Author: Dan Hoelscher

Dan Hoelscher founded Seniormark in 2007 in an effort to help individuals make a successful transition into retirement. Dan is a Certified Financial Planner™ Practitioner and holds Certified Senior Advisor (CSA)© and Certified Kingdom Advisor™ certifications. Since founding Seniormark, Dan has helped thousands of retirees throughout Ohio.

Hate Your Medicare Insurance Plan? Here’s a Quick and Easy Guide to Switching!

Hate Your Medicare Insurance Plan? Here’s a Quick and Easy Guide to Switching!

You thought the Medicare mess was all tidied up when you first enrolled and purchased proper Medicare insurance (whether it be Medicare Advantage or Medigap), but then you discover a sad fact of life: Costs change. Benefits change. Your needs change. Or, perhaps you’ve quickly come to realize that a plan you thought was all sunshine, rainbows, and good value is a terrible fit for you. Regardless of the reason, it’s time to switch to an option that is more suited to you needs.

 

That is why I want to offer you a simple guide, answering some questions you may have about switching. Is it possible for you to switch? If so, when? And how should you go about it? I will also cover some of my best tips all of us at Seniormark have learned after helping thousands of retirees through this process—tips to save you time and needless hassle.

 

This post is organized into section based on the type of switch you are planning to make:

  1. From a Medicare Supplement to another Medicare Supplement
  2. From a Medicare Supplement to a Medicare Advantage Plan
  3. From a Medicare Advantage Plan to a Medicare Supplement
  4. From a Medicare Advantage Plan to another Medicare Advantage Plan
  5. From a Part D Drug Plan to another Part D Drug Plan

 

Feel free to skip to the section that is most pertinent to you, and don’t forget to call us at 937-492-8800 if you have any additional questions!

From Medicare Supplement to another Medicare Supplement

Can I Switch?

Most people can, except people with very serious, chronic health conditions. You will have to undergo medical questioning and get approved, but don’t lose hope too fast: in many cases, even those with poor health can find a company who will accept them (click here for an blog to answer some questions about this)!

 

When Can I Switch?

Anytime of year. However, I recommend avoiding switching during the Annual Enrollment Period (October 15- December 7). That is a really busy time of year for insurance agencies, so the process might not be as smooth.

 

How Do I Switch?

 (1) Find the best plan for you by doing private research or shopping with an independent insurance agency like Seniormark. (2) Call the company and follow their application process. (3) If you are approved, cancel your previous supplement.

 

Best Tip

This type of switch is not just for those who hate their plans, but is also for those who like to save money (which I assume includes most of us). If you have been in the same Medicare Supplement for 3-5 years, you could save hundreds a year or more by switching without changing your benefits (click here for some help on shopping around).

 

From a Medicare Supplement to a Medicare Advantage Plan

Can I Switch?

Yes, in the vast majority of cases. As long as you don’t have End Stage Renal Disease (kidney failure), you can switch!

 

When Can I Switch?

You can switch during the Annual Enrollment Period (October 15- December 7).

 

How Can I Switch?

(1) Find the best plan for you by doing private research or by shopping with an independent agency like Seniormark. (2) Call the company and follow their application process. (3) Cancel your previous coverage effective January 1st and wait for your new coverage to go into effect for the New Year.

 

Best Tip

Before switching to an Advantage Plan, realize that you are giving up benefits for the lower premium. Advantage Plans are more cost effective when it comes to premium, but even the ones that cost $0 aren’t really free (click here for our blog on “free” Advantage plans), so make sure you understand what you are getting into.

 

And as you are shopping plans, remember to consider more than just the premium. For instance, are your doctors in the plan’s network? If your plan has a built-in drug plan, does it cover your medications? We’ve had unfortunate retirees call in for help after they found out they couldn’t see their own doctor without losing all coverage. And the worst part? They were locked into their plan for the whole year! Advantage Plans can be an excellent fit, but only if you find the right one for you.

 

From a Medicare Advantage Plan to a Medicare Supplement

Can I Switch?

