Category: Medicare Drug Plan

4 Lightweight Tips to Prevent Medicare Fraud

4 Lightweight Tips to Prevent Medicare Fraud

 

An ounce of prevention is worth a pound of cure. Very few people use this saying anymore, but the truth of it is still relevant—almost shockingly so. Especially when it comes to Medicare fraud.

 

No one wants to be a victim. No one wants to deal with some con down in Florida, racking up charges using their Medicare number. And no one wants to feel taken advantage of.

 

That’s why it’s much better to take the simple steps now. So let’s get started.

 

  1. Protect your Medicare Number!

First things go first. It’s the oldest tip in the book, but it works. This number is unique to you.  So protecting those 9 digits is doubly important: It’s your identity.

 

One way to protect your number is to avoid carrying the actual card unless you have to. And—this almost goes without saying—don’t share it with anyone except your doctor, health care provider, and your insurance agent, who will need it to write a policy.

 

  1. Take a Lesson From Sherlock Holmes.

This sounds like a pound-sized piece of advice, but it’s really not too heavy once you get into the habit. Be like Mr. Holmes and notice the small stuff. Check your Medicare Summary Notice for anything suspicious (i.e. billing to Medicare for care or services you didn’t receive). Check your pills before you leave the pharmacy to make sure everything is correct. Did you get your full prescription?

 

It pays off to notice things that no one else does. It’s elementary, my dear…umm…Medicare beneficiary?

 

  1. Strive to Understand for Yourself.

This is another tip that sounds heavier than it really is. So allow to me translate. For all intents and purposes, this means to ask questions. And I mean a lot of questions.

 

When you don’t understand your bill or your plan or your Medicare options, just ask. Ask your doctor’s office, or ask at your insurance agent’s office.  Shift the weight on the expert to help you understand. If he gives you a boulder-sized answer, give him another boulder-sized question. And don’t let down until you get a manageable answer. This might sound stubborn, but you have a right to know what you want about your health care. It’s the expert’s job to give you an understandable (yet accurate) answer.

 

Because knowing how Medicare works, your plan works, and why you were taken care of the way you were are excellent starting points for noticing and preventing fraud.

 

  1. Don’t go to the mousetrap for the free cheese.

Only a mousetrap has free cheese. This is the truth with all the sales and advertising junk pared away.

 

It’s not that I don’t understand the allure. Someone comes to your door or calls you to offers you something for free. Do you believe it? FREE! All you have to do is give them your Medicare number and then POOF…all your money saving dreams can come true.

 

But don’t fall for it. Don’t go for the cheese. This is a surefire way to get snapped into the metal jaws of Medicare fraud.

 

Stopping Medicare Fraud Ounce by Ounce

In closing, Medicare fraud is a crushing problem. The Medicare Fraud Strike Force is constantly hunting down the bad guys, trying to recover as many funds as they can. But it hardly puts a dent in the 60 billion dollar a year problem, according to AARP. This is why the government needs you to take the necessary measures of prevention. It’s a big problem, but I am confident that if enough people decide to get smart and do these small  “ounce-sized” things now, we can prevent another round of crushing Medicare fraud later.

 

Think you’ve been a victim of fraud? Want to make up to $1000? Then check out this post! 

 

Still have questions?  Call our office at 937-492-8800.  We can help!

How to Understand Medicare in 3 Simple Steps

How to Understand Medicare in 3 Simple Steps

 

Medicare, like many other government programs, is far from being easy to understand. From family and friends, you get little snippets of guidance, but nothing that gives you a cohesive picture. From the government, you receive the overly exhaustive Medicare & You handbook that is so thick and dry, it might as well come with a “drowsiness may occur” label. And, as for the rest of the Medicare mail, there is little more than ads, ads, and more ads, very few of which offer any more substance other than a quick sales pitch for a Supplement or Advantage Plan (you’ll learn what these are later on). For those approaching 65, understanding Medicare is often daunting.

 

That’s why I am writing this post. I want to help you see your Medicare “big picture.” I’ll try not to go into mind-numbing detail (although I can’t promise this will be evening pleasure reading), and I won’t give you unhelpful bite-sized chunks. You will likely still have questions afterward, but I hope this step-by-step guide helps clears up some confusion about what you will encounter as you make the transition from your private (or employer) insurance to Medicare.

