Author: Pam Kaiser

Pam is the voice of assurance you’ll likely hear from your first call to the day you can hold your insurance card in hand. She oversees the entire application process from start to finish. In addition, holding life and health licenses, she writes both the term and whole life policies for the agency. Pam wuz also the spelling bee champion in the 6th, 7th, AND 8th grade. The runner-up was the same every year (too bad so sad, Fran)!

Half-Truths And Medicare Advantage Commercials

Half-Truths And Medicare Advantage Commercials

Weekly, we receive phone calls from people asking about something they saw on their tv and wondering if their insurance covers whatever they are seeing advertised.  This is more prevalant in the fall of each year, when Medicare Advantage companies ramp up their advertising during annual enrollment.  As an office, we offer both Medicare Supplements and Medicare Advantage plans to our clients.  We try to help people figure out what is best for their situation, budget, and lifestyle.  Our end goal is to help people avoid costly Medicare mistakes.  Sometimes, what is portrayed on tv is only half of the story, as you will see below.  This is an article recently published online at Forbes magazine, but echoes our thoughts so we wanted to share.  Source:


If you watched any television in the last several months, you probably saw a slew of commercials for Medicare Advantage plans. One that pops up frequently features a former professional football player who once did a commercial wearing pantyhose. His commercials must be working so well that another former NFL star has also started promoting Advantage plans.

All the commercials, no matter the narrator, talk about the Medicare benefits you deserve, that you should be getting. They list those benefits in a very big and bold font, and encourage you to call the free number and sign up today.

According to Federal law, whatever we see or hear in an advertisement must be truthful and not misleading. I spent some time the last few days closely watching several different commercials. Everything that was said about the cost and benefits was true, to the extent that it was said. But there was much left unsaid and that’s the important information you need to make a smart decision.

First, the benefits

Get the benefits you deserve, including rides to medical appointments, private home aides, nurse and doctor visits by telephone.

Medicare describes these as benefits for daily maintenance and doesn’t cover them. However, because of policy changes, Medicare Advantage plans can now provide them. The plan, not Medicare, must cover the costs. This is a new program and not that many plans offer these benefits.

Based on my preliminary plan research, here are some important points not mentioned in the commercials:

  • These benefits appear to be more common in health maintenance organization (HMO) plans. Except for an emergency, the benefits are only available through a network of selected providers, which can limit the individual’s choice.
  • The plan likely will require prior approval or authorization. Before receiving care, the plan must review and approve the physician’s order.
  • There are limits on these benefits. For example, two meals a day for five days after hospitalization with a limit of four hospitalizations, and a private home aide four hours a day for no more than 31 days in a year.
  • And, most important, the plans we researched require members to select only one benefit per calendar year.

In some of the commercials, there were two more benefits that require clarification.

Free preventive screenings

Medicare covers a long list of preventive and screening services. You don’t need to enroll in one of these plans to get preventive services.

A 75% discount on prescription medications in the Coverage Gap

You see this and think, “Wow! A big discount on drugs! Where do I sign?” However, as with preventive services, this benefit is not unique to Medicare Advantage plans.

The Coverage Gap is more commonly known as the donut hole. In 2020, the donut hole closed. Beneficiaries are responsible for 25% of the cost of medications in this payment stage. Or, in other words, they get a 75% discount. Anyone with Part D prescription drug coverage will qualify automatically for this discount when their total drug costs hit $4,080. This benefit comes with the plans in the commercials, some other Advantage plan with drug coverage, or a stand-alone Part D drug plan.

Second, the costs

All these benefits may be available at no additional cost to you.

The commercials focus on zero-premium plans and benefits available for no added cost. However, at the moment the narrator says this, a line of small type appears on the bottom of the screen. It’s there for only four seconds, while the list of benefits continues. The small type reads, “Plan premiums, copayments, and coinsurance can apply.”

Not all Medicare Advantage plans are zero-premium. And for those that are, it’s important to know that zero-premium does not mean zero costs. There are out-of-pocket costs for most services. Plan members will pay their share of costs until they reach the plan’s out-of-pocket maximum limit. That’s how much a person could write in checks when something happens, like a cancer diagnosis or a major car crash. In 2019, the average limit was $5,059.