Most people can, except people with very serious, chronic health conditions. Anytime you switch to a Medicare Supplement, this will be the case: You will have to undergo medical questioning and get approved. But don’t lose hope too fast: in many cases, even those with poor health can find a company who will accept them (see link above)!

 

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by doing private research or by shopping it with an independent, local insurance agency like Seniormark. (2) Call the company and follow their application process. (3) If approved, ensure that your policy gets cancelled effective January 1st and then simply wait for your coverage to go into effect in the New Year.

 

Best Tip

Don’t wait until the last minute to switch. Since Annual Enrollment is such a busy time of year for Insurance companies, it may take 3-4 weeks for your application to get processed. So, put your application in early (in October or early November); you don’t want to be stuck in an Advantage Plan you hate for another whole year!

 

From a Medicare Advantage Plan to Another Medicare Advantage Plan

Can I Switch?

Yes, in the vast majority of cases. As long as you don’t have End Stage Renal Disease (kidney failure), you can switch!

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by doing private research or by shopping it with an independent, local insurance agency like Seniormark. (2) Call the company and follow their application process. (3) Wait for your previous plan to cancel by itself and wait for your new coverage to go into effect on January 1st.

 

Best Tip

As I’ve previously noted, make sure your new Advantage Plan has your doctor in its network, and—if your new plan has a built-in drug plan—that your medications are covered. It’s a real pain to kick off New Year off with an ill-fitting insurance plan!

 

From a Part D Drug Plan to Another Part D Drug Plan

Can I Switch?

Yes, there are no restrictions to changing coverage!

 

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by shopping it yourself on Medicare Plan Finder or call OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578 and they can help you re-shop your plan. (2) Enroll online at www.medicare.gov for a new plan. (3) Your new coverage will go into effect on January 1st and your old coverage will automatically end when you sign up for a new part D plan.

 

Best Tip

Do not make drug plan decisions with a tunnel vision focus on premiums. Make sure you find a plan that covers all of your medications and, if possible, has your desired pharmacy as one of its preferred pharmacies.

 

The Ultimate Best Tip: Get Expert Guidance When Making Your Switch This Annual Enrollment Season!

Annual Enrollment is the only time of year you can switch your Medicare Advantage and Prescription Drug plan.  Looking to review your plans with a Certified Senior Advisor this Annual enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

Why You Can Try a Medicare Advantage Plan at No Risk

Why You Can Try a Medicare Advantage Plan at No Risk

 

Infomercials have done it for years.  When people feel uneasy about trying a new product, they offer a free trial or a money back guarantee.  It provides security for the buyer to know that even if the supposed benefits of a product were oversold or blown out of proportion, he can still send it back.  There’s no risk.

 

Well, Medicare offers something very similar.  It’s called the “Medicare Advantage Trial Right”.

 

A lot of people are uncomfortable with trying Medicare Advantage because they don’t want to feel trapped in a plan they hate until the next Annual Enrollment Period.  The trial period takes this risk away.  As long as it will be your first time enrolling in a Medicare Advantage Plan, you qualify for Medicare Trial Right!  This means that—no matter what time of year it is—you can drop your Medicare Advantage plan with no penalty and enroll in a Medicare Supplement Plan.  This “free trial” period lasts 12 months from the date the Advantage Plan coverage goes into effect.

 

But as the infomercial cliché puts so obnoxiously…

 

 WAIT…There’s More!

 

Some people believe that if they have pre-existing conditions and get on an Advantage Plan, they will be denied switching back to a Medicare Supplement Policy based on their health.  In other words, they think that if they give up their Supplement for an Advantage Plan, they will never get it back.  But that’s where the “money back guarantee” part of the deal comes in.  Regardless of health, the Medicare Trial Right guarantees that you will be able to get back on a Supplement, no medical underwriting involved.