 

If you don’t have time to read this right now, you can call us at 937-492-8800, and we can set you up with a Medicare expert who will walk you through all this information one-on-one.

 

But if you are ready to learn, it’s time to get started.

 

Step #1: Learning the Parts of Medicare

The best way to understand a complex topic is to split it up into parts. Medicare has made this easy for us because Medicare is already made up of four parts: Parts A, B, C, and D. It is essential that you understand them before we go any further.

 

Part A (A.K.A. Inpatient care, A.K.A. Hospital Insurance)

Part A is coverage for care received while officially admitted in at a hospital. Beyond that, it also covers skilled nursing/rehab, hospice, and some home health services. However, for simplicity’s sake, think Part A equals hospital insurance!

 

Part B (A.K.A. Outpatient care, A.K.A. Medical Insurance)

Part B, on the other hand, is the exact opposite, covering care received while checked out of the hospital. So, in a sense, it covers (at least in part) about everything else. This includes diagnostic tests, x-rays, and outpatient surgeries as well as an extensive list of preventative care options. Note that Part A and B together make up what is known as “original” or “traditional” Medicare.

 

Part C (A.K.A. Medicare Advantage)

The C in Part C is for complicated, so I’ve decided to address this later on in the post. For now, just keep it in the back of your mind. This is one of your “2 main options” we will meet again in step 3.

 

Part D (A.K.A Prescription Drug Plan)

The D in Part D is for drugs. In other words, it helps cover the bills for your medications. Part D drug plans are offered by private insurance companies that are regulated by Medicare. Whether or not you need one will be determined by which option you choose in step 3. If you do need one, you purchase it as a stand-alone plan based on your medications and preferences. I recommend using Medicare’s Drug Plan Finder.

 

Step #2: Understanding Signing Up for Parts A and B (Who and When and How)

Now that you have a basic understanding of Medicare’s parts, you should know who should sign up for Parts A and B, when you should do it, and how it is to be done. Let’s start with “who.”

 

Who Should Sign Up?

These two Parts are absolute musts! Everyone should sign up for Medicare Parts A and B eventually. Where situations differ is in the answer to the next question: when?

 

When Should You Sign Up?

Since Part A is free for most everyone, almost everyone should sign up Part A during their Initial Enrollment Period (IEP). The IEP is the seven-month period starting 3 months prior to your 65th birthday month. The only reason you might want to opt of Part A is because of HSA contribution difficulty.

 

Part B, on the other hand, has an associated premium of $135.50 (in 2019). This means if you will continue working and have better value coverage with your employer, it may be a good idea to put off signing up for Part B until you are finished working. Why pay the extra premium if you don’t need to, right?

 

However, you have to be careful with this. If you are going to delay signing up for Part B, you must make sure that you are qualified, otherwise you will incur a penalty. And even if you are qualified, you need to make sure it makes financial sense for you to do so. To give you a quick run down, in order for it to be a good idea to delay Part B, the following three things must be true about your situation:

  • You must have insurance through active employment, not retiree benefits or COBRA. In other words, you must be working (or you spouse must be working if you are covered under their plan).
  • Your employer insurance must cover 20 or more employees.
  • Your employer plan should be a better value than Part B.

 

For more details about whether you should sign up for Part B, click here.

 

If you found that you cannot delay, you must sign up for Part B during the Initial Enrollment Period, just like for Part A.

 

However, if you can delay, you just sign up when you retire. You will likely have a Special Election Period to sign up after your employer coverage ends.

 

How Should You Sign Up?

Unlike the last one, this one is easy and straightforward! There are four ways to sign up for Parts A and B:

  1. If you are already receiving Social Security benefits, it is automatic!
  2. You can sign up online at https://www.ssa.gov/medicare/.
  3. You can call your local Social Security Office.
  4. You can go and visit your Social Security Office for an in-person appointment.

Once you’ve signed up, expect your Medicare card to come in the mail soon after. Not too difficult, right?

 

Step #3: Understanding Your 2 Main Options

After figuring out the who and when and how of signing up for Parts A and B, this is where you have to make a big decision. It is here where the Medicare trail diverges into three possible paths:

  1. You could go with Original Medicare (Parts A and B) alone.
  2. You could pair a Medicare Supplement with Original Medicare.
  3. You could go with a Medicare Advantage Plan (Part C—I told you we’d meet him again).

