Tag: Medicare supplement

6 Things Everyone Needs to Know About Their 2 Medicare Choices

Posted on September 27, 2016 by - Medicare, Medicare Advantage, Medicare Supplement

6 Things Everyone Needs to Know About Their 2 Medicare Choices

Medicare Advantage and Medicare Supplements. Two feasible choices. Two Medicare buzzwords. One startling misconception. And here it is: Medicare Advantage plans and Medicare Supplements are the same.

 

But this is just not true…not even a little. In fact, Medicare Advantage plans and Medicare Supplements are fundamentally different. So different that not knowing these differences could cost you…in convenience, in security, and in dollar signs.

 

So…without further ado…these are the 6 things you need to know about the 2 Medicare choices:

 

  1. Medicare Supplements pay secondary. Medicare Advantage Pays Instead.

The “street name” for a Medicare supplement is a “Medigap” plan, and it is a nickname rightfully earned. Medigap plans are called as such because they “fill in the gaps” of what traditional Medicare (Parts A and B) doesn’t cover. Therefore, you will have little to no out-of-pocket expenses. A Medicare Advantage plan doesn’t do this. It functions as an alternative for traditional Medicare. This means that—if the Advantage plan doesn’t cover it—you can be stuck with some pesky deductibles, copays and coinsurance.

 

  1. Medicare Advantage Plans have Networks. Medicare Supplements Don’t.

Medicare Advantage plans contract with specific hospitals and health care providers. And if you don’t go to their pre-picked “network” of providers, your share of the costs may rise. In some cases (especially out of state), the plan may not cover you if you receive care at a hospital outside of their network (except in the case of emergency)! Medicare Supplements allow you to go to any doctor or hospital you want as long as they accept Medicare.

 

  1. Medicare Supplements Don’t Change. Advantage Plans Do.

Since Advantage Plans are funded by government subsidies, their benefits are greatly affected by politics. The more money they can get from the government, the better their benefits and premiums can be. This means that plans will likely change from year to year and you may have to reevaluate, re-shop, and re-enroll in a different plan. Medicare Supplement plans are the opposite. Since the policyholder funds them, the plans are usually consistent from year to year.

 

  1. You Can Always Change to an Advantage Plan. You Can’t Always Change to a Medicare Supplement.

If you are in a Medicare Supplement plan, you can switch to an Advantage plan without any medical health questioning as long as it is during the annual enrollment period. It doesn’t matter if you have pre-existing conditions (with the exception of kidney failure); you will still be able to obtain coverage.

 

However, if you want to switch from an Advantage plan to a Medicare Supplement, it is not as simple. Although you can still enroll during annual enrollment, you will have to qualify based on your health. This can be a problem for those with pre-existing conditions. For instance, let’s say the government curbs their funding for your Advantage Plan. This raises the premium and lessens the benefits significantly. You have cancer. You can’t change to a Medicare Supplement because you couldn’t qualify based on health. What do you do? More than likely, you will have to stay with your unwanted Advantage plan!

 

  1. Medicare Supplement Have Premiums. Advantage Plans Have Low Or No Premiums.

While the average Medicare Supplement premium is up around $100-120 a month for a 65 year-old, the average Advantage plan premium is about 50-60. And (aside from your Part B premium) they may be completely free!

 

  1. Two Choices Can Quickly Become Two Hundred.

You only have two options in the beginning, but once you choose a route—whether Medicare Advantage or Medicare Supplement—it will likely multiply into many more choices. There are 11 supplements, 24 drug plans, and dozens of Advantage plans. Not to mention the other decisions you have to make regarding when and how to go about signing up for Medicare to avoid penalties. Like I always tell my clients, Medicare is a big animal. I always recommend consulting with a retirement advisor for help.

 

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!

Aetna increasing household discount!

Posted on June 9, 2015 by - Medicare, Medicare Supplement, Retirement Planning, Social Security

seniormark favicon
logofinal black bagrMedicare Supplement Household Discount Increasing to 7% in OH

Aetna will increase the household discount from 5% to 7% on Medicare Supplement plans issued in Ohio effective June 15, 2015.

No action needed to get the higher discount

Eligible applicants and existing policyholders will receive the increased household discount.