 

It’s true that Medicare Advantage plans are alluring with their sometimes shockingly low premiums.  But they aren’t always the right (see here for related article) fit for retirees.  They change unpredictably and can be quite a hassle.  This is why the Trial Right is so beneficial.  It allows you to try a plan on for size, and then toss it back on the rack.  To test drive it around the block, and then park it in the lot if it doesn’t meet your standards.  And all the while, it guarantees that your old, trusty Medicare Supplement will be there.

 

Want to look into switching to a Medicare Advantage Plan?  Call Seniormark at 937-492-8800 for a free consultation.

Drug Plan Check Up: Is your Drug Plan Still the Best Plan for You?

It’s annual enrollment…is your Part D drug plan still the best plan for you?

As most of us remember, there are some VERY important dates associated with Annual Enrollment.  As we discussed earlier in “Don’t set it and forget it” we don’t want to miss these dates.  There are several things that need to be done during annual enrollment but for now let’s focus on the Part D drug plan.  DON’T ASSUME THAT SINCE YOUR PLAN COVERED YOUR MEDICATIONS LAST YEAR THAT YOUR MEDICATIONS WILL BE COVERED THIS YEAR.  Yes, I know, it isn’t convenient that things change, but they do.  So please make sure you review your part D plan this annual enrollment.

For 2019 there will be more than 20 drug plans available in Ohio.  How in the world do you know which is best for you?  Well, there are several things to consider.  Your medications.  The plan’s formulary.  Your preferred pharmacy.  The plan’s preferred pharmacy.  The premium cost.  And so on…  You should have received the Annual Notice of Change for your current plan in late September so make sure you review it!   How do you know if your current plan is still the best plan for you in 2019?  Let’s face it, even if you try and do your homework this stuff is confusing!  As much as we would love to help everyone review their prescription drug plan for 2019, annual enrollment is just too busy for us.  We unfortunately can’t help with the Part D comparisons BUT there are people that can!    If you are still confused and unsure if you’re in the right plan for 2019, please call OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578.  OSHIIP trained volunteers are happy to help.  Make sure you have your Medicare card and list of prescription drugs handy.  If you don’t want to make a phone call, check with your pharmacy and see if they will help you re-shop your plan.  Some pharmacies will assist with this process.  And of course, if you are internet savvy and comfortable doing the comparisons on your own, visit www.medicare.gov and shop it yourself.  Please click here for more information on comparing your plan online.   No matter which way you choose – please make sure you review your Part D drug plan this annual enrollment period starting October 15th through December 7th!

And, as always, if you still have questions, do not hesitate to give our office a call at 937-492-8800.

Don’t “Set It and Forget It” This Annual Enrollment Season!

Don’t “Set It and Forget It” This Annual Enrollment Season!

Does anyone remember Ron Popeil?  If you don’t, allow me to rephrase the question.  Does anyone remember the “set it and forget it” infomercial king?

 

I bet it’s ringing a bell now.

 

I, for one, can still see him in his green apron, armed with nothing but some well-seasoned meats and a fancy rotisserie cooker, taking the cheesy and overly scripted infomercial world by storm: “All you have to do is…”  The unrealistically enthused audience chants, “SET IT AND FORGET IT!”

 

He was like the Billy Mays of the 70s, but with food instead of cleaning products.

 

But I digress…back to the topic at hand.  The reason I retrieved this slogan from memory lane is to make a point: Many people have the “set it and forget it” mindset with their Medicare Health Insurance Plans.  They think that once they undergo the process of enrolling in Medicare, enrolling in supplemental coverage or an Advantage plan, and signing up for a drug plan that they never have to change anything again.  Happily ever after.

 

But this just isn’t true.  Yes, most of the work is done.  And you’ve definitely done the minimum to get by.  But there’s a good chance your situation will change over time.  And, even if your situation doesn’t change, there is a very good chance your health care plans will, oftentimes drastically.  This leaves you in an ill-fitting plan that doesn’t meet your needs or your budget.  You may need to switch!

 

When it comes to Medicare Annual Enrollment, there is a reason for the season.  From October 15—December 7, you have the opportunity to make strategic changes to your health care plans.