 

I promise I can count (I’d be in bad shape as a financial planner if I couldn’t). The reason why it says there are only 2 options in the heading is because, although a very choice few disagree, most do not believe option #1 to be viable at all. Allow me to explain why:

 

Original Medicare Alone Leaves Some Potentially Devastating Gaps!

Parts A and B alone do not cover everything. For Part A, you have a $1,364 deductible that you may have to meet more than once per year and limited to no coverage for extended hospital stays. And for Part B, you have a 20% coinsurance on all outpatient services. And these are just a couple of the many costly gaps!

 

To give you an idea of what this might cost you, this means a 120-day hospital stay would be over $31,000! And if you have outpatient chemotherapy and radiation like my father-in-law, you could wind up being on the hook for over $30,000 that Part B won’t cover! Since there is no out-of-pocket spending cap with Medicare alone, there is no limit to what you might spend.

 

With that being said, I strongly recommend choosing one of the other two options (you can’t choose both). As the last part of our last step, we will look at what sets these two apart and outline some of the strengths and weaknesses of each.

 

What’s The Difference?

Medicare Advantage plans should be seen as an alternative to Original Medicare offered by private insurance companies that provide coverage that is at least as good as Medicare. Although you still have to sign up for Parts A and B, if you sign up for Medicare Advantage, the private insurance company will REPLACE Medicare as the payer of your claims. But you will still pay the Part B ($135.50 for 2019) premium each month.

 

A Medicare Supplement, on the other hand, pays SECONDARY to Medicare. Medicare pays what it normally pays for, and then the Supplement swoops in to pay your share of the costs (i.e. those gaps we talked about earlier such as 20% on outpatient services).

 

What Are The Strengths And Weaknesses of Each?

To put it simply, the Medicare Advantage Plan wins at cost effectiveness. As an in-the-ballpark figure, an Advantage Plan will cost you about $60 per month on average. Some are even $0 premium plan! A Supplement, on the other hand, will cost an average of about $110 per month. In addition, an Advantage Plan almost always has a built in drug plan, while you will have to buy a stand-alone drug plan if you have a Supplement, which (depending on your medications) is about an extra $35 per month.

 

However, a Medicare Supplement wins at just about everything else. They cost you less in out-of-pocket expenses throughout the year. Their benefits package is much more stable every year. You have more freedom to choose healthcare providers, and you are more likely to have out-of-state coverage.

 

For a more in-depth look at the pros and cons of these two options, click here.

 

When it comes to deciding, it is all about what is important to you. For instance, if you travel a lot, out-of-state coverage may be very important to you. Therefore, you may want a Supplement. However, if you are more cost-conscious, an Advantage Plan might be the best. It’s all about finding the best plan to meet your unique needs and preferences.

 

Retiring soon and don’t know what to do? Call us at 97-492-8800 to discuss your options. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

 

Do I Need to Sign Up For Medicare If I Have Insurance with My Employer?

Do I Need to Sign Up For Medicare If I Have Insurance with My Employer?

This is an important question. If you sign up for Medicare, and you didn’t need to, you end up forking over cash in premiums for insurance you don’t even need. However, if you don’t sign up for Medicare and you needed to, the results are equally frustrating: penalties or high out-of-pocket expenses that suck the life out of your nest egg.

 

Here is an easy-to-follow guide to help you make a decision that’s the best for you. I’ll address each part of Medicare individually to help you come to a decision for each.

 

For a more in-depth explanation of the parts of Medicare, click here.

 

Part A (A.K.A Hospital Insurance or “Inpatient Care”)

This is an easy one. You can go ahead and sign up for Part A, regardless of whether you have insurance with your employer.

 

Why?

 

Because Part A is absolutely free! If there’s no premium, why not just take the coverage? As long you or your spouse has paid into Social Security for ten years or more, there is no associated cost.

 

There is only one reason why you would want to delay Part A: Health Saving Account contributions. You can still withdraw from a health savings account, but you cannot continue making contributions if you are on Part A.

 

But other than that, this is a simple decision. More often than not, you can just go ahead and sign up.