Third, the call

The narrators talk about the help you will get when you call the toll-free number. But, once again, the small print is revealing.

Dial the number and you’ll be transferred to a licensed insurance agent. One commercial noted that the agent may or may not offer Medicare Advantage plans. Another said the person you talk with may not offer plans in your area.

A question

The facts, as presented, are true but then the question becomes, “Are these commercials misleading?” According to the Macmillan dictionary, misleading means something that is intended or likely to make someone believe something that is incorrect or not true.

In fall 2019, the American Medical Association (AMA) passed a resolution.

“Whereas, Medicare Advantage plans are heavily marketed to seniors by insurance companies, with less than ideal transparency in advertising; … and

“Whereas, Presentations by insurance company officials to seniors can overemphasize the value of different options and can create confusion; therefore be it

“RESOLVED, That our American Medical Association encourage AARP, insurance companies and other vested parties to develop simplified tools and guidelines for comparing and contrasting Medicare Advantage plans.”

The AMA identified the need for tools to help individuals go beyond the TV commercials and get the information they need to make a smart decision.

The Centers for Medicare and Medicaid Services redid its tool for comparing plans. The Medicare Plan Finder shows the premium in a large font. Then, you can check out the plan’s out-of-pocket costs for medical benefits on the details page. Beyond that, as pointed out in a past post, most of the essential information has disappeared. The Plan Finder no longer has links to networks, a list of preferred pharmacies, and most important, complete information about coverage rules like prior authorization.

The best way to get all the facts is to check the plan’s Evidence of Coverage. This document describes in detail the plan’s benefits, how much you will pay, and how the plan works, including authorization rules, limits, networks, and more. To find it, go to the plan’s website, look for the Evidence of Coverage link. This may take some searching but you’ll get the information you need on available benefits, limits, approval, and more.

Keep in mind that these Medicare Advantage plans are offered by for-profit entities, corporations not unlike your cable provider, department store, or neighborhood used car lot. The purpose of the TV commercials is to get you to act, to call the number on your screen, to make a purchase. First, do your research. Be an informed shopper. Go beyond the commercials to the whole truth. Your Medicare coverage is too important.

If you would like help muddling through all of this confusing information, please give our office a call.  We are happy to help you sort through the complicated Medicare alphabet and choices!  Call our office at 937-492-8800 and schedule a free, no obligation consultation.

Source:  Diane Omdahl for Forbes Magazine

Annual Enrollment Period (AEP) To-Do List

  1. Write the important Annual Enrollment dates to remember on your Calendar, and clip your calendar on your fridge.
  2. Don’t eat that midnight snack until you’ve read the dates at least once.
    1. October 1st— we can talk about your options!
    2. October 15th— The AEP games begins.
    3. December 7th—AEP comes to exhausting close.
    4. January 1st— Plan changes go into effect.
  3. Compare your medications to the formulary (drug list) mailed to you by your drug plan company.
  4. Consider changing your drug plan if some of your medications are no longer covered or if the premium is too high (call OSHIIP at 800-686-1578 to reshop your plan).
  5. Call us and set up an appointment to have a good chat about your Advantage plan.
    • Consider switching Advantage Plans if:
    • Your hospital or doctor went out-of-network
    • Plan changes for the following year result in jaw-dropping out-of-pocket spending or a high premium.
    • Your medications are no longer covered or are costing a lot.
    • Your Advantage plan is (all around) a bit of a drag.

6.  Remember — you can change your Medicare Supplement any day of the year.  If you currently have a supplement, you are not bound by AEP in order to switch companies.  However, if you want to switch from a Medicare Supplement to a Medicare Advantage plan or if you want to switch from a Medicare Advantage plan to a Medicare Supplement, you must do that during this time.

7.  As a golden rule, your ultimate to-do list item is …plan ahead!

Still confused about what to do?  Give our office a call at 937-492-8800, find us on Facebook at or fill out the contact page and we will be in touch: We are here to help!