  • For new business, the 7% household discount will apply to new applications written on or after June 15, 2015. All pending applications that qualify for the discount will be issued at the new 7% discounted rate.
  • For existing policies issued with an effective date of July 1, 2015 or later (with premiums already paid AND where eligibility for the household discount was provided on the application), AHLIC will issue a new policy, which will include the higher household discount.
  • All other policyholders who previously received the 5% household discount will automatically receive the 7% household discount on their future premium that have a premium due date of June 15, 2015 or later.

Excess premiums, if any, will be applied to the policyholder’s future premiums.

Is your Medicare Supplement currently with Aetna?  They are offering great rates in addition to this additional discount.  Call our office today (937-492-8800) to see if you might be able to save money with Aetna and Seniormark. 

Medicare Supplement Policyholder Alert!

Posted on March 10, 2015 by - Uncategorized

postcard33Have you received this postcard in the mail?  Is it coming from Medicare?  Is it important information?  It does say, “REGISTERED DOCUMENT – DO NOT DESTROY.”  The truth is this is just a solicitation for insurance, and if you mail in the return postcard you are sure to get a call from an insurance agent, or worse yet a knock on your front door.  The unfortunate truth is we now live in a world of information overload and everyone is vying for your attention…yes, even me.  And in the world of Medicare, some lead companies resort to making the older population believe their mailing is more than it is.

If you look closely at the small print at the bottom you will read, “This information is not affiliated or endorsed by government agencies or the federal Medicare program.  You may be contacted by an insurance licensed representative.”  This disclaimer language is a sure sign that the mailing is a solicitation as it is required by Medicare.  I am not judging those who use these postcards to drum up business, in fact these cards are completely compliant with current regulations.  I just believe there is a better way…honesty!

Why can’t we replace the words, “REGISTERED DOCUMENT – DO NOT DESTROY” with, “THIS IS NOT A REGISTERED DOCUMENT – DESTROY IF YOU WANT…BUT IF YOU DO, OUR AGENCY WON’T BE ABLE TO HELP YOU!”  Why can’t we just get back to letting people know we are here to help when they need it.

Here is a great example:

https://www.youtube.com/watch?v=FrmYLo3tMA8

Medicare Supplement policyholders are paying too much for their coverage!

Posted on July 21, 2014 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Social Security, State Teachers Retirement

If your parents were like mine, they probably taught you to spend your money wisely. Let me use a story here to make a point. Suppose you are shopping for a new refridgerator. Your first stop is at Sears where you find the perfect Frigidaire XL2014, and at a great price, $2100. But because your parents told you to shop before you buy, you decide to check a few more places. The last stop you make is at Lowes, where you find the same Frigidaire XL2014. Same make, same model, same features…they are IDENTICAL! Only the one at Lowes costs $1500. Do you go back to Sears and buy the one for $2100? Unless you own stock in Sears, or your son is the sales rep, I hope your response is…Absolutely not! Why would you spend $600 more on the same thing. But Retirees are doing that very thing with their Medicare Supplement insurance.

 

But you may ask, “How do I know I’m getting the same benefits?” The answer is simple, our government did something right. Prior to 1992, Medicare Supplement insurance plans were not standardized. What this meant was that each insurance company’s Medicare supplement plans offered different benefits. This made it almost impossible for the Retiree to shop their coverage from company to company. Compare it to shopping for a car today. You can’t really compare cost from one dealer to another because the options are completely different. This one has leather seats, but the other one has On-Star. This one has a DVD player, but the other one has alloy wheels. It is impossible to truly compare cost because you are never comparing “apples to apples.” The same was true with Medicare Supplement insurance prior to 1992. But in 1992 the federal government stepped in and “standardized” Medicare Supplement insurance.

 

They did this because prior to 1992, unethical salespeople were taking coverage away from Retirees in order to save them money, and they weren’t disclosing the fact that they reduced their coverage. So the government stepped in and standardized the plans so this couldn’t happen anymore. They did this by offering 11 plans and giving them the letter names of A through N. In other words, it means you can compare a Plan F with one company to a Plan F with another company and know that the benefits are IDENTICAL. So you no longer have to say, “I know my supplement is expensive, but I don’t want to change it because it pays so well.” As long as you stick with the same Plan letter name, the new company is legally obligated to pay the same benefits as your old one.