 

Part B (A.K.A Medicare Insurance or “Outpatient Care”)

Part B, on the other hand, is much more complicated. But in the end, your decision will boil down to your answers to three questions:

 

  1. Is my coverage through active, current employment?

The keywords there are “active” and “current.” In order to delay Part B without penalty, you or your spouse must have insurance coverage through active employment. You have to be on the floor or in the office (or at home in your PJs if you are lucky enough to have one of those jobs)! This means retiree benefits or COBRA or any other insurance that begins after you are done working do not count.

 

  1. Is your employer the primary payer (as opposed to Medicare)?

You can delay Part B without penalty as long as you can answer “yes” to question #1, but unless you can answer yes to this one, you may be stuck with some hefty bills on outpatient services. If Medicare is the primary payer and you don’t have Medicare, you will have to pay 80% of your outpatient healthcare expenses.

The way to find out if your employer is the primary payer is pretty simple. If your employer’s health insurance plan covers 20 or more people, the employer pays first. If it insures less than 20 people, then Medicare pays first. Ask your employer or human resource representative for the exact number to make sure!

 

  1. Is your employer plan less expensive?

None of these questions really matter if Medicare is the better value. Perhaps you can delay Part B without penalty (question 1) and without paying extra on outpatient services (question 2), but if Part B is the better value, why would you want to? That is why you must perform a cost to benefits analysis. If Medicare is the better value, then you should sign up for Part B. If it is not and you answered “yes” to the other two questions, it may be a good idea to delay.

 

Part D (Prescription Drug Coverage)

All that matters when it comes to deciding if you need to sign up for part D is whether or not your current drug coverage is “creditable.” In order for your drug coverage to be considered “creditable,” it must be at least as good as part D. In other words, it is expected to pay (on average) at least as much as a Medicare part D plan. To find out, ask your human resources department. When you turn 65 your employer will send you a letter telling you whether or not your coverage is creditable, but it is a good idea to find out beforehand for planning purposes.

 

So Let’s Recap!

  • Sign up for Part A unless you want to continue HSA contributions.
  • It might be a good idea to delay Part B if have insurance through current employment, your employer pays first, and your employer plan is a better value than Medicare.
  • As long as your current drug plan is considered “creditable,” you can delay Medicare Part D.

 

Are You Still Unsure About Your Decision?

If you still have questions about how your employer plan coordinates with Medicare (or about Medicare in general), you are not alone. Many people approaching 65 find themselves overwhelmed with all of the options and information. The good news is that Seniormark is here to help, and we offer our services at no cost to you. We will guide you through the entire process, ensuring that you avoid all the costly mistakes and pitfalls. Call Seniormark at (937) 492-8800 for a free consultation.

 

10 Terms to Beef Up Your Medicare Literacy

10 Terms to Beef Up Your Medicare Literacy

In this day and age, you have a vast pool of knowledge available to you. But none of that matters if you can’t understand any of it. If you’ve done any researching on the Internet about Medicare, you know what I mean. To help you out, I compiled a list of important terms that often catch retirees unaware.

 

  1. Annual Enrollment Period (AEP)

The AEP is the busy time of year for Insurance companies such as ours. You can think of it as the black Friday of Medicare. It is the time of year (October 15—December 7) when Medicare beneficiaries can switch plans, drop plans, and join new ones. It is an open market, a bustling time for anyone involved with the Medicare industry.

 

  1. Open Enrollment Period

The day you turn 65 and are signed up for Medicare Part B is the first day of your open enrollment. This 6-month long time frame is the window in which you can get on ANY Medicare Supplement plan, regardless of health! You will want to take advantage of this…your options narrow significantly outside of open enrollment.

 

  1. Deductible

A deductible is the money you have to pay upfront before the benefits of a plan begin. For example, Part A of Medicare has a $1340 deductible. They will not cover anything until you reach it.

 

  1. Copayments

Copays are a set dollar amount you pay in addition to the payment made by the insurer (whether it be Medicare or a private insurance company). Think of the $10-50 fees when you visit the doctor’s office or buy a certain prescription drug.

 

  1. Coinsurance

This is very similar to copayments, but it is a set percentage instead of a dollar amount. For example, the Medicare Part B coinsurance is 20%. This means you pay 20% of the total bill, not a set dollar amount.