 

Here are 3 reasons you might need to make changes this year!

 

The Medicare Supplement Creep

Medicare Supplements are typically consistent from year to year.  The benefits are guaranteed to stay the same, and the premiums rarely increase drastically.  But the premium cost almost always creeps up, dollar by dollar, slowly but surely.

 

If you stay on that ride for too long, you could end up paying $100+ more a month than you should.  In fact, if you have been in the same Medicare Supplement Plan for 4-5 years, there’s a good chance you’re paying too much for it.  Shopping around for a better deal this year could save you hundreds…and all without reducing your coverage.

 

REMINDER:  You can change your Medicare Supplement any time of year (click here for related info), not just annual enrollment.

 

The Advantage Plan Leap

There are so many aspects of an Advantage Plan that can frog around over time.  The deductible may go up.  The premium may go down.  You might have higher copays.  Your coinsurance might drop.  And beyond benefits and price, doctors and hospitals may go in and out of your plan’s network.  A doctor available to you this year, may not be available the next.

 

This is why it is important to review your plan.  Is your family doctor still within the plan’s network?  Is it still the best value for you?  If you simply set it, forget it and let it skate by another year, you’ll never know.

 

The Drug Plan Drop

A drug plan may vary in cost from year to year, but what you really need to check is the list of medications the policy covers, also known as the formulary.

 

Over the years, a drug plan may discontinue or reduce coverage on certain medications.  Imagine if the drug it discontinued was your most expensive one, and you didn’t realize it.  Yeah…it could be a financial disaster.

 

Review Your Plan This Year!

So make sure to take control of your health insurance options.  Review your plans, and take careful note of all the changes.  The “set it and forget it” philosophy might work well for cooking chickens, but it doesn’t work for this.

 

For your health insurance, I offer another slogan:  If you set it and forget it, you might regret it.

 

Maybe that will catch on…

 

Yeah…probably not.

 

Looking to review your plans with a Certified Senior Advisor? Call Seniormark at 937-492-8800 for a free consultation.

How to Choose A Medicare Supplement (A Comparison of the Three Most Popular Plans)

How to Choose A Medicare Supplement

(A Comparison of the Three Most Popular Plans)

So, you’ve likely come to realize that Medicare leaves some expensive coverage gaps wide open. In other words, you’re going to need some Supplemental coverage to ensure you won’t get hit with any high, unexpected out-of-pocket costs.

 

But let’s face it: comparing benefits among Medicare’s eleven lettered plans isn’t easy. There’s a lot to consider, and many people don’t even know where to start.

 

Although I won’t detail all of Medicare’s plan options that we offer (that would require an encyclopedia-length blog post), I will compare the cost and benefits of the most popular Medicare Supplements our clients choose: Plans F, G, and N. I will outline what each plan offers, highlight the major differences, and go over the pricing based on the current lowest rates of the diverse range of companies we represent.

 

Let’s meet the line-up.

Plan F—The Luxury Plan

Plan F is Medicare’s most popular plan, accounting for 53% of all policy types. Plan F is what many like to call the “Cadillac plan” because it is provides the most comprehensive coverage of all Medicare’s supplement coverage options. And, judging by this chart, detailing its benefits, it definitely lives up to its name:

Medicare Supplement Benefit Does Plan F Cover It?
Part A Hospital Coinsurance—and up to 365 additional hospitalization days after Medicare benefits end YES
 The 20% Part B Coinsurance and Copayments YES
Blood (First 3 Pints) YES
Part A Hospice Care Coinsurance and Copayments YES
Skilled Nursing Facility Coinsurance YES
$1340 Part A Deductible YES
$183 Part B Deductible YES
Part B Excess Charges YES
Foreign Travel Emergency YES

 

So, in other words, Plan F guarantees little to no out-of-pocket costs. The only things that aren’t going to be covered in Plan F are health care costs that aren’t covered in any of Medicare’s supplemental coverage options such as dental, vision, and hearing care. But I usually don’t recommend insuring these costs.