 

So what does this mean for you? It means it would be a good idea to know what premium you pay compared to what others your age and in your area are paying for the same plan. This is important because you may be paying hundreds if not thousands of dollars more per year in premium and not be getting any better benefits. For example, the premiums for a Plan F for a 70 year old female range from $130/month on the low end up to $276/month on the high end. That’s a difference of $1,752 per year. And worse yet, the person paying $276/month is not getting any better benefits than the person paying $130. And don’t forget, you can change your medicare supplement policy any time of the year…you don’t have to wait for the Annual Enrollment Period at the end of the year.

 

If you would like to see how your premium compares, you can go to our website at www.seniormark.com and click on the “Supplement Rates” tab. And don’t worry, you will get instant numbers and we won’t collect your personal information. If you are not tech savvy just call us at 877-492-8803 and we will provide you with a free comparison report.

 

I bet your momma never thought shopping would be this easy!

Seniormark Alert: Observational Status could cost you tens of thousands of dollars

Posted on January 23, 2014 by - Medicare, Medicare Advantage, Medicare Supplement, Social Security

For the past year and a half I have been talking with clients about the difference between an “Inpatient” hospital stay vs. being in the hospital under “Observational Status” and why it matters.  If you missed my previous blog post on this issue you can read it HERE.

This information is finally getting media coverage which is good because what you don’t know can Hurt A Lot!  Here is NBC Nightly News’ coverage of the topic from a few weeks ago:

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Feel free to comment below if you have any questions…

Can Medicare Advantage survive PPACA?

Posted on September 6, 2013 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Social Security, Uncategorized

Here is a great article about how the Patient Protection and Affordable Care Act (aka Obamacare) may affect the Medicare Advantage program…

Can Medicare Advantage survive PPACA? | BenefitsPro.

Part B or Not Part B…That is the question

Posted on April 17, 2013 by - Uncategorized

One of the most commonly asked questions I receive is, “I am turning 65 and I have employer health insurance, do I need to sign up for Part B of Medicare?”

To start, let me explain what Parts A and B are.  Part A of Medicare covers inpatient care in a hospital or skilled nursing facility, while Part B covers doctor’s visits and other outpatient care.

For most Medicare beneficiaries, the Part A decision is easy because it doesn’t cost anything.  Therefore, most people will sign up for Part A as soon as they turn 65.  But the Part B decision can be a little more complicated, since you have to pay a monthly premium for Part B which is $104.90 for most individuals.

When deciding whether to sign up for Part B, the first question you need to answer is whether you have employer health insurance through your employer based on your active employment or if you are covered under your spouse’s employer plan based on his/her active employment.  The key word here is “ACTIVE.”  If your health coverage is based on active employment, then whether you decide to delay Part B will depend on the number of people employed by the employer providing the insurance.

If there are 20 or more employees at the company where you or your spouse work, then the employer insurance pays first and Medicare pays second.  If this is the case then you may want to delay enrolling in Part B as long as you are happy with the employer coverage and the cost is not too high.

If there are fewer than 20 employees then Medicare pays first and the Employer plan pays second.  In this scenario you should not delay enrolling into Part B.  If you decline Part B you will have no primary insurance for doctor office visits or outpatient services, which is usually like having no insurance at all.

In either case, as long as you have coverage from active employment, you will have a Special Election Period to enroll in Part B when you retire with no late enrollment penalty.  It is important to remember that COBRA and retiree insurance are not considered current employer insurance and you will not have a Special Enrollment Period.  If you have COBRA or retiree insurance and delay enrollment in Part B you may have to pay a penalty when go to sign up.

Medicare is a big animal with a lot of rules, so it is important to discuss your personal situation with an expert before you make these decisions.

Donut Holes Aren’t Always Tasty!

Posted on February 2, 2012 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Social Security

If your brain works like mine, it thinks about food a lot more than it should.  And it’s always food that’s not good for me, like donut holes.  Nothing beats a donut hole.  It’s like eating a whole donut in one bite…AWESOME!

But when it comes to the Medicare Prescription Drug Plan, donut holes lose their luster.  Don’t ask me why Medicare decided to give it the name donut hole, maybe it was to take the edge off its bite (no pun intended, unless you think it’s funny).  The Donut Hole, otherwise known as the coverage gap, is exactly what it sounds like.  It is a hole in your coverage.  Here’s how it works according to the Medicare guidelines:

Stage 1: The plans start off with a “Deductible Period.”  This is the amount you must pay for out of your pocket before the plan will pay anything.  Not all plans have a deductible.  The plans cannot have a deductible higher than $320.

