?
Did you miss your enrollment period? Are you living without health insurance?
Under Obamacare, also known as the Affordable Care Act, everyone is required to have health insurance. Your window to sign up is from three months before you turn 65 through three months after your birthday (unless you have a Special Enrollment Period). If you miss that period, you’ll be subject to a penalty fee. The fee will be added to your premium once you enroll. This means that the longer you wait to sign up for Medicare, the higher your premiums will be. Thankfully, you may be eligible for an exception.
CMS (the organization that oversees Medicare) decided that the ACA rules are not clear to many seniors, and most probably didn’t even know they were required to enroll when they turned 65. Many citizens with marketplace health care mistakenly assumed that they would automatically be enrolled.
If you did not receive the required information which tells you about the penalty fee, you can have your fee waived. You may qualify for the waiver until September 30th, 2017.
[clickToTweet tweet=”If you didn’t know about the penalty fee, you may qualify for a waiver until September 30th, 2017.” quote=”If you didn’t know about the penalty fee, you may qualify for a waiver until September 30th, 2017.”]
You can find the following instructions to file for your waiver with more information on your eligibility at MedicareInteractive.org:
How To File A Waiver
- Gather appropriate documentation. You will need proof of your QHP enrollment. Bring a Part B enrollment form (Form CMS-40B) and your Medicare card. You can also fill out a Part B enrollment form at your Social Security office. Examples of proof of QHP can be:
- Letter about your enrollment in both Medicare and a Marketplace plan
- QHP premium bills and proof of payment
- IRS form 1095-A that shows months of coverage and/or cost assistance amounts
- A Marketplace eligibility determination notice
- Access through your Marketplace account
- Receipt from first premium payment you made to your QHP (also called a premium binder payment)
- Call the Social Security Administration (SSA) at 800-772-1213 or go to www.ssa.gov to find a local Social Security office that you can visit in person.
- Once at the office or on the phone with a representative, ask to use the time-limited equitable relief to enroll in Part B and/or eliminate your Part B LEP. Mention that you were enrolled in both premium-free Part A and a QHP. If you are calling to eliminate an LEP, you must specifically request that you want the LEP eliminated.
Are looking for more information about your Medicare? Interested in switching plans or adding coverage? Speak to one of our highly qualified agents! Call today at 1-844-431-1832.
All You Need To Know About Your Medicare Diabetes Care and Coverage
Are you a diabetic Medicare beneficiary? Are you concerned that your diabetes care and coverage won’t be enough? Medicare Part B covers most diabetes care, and any corresponding drugs will fall under your prescription drug coverage.
Coverage
Most of your diabetic care will require that you pay just 20% of the Medicare-approved amount. This includes blood sugar testing strips and monitors, lancets/lancet devices, glucose control solutions, therapeutic shoes, and DMEs, or Durable Medical Equipment. A DME is a medically necessary device used in the home that is not harmful to others and is durable (can last at least three years). For your diabetic care, that includes insulin pumps.
Though Medicare Part B covers insulin pumps, it does not cover insulin. Insulin is a prescription drug, which means that it, along with insulin pens, syringes, needles, alcohol swabs, and gauze instead fall under your prescription drug plan. That can mean Medicare Part D or a MAPD plan (Medicare Advantage with Prescription Drug Coverage).
Services
Your diabetes coverage with Medicare is not limited to home care devices. It also includes some services. With Medicare Part B, you’ll only need to pay 20% for DSMT (Diabetes Self-Management Training), yearly eye exams for diabetic retinopathy, foot exams every six months, and regular glaucoma tests. You’ll also have access to 100% free MNT (Medical Nutrition Therapy).
As with any other medical treatment you receive, you’ll need to be sure that the doctor you visit for treatment and the pharmacy you get your prescription drugs from accept Medicare. Make sure you’re getting the diabetes care and coverage you deserve. If you need help figuring out what doctors and pharmacies are in your network, speak with your carrier or agent. To speak with one of our reputable agents, call 1-844-431-1832.
How Much Should You Be Spending on Ancillary Insurance?
Ancillary Insurance Costs
How much should you be spending on ancillary insurance policies? The short answer is, it depends. It depends on a lot of factors.
Everything from your weight to your gender matters when determining your health insurance costs, and ancillary products like vision coverage and life insurance vary drastically.
Dental, Vision, and Hearing
If you have Medicaid or a Medicare Advantage plan, you may already have dental, vision, and/or hearing included in your coverage. If not, you may want a separate plan. Keep in mind that these plans are commonly bundled, so you may not need to pay three premiums.
Dental coverage costs will average at about $350 per year or $30 per month. That may seem like a high cost for one type of service, but consider that one crown can cost about $1,000, and a dental plan will cover anywhere from 80-100% of that. It’s worth the cost.
Without insurance, a vision appointment will cost an average of $200, and glasses and contacts can cost over $300 per year depending on prescription strength and brand. Monthly costs average at about $30 per month. Hearing coverage falls into the same range.
Cancer, Heart Attack, and Stroke
Cancer plans can start as low as $15/month, but can reach up to $40 or $50/month. Heart attack and stroke coverage are usually bundled together for about $20/month. These three types of plans are among the most wallet-saving as care costs for these conditions can total in the upper thousands.
Short-Term Care and Hospital Indemnity
Monthly premiums for short-term care policies generally fall in the $30-$40 range for basic coverage and can be over $100 to include homecare and other services. Since these policies are only active for a year or less, total costs may be smaller than those for a long-term policy.
Hospital Indemnity plan premiums vary based on how much coverage you need. They can be as little as $12 per month or as much as $300 per month.