 

However, as you may have guessed, with such a high-quality benefit package, you are going to pay for it in premiums. Here are our current lowest rates:

  • For a female, age 65:  $125.72 per month
  • For a male, age 65:  $140.06 per month

 

Before we meet Plan G, there is one other thing you need to consider about Plan F: it is being discontinued in 2020 (click here for more information). You can still hop on a Plan F, and you will be allowed to stay on even after 2020, but this is very important to consider (because rates can increase dramatically when a plan is discontinued).

 

Plan G—The Second Place Winner

Plan G is silver medalist when it comes to benefits. It covers everything that Plan F covers, except for one thing: the Part B deductible. This means that in a Plan G you will have to meet that $183 deductible before Medicare pays anything for outpatient costs each calendar year. With that in mind, let’s look at the costs:

  • For a female, age 65:  $100.57 per month
  • For a male, age 65:  $110.52 per month

 

So, this is an easy comparison. A Plan G is about $300 cheaper than Plan F per year. Subtract the $183 from that, and you come to a net savings of, well, $117 per year. So, in other words, it’s a wash. However, you have to keep the following things in mind:

  1. This is assuming you meet the deductible every year. If you don’t, the savings can be much higher.
  2. This is based on our current rates.  When you sign up, there may be a bigger difference in premium between Plan F and G.
  3. This isn’t taking into account that Plan F is historically more prone to rate increases and that these rate increases are likely to happen more frequently after Plan F discontinues.

 

Now, moving on to our third most popular plan.

 

Plan N—The New Kid on the Block

Introduced in June of 2010, this plan showed up late to the party, although it still holds its own when it comes to high-quality benefits at reasonable prices.

 

However, there are some things that Plan F covers that Plan N does not. Like Plan G, you will have to pay the $183 deductible. In addition, you will also have to pay up to a $20 copay for each doctor’s office visit and up to a $50 copay for each emergency room visit.

 

Finally, the last thing that a Plan N doesn’t cover is Part B excess charges. Allow me to explain a little bit of what this is…

 

For every imaginable procedure, Medicare has an approved amount of what it should cost to perform it. In Ohio, healthcare providers are never allowed to charge above this Medicare-approved amount, no matter what. However, outside of Ohio, some states allow providers to issue an excess charge of up to 15% more than the Medicare approved amount. Plan N may leave you on the hook for that 15% outside of Ohio.

 

So, here’s my recommendation for my fellow citizens of the buckeye state: If you rarely leave Ohio except for a few weeks out of the year, whether a Plan covers Part B excess charges shouldn’t really factor into your decision. But if you are a snowbird in a state where those excess charges are allowed or you travel frequently, it may be something to consider.

 

Now, without further ado, the costs:

  • For a female, age 65:  $80.97per month
  • For a male, age 65:  $93.21 per month

 

So, compared to a Plan G, you pay about $300 less in premiums. Whether this pays off in the end depends on how much you visit the doctor or emergency room in a given year, which—not surprisingly—is impossible to pin down. Taking the Part B excess charges out of the decision, you would have to go to doctor 10 times and the emergency room twice for a Plan G to be worth it. I hope that puts it into perspective, and you can make a decision based on your unique situation.

 

Because, in the end, no matter which plan you choose (if any of them), it is a personal decision.

One More Vital Piece of Advice

After you’ve decided on one of Medicare’s 11 plans, I have one piece of advice for you: Shop with an independent agency!

 

All of these plans will offer the same benefits, no matter which company you chose, but the premiums can vary dramatically. If you just call one company, they will only sell you their plans, which may or may not be the best value on the market. Independent agencies, on the other hand, can compare rates across companies to find the best value for you.

 

If you want to compare Supplement rates now, you can use our free quoting tool. We do not ask for any personal information, so you can be sure you are not in for an onslaught of junk emails!

 

Or, if you are ready to talk to a local, independent agent, call Seniormark at 937-492-8800. We are here to help!