Stage 2: After you have met your deductible (if you have one) you go into what is called the “Initial Coverage Level.”  During this stage you will pay approximately 25% of the cost of the medication.  Most drug plans set up copays during this stage based on the medication which they assign to a Tier.  For instance, you might pay a copay of $5 for generics (Tier 1), $25 for formulary brand names (Tier 2) and $45 for nonformulary brand names (Tier 3).

Stage 3:  Once you have had $2930 in total drug costs, you will go into the “Donut Hole.”  Notice I said “total drug costs.”  This means what you paid for the medications plus what the plan paid.  For example, if the total cost of a medication is $100 and you only had to pay a copay of $25, it’s the entire $100 that goes toward the donut hole number.  Once in the donut hole you will pay 50% of the full cost of any brand name medications and 86% of the full cost of any generics.  Due to the new healthcare reform, these percentages will continue to decrease each year until they reach 25% in the year 2020.

Stage 4:  Once you have paid a total of $4700 in out-of-pocket costs (not including the premium for the plan), you enter the “Catastrophic Coverage Level.”  Notice that this amount is out-of-pocket meaning that you would have to pay a total of $4700 before you entered this next level.  Once you hit this level you would only pay approximately 5% of the cost of the medication for the rest of the calendar year.

Once you reach the end of the calendar year, all plans start back at Stage 1 on January 1st.

According to a report from the Kaiser Family Foundation, approximately 19% of Medicare beneficiaries reach the donut hole at some point during the year.  So not everyone has to worry about hitting the donut hole, but if you do your expenses can add up in a hurry.  For those of you who are in this situation, maybe you can ease the pain with a box of donut holes (the good kind from the local bakery).

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Don’t Retire Naked!

Posted on January 25, 2012 by - Uncategorized

Every day, thousands of people are making the decision to retire.  You probably even know of someone personally.  A good number of those who are making that decision are doing it prior to turning age 65.  And it never fails that some of them will do it NAKED!  No, I don’t mean without clothes…at least I hope not.  What I mean is they are doing it without insurance coverage.

You may say, “Who would ever take that chance!”  Well, most of them didn’t do it on purpose.  They did it accidentally through a lack of planning.  It usually starts with them making the assumption that they will automatically qualify for coverage because they have always had insurance coverage.  That is not the case.  When you are age 65, you can go on Medicare and get a medicare supplement regardless of your health.  The same cannot be said if you retire prior to Medicare age.  If you retire at age 62 for instance, a health insurance company can refuse to insure you based on your current health.  Some health conditions that may cause you to be declined include heart conditions, insulin dependent diabetes, Alzheimer’s disease, etc.

Another common mistake I see is when an individual retires early and goes on COBRA coverage.  COBRA coverage is temporary!  It normally lasts only 18 months (36 months in some circumstances).  I recently spoke with an individual whose COBRA coverage ran out 6 months prior to him turning age 65, and he had an uninsurable heart condition.  So what are his choices?

He has only 3 options…

Option 1:  Because he has exhausted his COBRA insurance, he qualifies as a HIPPA eligible individual.  This means he can get health insurance regardless of any preexisting health conditions.  GREAT!  Problem solved.  The only problem is he will have to pay $1,2oo a month for a plan with limited coverage.  “But what about the Obama healthcare reform, didn’t it take care of people being left without insurance?”  Not really, which brings us to…

Option 2:  The new healthcare reform set up high risk pools in each state to help the uninsured get health insurance.  There’s one big problem, you have to be without insurance for 6 months before you qualify.  So this solves nothing for the gentleman I was talking to because by the time he would qualify for the high risk pool, he could go on Medicare.  Even if he wasn’t Medicare age yet, who wants to be NAKED for 6 months.  So what’s his last option…

Option 3:  Go without insurance coverage until he turns 65 and goes on Medicare.  Definitely not a good option, but for many this is what they are left with.  And with an open heart surgery costing well over $200,000 this could be devastating.

Retiring naked is not only cold, but could be detrimental to everything you worked your whole life for.  So, before you decide to retire, do a little planning and PUT SOME CLOTHES ON!