Know Your Investment Lingo! 5 More Terms Every Soon-to-be Retiree Should Know

Know Your Investment Lingo! 5 More Terms Every Soon-to-be Retiree Should Know


It’s easy to get confused when someone is talking over your head. And when it comes to the world of investing, it is easy for the jargon to fly a mile high. In fact, even after years of investing experience, I still find myself baffled by some of it! That is why I am determined to translate some of the most commonly misunderstood (but often most important) concepts into terms soon-to-be retirees like you can understand.


Here are 5 important terms to get you started:


1. Fee-only vs. Fee-based Managers

Fee-only money managers are paid by you only. You give them a flat fee or a percentage of your portfolio every year, and that is it.


On the other hand, fee-based managers may charge fees as well, but they also receive commissions on the products they sell. In other words, the companies they represent also pay them via higher fees—not just you.


Here’s why this term is important to understand: although there are conflict of interests with any transaction, a fee-only manager is more likely to act in your best interest.


2.  Average Annual Return

Market fluctuations cause returns to vary. You’ll have some good years, and others in which your investments fail to stay in the black. But the Average Annual Return examines how an investment performs over a block of time—usually over three, five, or ten years—rather than the fluctuations from year to year, giving you a well-rounded evaluation of the investment’s performance.


This number is calculated by taking the beginning value and determining how much it had to increase consistently (or, God forbid, decrease) each year to reach the ending value. Pretty simple, right?


3.  Fiduciary

Fiduciary has to do with trust, coming from the Latin word “Fidere,” which actually means, “trust.” More specifically, in the investing world, a fiduciary is a person who has the ethical and legal obligation to act in your best interest when managing your assets.


Of course, not every fiduciary lives up to this definition. But, when you choose a fiduciary, there’s a better chance he’s making decisions that are the best for you, not for his bank account.


4.  Mutual Funds and ETFs (Exchange-Traded Funds)

Mutual funds and ETFs are very similar in a lot of ways. They are both investment options in which others choose the stocks or bonds for you. However, they differ in a couple ways that are important to note:

  1. When investing in a Mutual fund, the transaction occurs between you and the Mutual Fund Company. With an ETF, you trade directly with other investors.
  2. Mutual funds are sometimes actively managed, while ETFs always track an index (such as the S&P 500).

These differences cause many ETFs to be more cost-effective and easy to use. However, they are the new kids on the block so many people still stick with the old, trusty Mutual Fund.


5.  Required Minimum Distribution (RMD)

Because the government wants you to save, they allow you to invest tax-free in any one of many qualified retirement accounts: IRAs, 401(k)s, 403(b)s just to name a few.


However, because the government still wants to collect tax, they also require you to take out a certain amount each year after you turn 70 and ½. The amount you must take out is also known as your required minimum distribution.


Well, there you have it. Making retirement investment decisions is often overwhelming and scary, but taking this step to understanding your options will help you immensely. If you have come across a term that was not on this list, check out our other blog (See our blog on Five Investment Terms You Should Know) that complements this list or leave a comment. We love to hear from you!


Want a Certified Financial Planner to analyze your portfolio at no cost to you? Looking for someone to walk you through your retirement transition? Call Seniormark at 937-492-8800 for a free consultation.



Annual Enrollment Period (AEP) To-Do List

Annual Enrollment Period (AEP) To-Do List

  1. Write the important Annual Enrollment dates to remember on your Calendar, and clip your calendar on your fridge.
  2. Don’t eat that midnight snack until you’ve read the dates at least once.
    1. October 1st— we can talk about your options!
    2. October 15th— The AEP games begins.
    3. December 7th—AEP comes to exhausting close.
    4. January 1st— Plan changes go into effect. Double Whammy: You can also drop your advantage plan starting the 1st all the way through the 14th (which is also Valentine’s day…you’re welcome)
  3. Compare your medications to the formulary (drug list) mailed to you by your drug plan company.
  4. Consider changing your drug plan if some of your medications are no longer covered or if the premium is too high.
  5. Call OSHIIP with any drug plan questions.
  6. Call us and set up an appointment to have a good chat about your Advantage Plan.
  7. Consider switching Advantage Plans if:
    1. Your hospital or doctor went out-of-network
    2. Plan changes for the following year result in jaw-dropping out-of-pocket spending or a high premium.
    3. Your Advantage plan is (all around) a bit of a drag.
  8. As a golden rule, your ultimate to-do list item is …plan ahead!