Note: All pricing is based on the zip code 45365. They are very good estimates, but prices may vary.

 

 

Inflation Rewind: 7 Items That Cost an Arm and a Leg Less in 1972

Inflation Rewind: 7 Items That Cost an Arm and a Leg Less in 1972

Breaking news. People everywhere are hobbling out of grocery stores, theatres, post offices, and colleges with fewer limbs than ever before.  We’ve got hoppers.  We’ve got crawlers.  We’ve got consumers who have no choice but to roll.

 

To cope with this tragedy, we shall look fondly upon a time when prices were a third, a half, or even 25 times less than they are today.  Pine.  Lament.  Gasp.  Laugh.   Your reaction is your choice, as long as you have a little fun reminiscing in the process.  Here are 7 items and their prices in 1970.

 

  1. Sugar—$0.65 for a five pound bag

Many Americans have a relentless sweet tooth, but now that sweet tooth is going to cost them more than ever.  Not only has the bag size been reduced to 4 pounds, but that smaller bag costs over $2 more as well.

 

  1. Ground Coffee – $.99 per pound

Starbucks has changed the coffee prices forever.   I’d be happy to get a cup for $.99 let alone a pound.

 

  1. Ground Beef—$0.64 per pound

Nothing like enjoying a still-sizzling burger hot of the grill …for almost 4 times the price, that is!

 

  1. Movie Ticket—$1.75

Let’s not even consider the financial impact of the inhumanely large tub of popcorn and 5-gallon bucket of soda.  Even if you manage to escape the gravitational pull of those buttery, sugary aromas, the ticket is still hard on the wallet.

 

  1. Postage Stamp—$0.12

No wonder why people send so few letters today.  At almost 50 cents a pop with a lot more hassle, it’s hard to resist the convenience of clicking and typing your birthday wishes and personal notes.

 

  1. Gasoline—$0.55 per gallon

Who hasn’t complained about the price of gas a few times in their life?  I certainly understand the frustration.  For those who grew up in a time when gas cost little more than a pack of gum costs now, it can seem like a major rip off to pay well over $2 for one measly gallon.  Thank God for fuel efficiency.

 

  1. Tuition to Harvard—$2,800 per year

This one hits home with me.  Going to a private Christian school, I’m starting to feel the student debt itch that refuses to be scratched by even the most lucrative of summer jobs.  Can you imagine attending one of the most prestigious schools in America for $2,400 a year?  It just about makes me light headed.  Today?  Try $67,580—almost 25 times as much.  Geesh.

 

With the cost of college, I may run out of limbs to sell…I only need one of my kidneys, right?

 

Noticed any other items that would deserve a spot on this list?  Share them in the comments.  We love to hear from you.  It’s always a good time to think about how different life was 48 years ago!

 

Turning 65 soon and not sure what to do?  Need Medicare questions answered?  Call Seniormark at 937-492-8800 or click here to schedule a free consultation!

 

1972 price information courtesy of Seek Publishing, Inc – Birmingham AL

The #1 Reason Why You Should Enroll in Medicare Part A (Even If You’re Still Working)

The #1 Reason Why You Should Enroll in Medicare Part A

(Even If You’re Still Working)

Whether or not you should sign up for Part B while still actively employed is a little more questionable.  I mean, why pay that $134 a month premium if you’re employer plan is doing a fine job at a cheaper price?  (Call our office if you would like advice on whether or not to take Part B.)  But Part A is not like that.  There are basically no downsides to enrolling once you’ve turned 65.  Why, you ask?

 

Because It’s Free!

Of course, that is neglecting the fact that you’ve paid into social security for about 40 years and—therefore—have earned it.  But—wherever you stand on the proverbial “free lunch” debate— this does not change the fact that Medicare Part A has no associated premium.  If you are approaching 65 and have paid into Social Security for at least 10 years, there is no reason to delay.