 

  1. Out-of-pocket Costs

All three of the previous terms (deductibles, copays, and coinsurance) are all a part of a much larger concept of out-of-pocket costs. In other words, your out-of-pocket costs are everything you pay for your healthcare beyond your premium. One warning you will receive a lot is this: With only traditional Medicare (parts A and B), there is no limit to your out-of-pocket spending. Yes, I am low-key warning you again, but hopefully you fully understand it now.

 

  1. Donut Hole

Speaking of out-of-pocket costs, for a Part D drug plan, they are highest in the donut hole, a gap in prescription drug coverage. You enter the donut hole when you reach $3750 in total costs and exit it once you reach $5000 in out-of-pocket costs.

 

  1. Drug Tiers

Drug plan companies often organize the medications they cover into levels. They call these levels—you guessed it—tiers. Drugs on a lower tier (often generic brands) have lower copays and coinsurance. Drug on a higher tier (such as brand name or specialty drugs) often have higher associated costs.

 

  1. PPO

PPO stands for Preferred Provider Organization. So a PPO is a health plan that has a network of “preferred” doctors and hospitals. If you use those doctors and hospitals, they reward you will lower out-of-pocket costs.

 

  1. HMO

HMOs (Health Maintenance Plans) are a little bit more intense than PPOs. It is the same idea, but HMO plans won’t cover you at all if you don’t use their network of hospitals and doctors.

 

That brings this list to close. If you are still confused about a term on this list, ask us for help in the comments section. Have you come across another difficult word on your Medicare planning journey that you think we should add? Let us know. We want to hear from you!

 

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

Take Advantage of What Medicare Covers in FULL

Take Advantage of What Medicare Covers in FULL

Medicare alone doesn’t cover very much in full. There’s almost always some sort of coinsurance or copayment or other out-of-pocket cost.  This is why many people purchase Medicare Supplement Insurance to fill in the gaps (I recommend that you do so as well).

 

But there is something that Medicare fully covers—and that is preventive services. This includes lab tests, screenings, vaccinations, virtually any service performed to ensure that health problems are caught early—before they become…well…even bigger and more threatening problems.

 

This means that—as long as you meet basic eligibility requirements—you won’t pay a dime for most preventive services. The only ones I found that required any out-of-pocket costs were glaucoma screenings, diabetes self-management training, digital rectal exams (to detect prostate cancer), and barium enema (to detect colon cancer).

 

To give you an idea of the scope of preventive services that Medicare offers, here is a quick list:

  • Colonoscopies
  • Mammograms
  • Annual Wellness Visits
  • Diabetes Screenings
  • Vaccinations
  • Blood Tests
  • Depression Screenings

And this is just scratching the surface.

For a more comprehensive list with all the details, click here to access the Medicare preventive services guide.

 

Keep Track of Preventive Services on mymedicare.gov!

Some of these services are offered every year, some every other year, and some less or more often. Your risk level for certain diseases (based on age, gender, or family history) can also play a factor in how often you are eligible for services. Needless to say, it can be a lot to manage, which is why I recommend using mymedicare.gov. This free online account (among other things) allows you to see which preventive services you are eligible for and when.  Sign up here:  MyMedicare.  You can also print off a personalized report to bring to your doctor. This will help the both of you plan out when and if you should receive the various services.

 

I hope you consider taking advantage of what Medicare has made available. The reason they made it free is because they know how important it is for retirees to take care of themselves in a proactive way. It is good for them, and it is good for you—money wise and otherwise.  No one likes to spend time at a cold doctor’s office, especially when getting a colonoscopy (geesh). But staying on top of your health now, can save you having to deal with major health issues later. It can keep you on the go and healthy during retirement, an era of life that I believe should be as (if not more) fulfilling and exciting as all the rest.

 

Have any questions or concerns about Medicare? Call Seniormark at 937-492-8800 for a free consultation.

Turning 65 and not sure what to do?  Consider signing up for one of our FREE workshops in Sidney or Vandalia, Ohio!  Sign up here:  Seniormark workshops.

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

I know you’ve got a lot of dates to juggle: birthdays, anniversaries, holiday get togethers, or departure dates for long awaited travel plans. But you have to leave some empty space—in your memory and on your calendar—to add these 6 dates.

 

Why?