Life & Final Expense
Life insurance costs vary more drastically than any other form of coverage because consumers have so many options. You can request $500,000 worth of coverage or $1,000,000’s worth.
One of the first questions a carrier will ask is whether or not you are a smoker. Insurance rates for smokers are much more expensive than for nonsmokers because a smoker has much higher health risks. A 35-year old non-smoker may pay about $735 per month for a lot of coverage or closer to $200 per month for less coverage.
Final expense policies are based on personal choice. Funerals can cost upwards of $10,000, so you’ll end up paying anywhere from $10 per month to $20 per month depending on how much coverage you want for your final expenses.
How much are you spending on ancillary insurance? Visit our post about getting ancillary coverage for FAQ’s and information about what you may need. If you need more questions answered, set up an appointment to speak with one of our agents by calling 1-844-431-1832.
Make The Most Of Your Medicare
Take Advantage Of Your Medicare
Do you know how to make the most of your Medicare plan? Do you know all of your benefits? Millions of people who enroll in Medicare pay their monthly premiums but don’t take advantage of their available services.
When you have a Medicare plan, you should use doctors in your network and prescription drugs on your formulary to save as much money as possible. You should visit your doctor even when you feel completely healthy or have minor concerns. Get your vaccinations, get tested for diseases that your family has a history of, and take advantage of other benefits like gym memberships.
Read on to discover what coverage you’re missing out on:
Find Doctors In Your Plan Network
Some carriers have doctor and hospital search engines so you can see which doctors are covered under your plan. ZocDoc is a great non-affiliated doctor search website as well. If you continue to use a doctor that is outside of your plan, you’re wasting potential savings that you’ll receive if you visit a doctor who is within your plan’s network.
Prescription Drug Coverage
The same goes for pharmacies and drugs. Your coverage is likely much higher for generic brand prescription drugs, so ask your doctor for a generic version when he gives you a prescription. Your coverage includes mail-order prescriptions as well. Mail-order is often cheaper because there are less labor costs! Plus, you can buy bigger supplies.
Take Advantage of Preventative Benefits
Medicare coverage isn’t just for help in the event of illness or injury – It’s also great for prevention. That means you have coverage for well-visits with your doctor, vaccinations (like flu shots), screenings and tests, and prescription supplements. Why not take advantage of those benefits and get ahead of potential illnesses? As a bonus incentive, staying healthy can keep your life insurance rates low.
[clickToTweet tweet=”Take advantage of your Medicare and see your doctor for a well-visit or screening. ” quote=”Take advantage of your Medicare and see your doctor for a well-visit or screening. “]
Know Your Additional Benefits
Some Medicare plans include discounts and freebies like gym memberships, massages, nutrition classes, support groups, and even LASIK surgery. Some even provide “rewards” in the form of discounts if you stay healthy.
Understand Your Coverage
If you have questions about your Medicare coverage, don’t be afraid to contact your carrier or agent. If you are enrolling for the first time or hoping to change your plan, set up an appointment with one of our experienced agents by calling 1-844-431-1832.
Home Health Services Covered by Medicare
If you’ve been following our blog, you know that Original Medicare encompasses Part A, hospital care, and Part B, doctor care. Thankfully, hospital and doctor care covered under Original Medicare is not limited to in-office care. Most of your home care needs will also be covered by your Original Medicare.
Do You Need Home Health Care?
Home health care is usually equally as effective as the care you would receive in a hospital or facility. If you have an injury or illness that prevents you from leaving your house, you’ll want to consider home health care.
Home health care is not limited to treatments and doctor visits. It can also mean care education for you and/or your caregiver. You may have a relative or friend taking care of you who needs help to give you the best care possible.
However comfortable it may be to have a friend take care of you, if you need injections or close monitoring, it may be in your best interest to hire a professional to check in on you at your home. A home nurse or doctor will also communicate with your other doctors and health care professionals to keep everyone on the same page and keep all documentation updated. It’s all in the interest of promoting good health for you.
[clickToTweet tweet=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. ” quote=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. “]
Home Health Services Covered By Medicare
To be eligible, you must have Medicare Part A and Part B, and a doctor must certify that you need the service that you are requesting coverage for and that you are homebound. With your Part A, you will pay $0 for home services and 20% of the Medicare price for any required medical equipment.
Included:
- Skilled nursing care
- Physical therapy
- Speech-language pathology
- Occupational therapy
Not Included:
- 24-hour home care
- Delivered meals
- Homemaker or personal services
You will stop receiving coverage for your home care if your treatment is no longer medically necessary or if you are no longer homebound.
Choosing Your Home Care
Your doctor will probably recommend a home health care service to you if he doesn’t provide those services himself. Otherwise, Medicare has a Home Health Agency finder so you can locate the care you need in your area. When choosing an agency for yourself or for a loved one, make sure you’re asking the right questions, such as:
- Are you Medicare (or Medicaid) certified?
- Do you offer ____ service?
- What are your hours and do they align with my needs?
- Will you have emergency staff available on weekends and after hours?
- Do you perform background checks on staff? Do you have credentials?
- Will I have to pay anything out of pocket?
Once you’ve narrowed your choices down, you may want to inquire about an agency’s quality of care. Any home care agency who services Medicare clients and has serviced at least 20 patients will have a star rating. Patient Care Star Ratings are based on patient health improvement and the outcome of home treatments and care.
If you have more questions about your home care costs or are considering adding coverage, like a Medicare Supplement plan to help with costs, speak to one of our agents today. Call 1-844-431-1832.