 

There is only one reason why you would want to opt out of Part A…

 

Health Savings Accounts

If you have an HSA and wish to continue contributing to it, you may want to delay Part A.  Of course, you can still have an HSA.  And you can still use it to pay medical expenses.  But you cannot put any money into it after you enroll in Medicare.  There are some people who do, of course—whether unknowingly or purposefully—but this is not a wise choice.  If the IRS audits you, you will be subject to a stiff penalty.  According to IRS publication 969, the penalty is 6% of your contribution and its interest until you remove the funds from your HSA.

 

But other than that, you should definitely enroll in Part A if you are approaching 65.  All those years of the government dipping into your earnings have paid off—if only in a small way.  There may not be such a thing as a “free lunch”, but there is such a thing as taking advantage of what you’ve so rightfully earned.

 

We know.  Medicare is confusing.  But we can help make sense of it all by mapping out a plan that fits your needs and your budget.  Just contact Seniormark at 937-492-8800 or click here to schedule a free consultation!

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

There are few things more wrinkle-inducing than the stress of any unexpected bill, let alone a $6000-8000 nursing home expense left uninsured by Medicare.

 

But it happens everyday. If you receive only custodial care at the nursing home, Medicare will not cover you.  (Read this blog for a few answers.)   And even if you are receiving skilled nursing care, there is still a chance you won’t be insured.

 

Here’s the reason: Many people don’t receive 3 days of inpatient care before moving onto the nursing home. This is a requirement for coverage!

 

Check Your Status!

What really throws people for a loop is that not all hospital stays qualify as the required inpatient care. So even if you stay a week in the hospital’s luxurious half-room with a moaning mystery patient on the other side of the curtain, that doesn’t mean you satisfied the requirement (even though you definitely earned it, in my opinion).

 

Why, you ask?

 

It has to do with your official status. Some people are formally checked-in, but others are filed under “observation status”. In other words, they are not receiving any specific treatment but are rather checked in for the purpose of evaluation, testing, and monitoring. In almost all respects, they receive similar care to those who are formally checked in, but these patients are billed and covered like they are receiving outpatient services. They don’t fulfill the 3-day inpatient requirement and—when they move on to a skilled nursing facility like a nursing home—they are denied coverage when they need it most.

 

Sounds a bit unfair, right? I agree wholeheartedly. Luckily, the government is aware of the issue and is taking steps to resolve it.

 

Baby Steps

One of these small steps occurred in August of 2015 when Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act. I know—legislators have a knack for snappy titles. But in all seriousness: What the article lacks in creativity, it makes up for in functionality. This Act requires hospitals to alert you of your observation status and how it will affect your Medicare coverage in both writing and in person.

 

Potential Strides

The Notice Act doesn’t solve the whole issue, of course. It would be better to just allow all hospital stays to count toward the 3-day inpatient requirement. The good news is—yet again—politicians are working toward this.

 

But until then, be aware and ask about your status.  It pays to be educated. And it can save you an arm and a leg to know what others don’t and what hospitals neglect to tell you.

 

Turning 65 soon and confused about Medicare?  Call Seniormark at 937-492-8800 or click here to sign up for a free consultation!

Think Poor Health Will Stop You From Getting Medicare Supplement Insurance? Think Again.

Think Poor Health Will Stop You From Getting Medicare Supplement Insurance? Think Again.

Insurance companies can’t refuse you coverage for having cancer or being on an expensive chemo-treatment. They can’t deny you a policy for having diabetes or (Burger King-induced) sky-scraping cholesterol or any other pre-existing condition for that matter. These companies are federally mandated to grant you coverage as long as you enroll within the Medicare Supplement Open Enrollment Period. This is good news for you!

 

The Open Enrollment Period

The Medicare Supplement Open Enrollment Period is a 6-month window beginning the day you both turn 65 and are enrolled in Part B of Medicare. During this time frame, you have all the privileges of someone who doesn’t have poor health, including:

  • Access to all 11 Supplement plans (A, B, C, D, F, HDF, G, K, L, M, and N)
  • No premium hikes due to health conditions
  • No medical underwriting

 

You’ve Got Another Shot.