 

Because the Medicare Annual Enrollment Period is upon us, a time when the Medicare marketplace is bustling with transactions. Beneficiaries such as yourself are switching Drug Plans, Advantage Plans, or transitioning from an Advantage Plan to a Medicare Supplement or vice versa. These are strategic moves you can only make during Annual Enrollment!

 

Now, if you are thinking, “I’m perfectly fine with my health insurance. I’ll just let it go this year,” I’d like to offer a word of warning: Not reviewing your Medicare health insurance plans this Annual Enrollment Period could cost you thousands. You see, Benefits and premiums change from year to year, so you have to review your plans with a professional to ensure you are still in the best-valued plan for your needs.

 

It doesn’t seem like letting it slide just one year could end up being so costly, but I’ve seen it happen again and again. In fact, I recently had a man come into my office in January, confused about why his approximately $190 per month prescription wasn’t covered anymore. As it turns out, he missed Annual Enrollment. The insurance company dropped his prescription from their formulary (list of covered drugs) for the new year. Unfortunately, I had to tell him, he was stuck in the ill-fitting Drug Plan for the whole year, the consequences of a mistake that would (by the end of the year) cost him $2,280. Ouch.

 

So, if you are a current Medicare beneficiary, get your pen ready and calendar ready. Annual Enrollment (October 15—December 7) is chock full of clear-cut deadlines. Don’t find yourself locked into a financially draining health insurance plan! You (quite literally) can’t afford to miss these 6 dates:

1. October 1st

This is the day we, as an insurance agency, receive all of the new information regarding plan changes.

  • Did your Drug Plan drop your most expensive prescription from its formulary?
  • Was there a premium hike?
  • If you have an Advantage Plan, is your doctor still considered “in-network?”

October 1st is the day we have all these answers and can speak to you about the possibility of switching to save you money and hassle.

 

Note: You can call about your options anytime during Annual Enrollment, but the earlier is truly the better. This time of year is quite busy!

2.October 15

The marketplace is open!  Annual enrollment has officially begun, and you can now enroll in a new plan.

3.December 7

I hope you have made all the necessary changes, because—at this date—you are locked into your plans for another year. Annual enrollment is closed.

4.January 1

It’s a new year, a new resolution, and—quite possibly—new insurance. This is the date any changes you made during the open enrollment period go into effect.

5.January 1

Nope, you didn’t just read the same line twice, and you are not seeing double! I know this is a repeat, but I want to clarify why this date is worth the extra mention: It is also the first day of the Advantage Plan disenrollment period. Just in case you’re second-guessing your decision, Medicare set up a disenrollment period where you can get out of your Advantage Plan with no penalties.

6.February 14

Finally, this is the last day of Medicare’s disenrollment period. If you are in an Advantage Plan and don’t like it, this is your last chance to drop it!

BONUS: February 14th is also Valentine’s Day. You’re welcome.

 

Looking to Review Your Plans With a Medicare Expert?

Even if you are not yet sure if you want to switch, I recommend giving Seniormark a call at 937-492-8800! Our friendly and caring staff is more than willing to be a resource during this bustling Annual Enrollment season. We will help ensure you meet all the deadlines and end up in a great plan for your needs and pocketbook as the New Year rolls around.

How Much Does Medicare Cost in 2017?

How Much Does Medicare Cost in 2017?

The cost of health care is a big question mark for soon-to-be retirees. Perhaps you’ve been on a trusty employer plan for the last few decades or have come to know and love a private insurance plan that fits your needs and budget.

But now you’ve got to switch to Medicare. And although you’ve always been able to pay your premiums, the cost of Medicare is an unknown number among a sea of unknowns associated with health care in retirement (or retirement in general, for that matter).

Although I can’t grant you any magical, one-size-fits-all answer, I can give you some solid estimations based on my experience working as a local Medicare expert to help you compare what Medicare costs with your current plan.

I always like to start with some good news…

 

  • Medicare Part A (Inpatient Care) Is Free

Have you paid into Social Security for at least 10 years (40 quarters)? Then your premiums for Part A are paid for!

Unfortunately, though, it can’t all be free…

 

The Associated Part B (Outpatient Care) Monthly Premium Is $134.00

This figure is adjusted for high income, but that is not a concern for most people. $134.00 will be your monthly premium unless your income exceeds $85,000 per year or more as an individual or $170,000 filing jointly with your spouse.