Want help looking at your Medicare policies?  Call our office and we will guide you through the process.  937-492-8800

What Does a Medicare Supplement Really Cover?

What Does a Medicare Supplement Really Cover?

Everyone will say, “It fills in the Medicare coverage gaps” or “it covers what Medicare doesn’t” In fact, I’ve said those mantras to my clients many times. But when you’re looking at paying $80-150 in premiums per month for one of Medicare’s more popular and comprehensive plans, that’s not enough of an explanation.


Retirees like you have a lot of things pulling for your cash. And when you’re living post full-time employment, money can be tight. It can even leave you wondering if a Medicare Supplement is really worth it. For that reason, I think it’s time to take a closer look and see what that monthly premium is really paying for.


I have addressed Medicare’s most costly coverage gaps below. Do the most popular Medicare Supplements (F, C, G, D, and N) pay for them?


20% Coinsurance on Part B

For outpatient coverage like lab tests, doctor visits, and surgeries (any care received while not admitted to a hospital), Medicare covers 80% of the costs. A Medicare Supplement picks up where Medicare leaves off, taking care of the other 20%. The only popular plan that doesn’t cover the 20% in full is Plan N, but Plan N only leaves a couple small copays of $20 for office visits and $50 for trips to the emergency room.


If you are thinking of a $100 x-ray, the 20% isn’t a big deal. But what about a $20,000 outpatient surgery? What about $150,000-200,000 on chemo-treatments, like my father-in-law experienced? Then you start to understand why this is such an important benefit.


$1340 Part A Deductible

Before Medicare pays anything on inpatient care, you have to meet a $1340 deductible, sometimes more than once per year. All of the popular Medicare Supplement policies cover the Part A deductible in full.


Hospital Coinsurance

Medicare pays for the first 60-days of your hospital stay (after the $1340 deductible, of course). However, you will have to pay $335 per day for days 61-90 and $670 per day for days 91 and beyond (these days do not necessarily need to be consecutive.) Again, all of the popular Medicare Supplements cover this in full.


Without a Medicare Supplement, a 120-day hospital stay would cost you over $30,000 in out-of-pocket costs!


Skilled Nursing Coinsurance

Medicare pays for the first 20 days. For days 21-100, you pay $167.50, and for 101 and beyond, you pay all the costs. Yet again, all of the popular plans cover every dime of this coinsurance amount for days 21-100.


And all of these benefits are just the foundation of what makes a Medicare Supplement such an attractive option for retirees. Many plans cover a lot more than what I’ve addressed here. For instance, a Plan F (Medicare’s most comprehensive and popular supplement plan) covers, well, almost everything. Assuming a procedure is Medicare approved, you will have no out-of-pocket expenses with a Plan F.


That is why, although they are not right for everyone, I often recommend them to my clients. They really do “cover what Medicare doesn’t” and “fill in the Medicare coverage gaps,” as it has been said so many times. Of course, no one wants to pay the monthly premium, but in the end, you get what you pay for. For most retirees, the peace of mind to know that they will never get stuck in one of those huge Medicare coverage gaps is worth it.


Have more questions?  Sign up for our next workshop at or call Seniormark at 937-492-8800.  We offer the answers to these questions and many more!

New Medicare Cards Come with New Scams

New Medicare Cards Come with New Scams


There is great news for Medicare beneficiaries, and a bit of caution regarding scammers.  The good news is that Medicare will be sending out new Medicare cards to each recipient.  Mailing of the new cards will begin April 1st of this year and will be completed by April 1st of next year.


The new cards will not have the enrollee’s Social Security number on them, as they do now.  This is a major accomplishment for Medicare and is being done to help put a stop to identity theft via Social Security identification numbers.  This problem has been rampant nationally and is very serious business for Medicare enrollees who have had their cards compromised by internet bandits.


The new cards will have a randomly generated 11 digit number that even the holder will not be able to decipher.  So that is good news.  For the State of Ohio, delivery of new cards is scheduled to begin after June 1st.


But, along with the good news, bad news sometimes seems to follow.  The bad news is that Medicare scammers have already jumped into the game.  There is more than one technique involved, but these are the two most used.