And then there’s guaranteed issue. Although this is based on very specific circumstances (such as coming off of employer insurance or your current plan discontinuing service), it still offers many people with pre-existing conditions another shot at getting on a plan. It is important to note, though, that some plans may not be available under guaranteed issue. It isn’t an all-access pass like the Open Enrollment Period, but it does give you the assurance to know you will not be denied.

 

 

It’s Not the End of the World!

But don’t sweat if you are no longer within the Open Enrollment Period. This definitely does not mean you won’t be able to get Medicare Supplement Insurance. It just means you will have to answer questions about your health, where they might look at your whopper addiction with a more critical eye.  You may have to pay more, but (depending on your specific conditions) they won’t automatically deny you coverage.

 

Of course, this doesn’t mean that there aren’t still circumstances where you will be unable to receive coverage. But—because of open enrollment and guaranteed issue—this doesn’t happen nearly as much. The government is making strides to ensure that health coverage is available to those who need it most: those who are unhealthy.

 

Need help picking out one of the 11 Medicare Supplement Plans? Want somewhere to start? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

Why Dental Plans Aren’t Worth Their Weight in Premium For Retirees

Why Dental Plans Aren’t Worth Their Weight in Premium For Retirees

If you’re coming off your employer plan and onto Medicare, you might have been surprised to find out that neither Medicare nor Medicare Supplements cover most routine dental services. So I understand why you might find it quite attractive to get on a dental plan in addition to Medicare.   After all, who else will insure your million-dollar smile?

 

But allow me to reason with you. Because I believe that—in most cases—a dental plan just isn’t worth it.  Don’t believe me?  Using the pictured plan as an example, give me a few minutes to explain.

 

Scaling Benefits, Depleting Value

Way back when, Dental Plans had much better benefits. Their maximum benefits started on day one and continued until you dropped the plan.  But people abused it.  They got on a plan when they found out they needed a major surgery, let the insurance company foot the bill, and then cancelled the plan, getting away with no more than $30-40 in out-of-pocket costs.

 

The insurance companies needed to get smart if they were going to make any money.  So what did they do?  They fought fire with fire, and introduced scaling benefits.  Now most plans do not grant you full benefits until much later, after you paid your dues in premiums.  In the example below, the full benefits aren’t granted until 2 years.  In other words, not until you spend $800 in premiums!  The only thing the plan pays in full on day one is preventative services such as cleanings and exams.

 

Maximum Benefits

Here’s where a dental plan can really get you: the maximum benefits per calendar year is $1000.  This means you will never squeeze anymore than one grand out of them per year, no matter how long you’ve paid into the plan.

 

So what do you pay in premiums per year for this plan?  Let’s crunch the numbers.  $33.71/ month X 12 months per year = $404.52.  So, for all intents and purposes,  you pay about $400.  Consider this:  if you put the money you would’ve paid in premiums into a savings account, you would cover the maximum benefits in 2.5 years.  So—as long as you don’t expect to spend well over $1000 in 2.5 years—why would you bother with a dental plan?  For most people, it is just not reasonable.

 

You might’ve notice that you can upgrade your maximum benefits to $2000 dollars for an extra $7.61 in monthly premium.  But did you notice the fine print?  Without squinting, you probably didn’t.  So let me help you out with the gist: despite the upgrade, major services will still not exceed $1000.  In other words, for the services that actually have a chance of exceeding $1000 like dentures and oral surgery, the benefit limit is the same.

 

What to Do Instead

If you are still concerned about paying for routine checks, I would recommend telling the dentist you don’t have insurance and asking about “network pricing.”  A lot of times they are willing to cut the price (as much as 50% for exams and cleanings).

 

And if you are still concerned about major services that are going to cost up to $1000 or more, I recommend saving up what you would’ve paid in premium to put into a savings account.  In 2.5 years, you will have a thousand dollars of self-insurance for that million- dollar smile.

 

Need help with your retirement transition? Seniormark is here to help! Call us at 937-492-8800 for a free consultation.