This is where there is a fork in the road. From this point, the cost of Medicare is heavily affected by which path you take. You can boil down all the madness into two basic choices (“Swamped with mail? Here’s what it all means”): Medicare Advantage or Original (traditional) Medicare.

 

The Traditional Medicare Route

If you take this path, I always suggest picking up a Medicare Supplement Plan. It might seem unnecessary (“Do I Really Need a Medicare Supplement?”) to some, but without the extra coverage, there is no limit to your out-of-pocket spending.

A Supplement’s price range is anywhere from $50-150, but a standard, middle of the road Plan G usually costs about $110 per month. This is the typical plan I recommend to my clients.

Then, since a Supplement does not cover those sky-high prescription drug costs, the vast majority of retirees purchase a Part D Drug Plan. Although the prices span anywhere from $14.60 to $157.40 per month, the average cost for a drug plan is $35.63 as of 2017. The out-of-pocket costs associated with Part D vary greatly depending on your medications. Just keep in mind that there will likely be copays and coinsurance regardless of which plan you choose.

 

The Medicare Advantage Route

The other choice is the less beaten path. From my experience, most people feel very cozy in the stability of a Medicare Supplement. However, an Advantage Plan often appeals to the more cost-conscious, risk-taking retirees. Offered as an alternative to Traditional Medicare, Advantage plans range from $0-179 per month with most settling in around $70. To make them even more attractive, a Drug Plan is almost always included as a part of the package.

Caution: Check For Possible Out-of-pocket Costs
At first glance, it looks like choosing a Medicare Advantage is a no-brainer, but there is a reason it appeals to risk-takers. With a Medicare Supplement (only available with Original Medicare), the maximum out-of-pocket is only $183 annually for Plan G (not including prescription drug costs). However, in an Advantage Plan, the coverage is a bit spottier. You pay less in monthly premiums, but copays, coinsurance, and deductibles are much higher. The potential out-of-pocket for an advantage plan can be as a high as $3500-6000 per year or more! Some years you will save money because of the cheaper premium, but one year of bad health can turn that around really quickly.

The Costs At a Glance For a 65-Year-Old

Original Medicare
Free Part A
+
$134 per month Part B
+
$110 per month for Medicare Supplement Insurance
+
$35.63 for Part D Drug Plan
= $279.63 monthly
(with LOW out-of-pocket spending limit)

Medicare Advantage
Free Part A
+
$134 per month Part B
+
$70 per month for an Advantage Plan (Part D included)
= $204 monthly
(with HIGH out-of-pocket spending limit)

 

Interested In A More Personalized Analysis?

So there you have it! This should give you a good idea of what Medicare costs for the average 65-year old. But—as I said before—the cost of Medicare is different for every person. If you are interested in more personalized figures, call us at 937-492-8800 for a free consultation. We will assess your financial and health situation to find an overall plan that meets your needs, concerns, and pocketbook. Ensuring you a successful and secure transition into retirement is our number one priority.

There will always be some unknowns when it comes to health care costs in retirement, but sitting down with a professional in order to assess your situation can diminish even the biggest question marks and settle your deepest concerns.

Disclaimer: Numbers are based on Sidney, Ohio.

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7 Reasons Why You Should Choose a Retirement Advisor (Instead of a Salesperson)

7 Reasons Why You Should Choose a Retirement Advisor (Instead of a Salesperson)

Are you turning 65 soon and thinking about retirement? Then buckle up. An onslaught of sales mail is coming your way. You might even get a few sales calls and knocks on your door as well. Salespeople are definitely assertive. And once you are between 3-6 months of your 65th birthday, hundreds of them will be vying for your attention, Medicare Advantage Plans and Supplement insurance extended in hand.

 

But I don’t think you should buy from them.

 

It’s not that I have a special vendetta against salespeople. You just have a better choice available: the reserved, resourceful guys on the fringes of the chaos, just waiting for you to come to them. That’s right, I recommend seeing a retirement advisor, and here’s why:

 

Advisors Have More Certification

I’m not saying there aren’t well-studied salespeople, but it isn’t the norm. An advisor, on the other hand, will almost always have some form of certification. They have to. Because they aren’t just sweet talking you into a healthcare plan, they are working with you to develop a comprehensive retirement strategy based on your unique situation. You need skill to do this. You need to know your industry backwards and forwards. This takes reading the right books and completing the right classes. It takes a certain level of certified expertise.