First, scammers are calling Medicare recipients, sometimes identifying themselves as Medicare or “government” officials, and telling them that the new cards are coming out, but that they will have to send $30-50 to get the new cards.  This is bogus—there is no charge for the new cards—and CMS/Medicare does not call people—it only uses the US Postal Service to communicate.


The second technique is for the scammer to say that they have a Medicare Advantage Prescription Drug Plan available, but then request personal Medicare information so that the new plan can be utilized.  This is also bogus.  Whatever you do, do not fall for this.  Medicare information is personal, and the scammers simply use it for illegal activities.


So, we don’t know when or how the scammers will spring into operation in Ohio, or the Miami Valley region, but if you receive one of these calls, just hang up, and report the activity with a call to 1-800-Medicare.  And…above all, do not feel pressured to respond to any of these calls—the scammers are well-trained in intimidation and persistency.  Don’t fall for it.

A Major Announcement from Premier Health Plans!

Major Announcement from Premier Health Plans!


Premier Health Insuring Corporation, which does business under the name Premier Health Plan (“Premier Health Plan”), and the Centers for Medicare & Medicaid Services (“CMS”) recently mutually agreed to terminate their Medicare Advantage plan contract, effective April 1, 2018.


Each beneficiary enrolled in Premier Health Plan’s Medicare Advantage plans (Premier Health Advantage (HMO), Premier Health Advantage Choice™ (HMO-POS), and Premier Health Advantage VIP (HMO SNP) will receive a letter within the next few days that will outline important details about this transition. Click on the appropriate plan description below to view a copy of the notice letter. The letters will begin mailing on March 2 and should arrive in as early as March 5.


CMS has granted each impacted beneficiary a Special Enrollment Period (“SEP”) through May 31, 2018. If a beneficiary does not take action by April 1, 2018, they will be automatically enrolled in Original Medicare and Silverscript, a Part D plan for prescription drug coverage.


2018 Medicare Parts A & B Premiums and Deductibles Announced

2018 Medicare Parts A & B Premiums and Deductibles Announced


Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the 2018 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

For 2018, the Part B premium will be $134 for those new to Medicare.  For those already on Medicare, their premium will be between $108-$134, depending on the amount of their social security cost of living increase.  The Part B deductible will remain the same ($183). There are some changes to the numbers which are listed below, but if you have a Medicare supplement policy, it will take care of some, if not all, of these expenses.
2017                     2018
Part B Premium                                              $109.00                $134.00
Part B Deductible                                           $183                     $183
Part A Hospital Deductible                             $1316                   $1340
Part A Hospital Coinsurance Days 61-90        $329/day          $335/day
Part A Hospital Coinsurance Lifetime Reserve Days
$658/day          $670/day
Skilled Nursing Coinsurance Days 21-100
$164.50/day      $167.50/day

For more information on the 2018 Medicare Parts A and B premiums and deductibles, please contact our office at 937-492-8800.

7 Hits From 1970: Did You “Groove” to Any of These Songs Your Graduation Year?

7 Hits From 1970: Did You “Groove” to Any of These Songs Your Graduation Year?

Music has often defined a generation, and—let me tell you—you baby boomers had it all. The most iconic music festival of all time (need I actually say it?). Heart felt country. Psychedelic rock.  Folk rock. Soul. You guys even had the Beatles and the Jackson 5 for crying out loud! It’s just not fair (really…we’ll trade you Taylor Swift and then we can call it even)! The 60s and 70s were no-doubt the complete package.


So—as a testament to your senior year of high school—here are 7 songs you used to groove to in 1970. Click the links; hear the tunes.

  1. Coal Miner’s Daughter by Loretta Lynn

The twang of steel guitars interpolated between the twang of Loretta’s sweet voice is still ringing in my ears. And the genuine, tear-jerking lyrics are a refreshing change from the worn out phrases that so often adorn the overly produced country music of modern times. Loretta Lynn had it right. Being country has little to do with alcohol or trucks or “painted on blue jeans;” instead, it has everything to do with humble roots, a good work ethic, and priceless love in the midst of financial hardship.