But be careful: Not all certifications are equal.  Here is a link to some of the most significant certifications.

 

They Specialize

Be leery of those who “specialize” in Medicare Supplements, Long-term care insurance, home and auto, life insurance, annuities, rollovers, and pet insurance. If their list is long and their Santa bag of products is larger, there is a good chance they’re the proverbial Jack-of-all trades who is—unfortunately—a master at none. Typically, an advisor isn’t like this. They will pick a few areas of finance or insurance and specialize. Their specialization leads to mastery. And their mastery leads to good advice and service.

 

They Are Accessible

They have an office space, so you know where to find them. They have office hours, so you know when they are available. When you call, they pick up. When you email, they respond. Predictability is the key. This is because their job isn’t just to sell (although they do this as well); it is to service their products afterwards. Claim issues? Questions? Concerns? An advisor sticks around long enough to tackle them.

 

They Educate You

The goal of an advisor is not to decide for you. It is to educate you, so you can make a decision for yourself. They will give you recommendations, of course. They aren’t just going to slap down 11 supplements, 24 drug plans, and several dozen Advantage Plans and say, “Choose!” But the point is, you make the choice to buy. You know the advantages and disadvantages of different options (because they taught you).  And you become the driving force of your own fate. So when plans go well, you don’t just have an advisor to thank; you can also thank yourself.

 

They Challenge You

Advisors aren’t just “yes men”. They are straight up with you. When you wander onto a questionable path, they care enough to stop you. I remember when a client of ours stormed in, fighting mad about the weak points of his employer plan. He wanted to get off it immediately and onto Medicare. But I knew this was an emotionally charged decision. Sometimes employer plans can be frustrating, but it was going to be way more expensive for him to get on Medicare. It took quite a bit of convincing, but I challenged him. It’s what an advisor does. Your first instincts are not always the best ones.

 

They Give You Time to Process

A lot of salespeople try to communicate something called “urgency”. This isn’t always a bad thing. Some situations are just urgent! For instance, I almost always recommend getting on Medicare when you are first eligible because not doing so can result in life long penalties. But a lot of this communicated “urgency” is just to rush you into buying a product. But advisors give you time to think things over. They realize that you want a methodical approach, a framework for weighing all your options.

 

They Are Client-Centered

 An advisor focuses on you, not the product. The whole process starts with an analysis of your situation and ends with your decision. Advisors advise people that buy products. Salesmen sell products that people buy.  This seems like splitting hairs, but listen to the people around you. Have you ever heard someone say, “Yeah, this guy came by my house and sold me this?” Notice the lack of agency. They didn’t buy it. Someone sold it to them. That is a sure sign of a product-centered approach: a sense of buyer’s guilt and a subtle, underlying regret.

 

Before I end this post, I want to make something very clear. I am not saying that salesmen are bad people. And I am not saying that all advisors are these haloed angels in disguise. But I know what it is like to be on both sides. I’ve worked for a large brokerage firm, a large insurance company, and a large bank. And in all 3, I had the same problem: I felt bound by the ever-present pressure of sales quotas. I tried to advise and do what was best for the client, but—for all intents and purposes—I was a salesperson. My job was to sell products that people buy.

 

Now that I’ve switched sides, I will never go back. The advising side is just better. It is better for clients. And it’s better for everyone, really.

 

But enough about me. Now back to you. You are approaching retirement, readying yourself to leave that stressful job behind and explore new hobbies, new places, and new experiences. Or maybe you just want to stay local and spend more time with family.

But whatever your situation, I want to make a suggestion. As an advisor, I want to advise. Whoever you choose to help you with retirement, makes sure it is someone you can absolutely trust. Makes sure it is a person who is knowledgeable in the area you need the most help. And make sure they aren’t just there to sell products to people, but rather to invest in people who buy products.

 

Your retirement decisions are just that important.

 

If you are confused and interested in some Medicare planning help, click here to sign up for our free workshop! No high-pressure sales pitches here, just in-depth discussion and Q and A about Medicare.