Memorable Lyric: “Well, I was borned a coal miner’s daughter in a cabin, on a hill in Butcher Holler. We were poor, but we had love. That’s the one thing that daddy made sure of. He shoveled coal to make a poor man’s dollar.”

2. Ain’t No Mountain High Enough by Diana Ross

This song was originally released by Marvin Gaye and Tammi Terrel in 1967, but Diana Ross’s version resurfaced the classic song in 1970. Ross puts some new twists on the song including several dramatic spoken sections, but the gospel vibes and the soulful, dynamic power that inspires audiences to overcome any difficulty still remain from the original release all the way to now. Thank you, Diana Ross. Your soaring vocals are greatly appreciated.


Fun Fact: According to, Hillary Clinton used this song extensively in her 2016 campaign for the presidency.

3. Bridge Over Troubled Water by Simon and Garfunkel

With a gentle piano accompaniment and Garfunkel’s flowing tenor vocal, this song stills the troubled mind. A simple but profound piece about sacrificial love, “Bridge Over Troubled Water” is a ballad not too soon forgotten. According to The Rolling Stone, it reached the number one spot in spring of 1970 and didn’t sink from the charts for over a year, remaining at the top for 10 weeks and selling 13 million copies!


Memorable Lyric: “I’m on your side, oh, when times get rough and friends just can’t be found. Like a bridge over troubled water, I will lay me down.”

4. American Woman by The Guess Who

I felt like we’ve been a little soft so far down this list, so I’m going to drop in a hard rock song for good measure. “American Woman”, with its aggressive, no-nonsense lyrics and its growling, “stick-it-to-you” vocal does just the trick.  But be careful. It may induce head banging.


Memorable Lyric: “American woman, stay away from me-he. American woman, mama let me be-he. Don’t come hanging around my door. I don’t wanna see your face no more…”

5. Layla by Derek and the Dominos

Instant ear gratification. The iconic fire of Eric Clapton’s opening guitar riff is almost mesmerizing. While “American Woman” is more about getting rid of a woman, “Layla” is all about going mad, pining for her affections. “Let’s make the best of the situation before I finally go insane. Please don’t say we’ll never find a way, and tell me all my love’s in vain,” Clapton writes. This anthem of unrequited love made the Rolling Stone’s List of “The 500 Greatest Songs of All Time.” Number 27…check it out.


Fun Fact: Did you know that Eric Clapton penned this classic about Pattie Boyd, the same woman who inspired the Beatle’s George Harrison to write “Something”? Dang, this girl must’ve been the cat’s meow! The whole story of this love triangle is quite unbelievable.

6. Let It Be by the Beatles

No 1970s playlist would be complete without a Beatle’s song, so I dug this one out of the archives. This simple song with its message of comfort and peace was written during one of the more turbulent times of Paul McCartney’s life. He said that his Mother (named Mary, of course) appeared to him a dream, whispering this profound and reassuring word of wisdom: “Let it be.”


Memorable Lyric: “When I find myself in times of trouble, Mother Mary comes to me,
speaking words of wisdom, let it be.”

7. ABC by The Jackson 5

To go out with a bang of boyish exuberance, I would like to reintroduce you to Jackie, Tito, Jermaine, Marlon, and (of course) little Michael himself. Taking on the concept of love, these 5 Jacksons sold it every performance—with color, soul, and some killer synchronized dance moves.


Memorable Lyric: “Sit yourself down, take a seat. All you gotta do is repeat after me…”


Well, that’s a wrap! I could write a witty conclusion to this post, but I think I’ll just let it be (did you see what I did there?).


Also, remember to talk to us! What’s your favorite song on this list? Can you think of another nostalgic song from the year 1970? If so, leave us a comment! We love to hear from you.


Turning 65 soon and not sure what to do? Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!



List ideas Courtesy of Seek Publishing, Inc – Birmingham AL

New Workshops Announcement

We are expanding our workshop offerings! Beginning in August, we will still be offering our Welcome to Medicare workshop, but we are adding in a Social Security Planning workshop, along with a 401(k) planning workshop. Our new series is titled “Life After Work” and will help people ages 62 and up start planning for retirement, as well as introduce them to the world of Medicare.

Visit our workshops page at to sign up for one or all of our workshops!

We look forward to seeing you there!