What You Need To Know Before Starting Medicare: The Basics


Starting Medicare can be an intimidating process. There are a lot of options, confusing terminology, and people everywhere trying to sell you something different.

Every year, the Center for Medicare & Medicaid Services (CMS) publishes a new Medicare & You handbook. This handbook thoroughly explains the parts of Medicare, what is covered and how it works. You’ll also come across another book dedicated solely to Medicare Supplement plans: Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

As the owner of an agency that helps seniors get insurance coverage, I know that these documents’ combined page count of over 200 pages can make this information very daunting. Those who attempt to start reading usually find themselves exhausted and confused. As your research continues, mail will start pouring in with brochures, flyers, postcards, booklets and pamphlets all related to Medicare options. The question is, “Where do I start?” The answer is the basics.

Original Medicare

Original Medicare consists of Part A (hospital coverage) and Part B (outpatient coverage). Original Medicare can be used at any doctor or hospital in the United States that accepts Medicare. To see if a specific doctor takes Medicare, you can use the Physician Compare tool.

Original Medicare is then often paired with a stand-alone prescription drug plan (Part D). Original Medicare generally only covers about 80% of outpatient services and has a separate deductible for inpatient care. There is no limit to the 20% coinsurance you are required to pay.

Because of these expenses, experience has shown me that most people who want Original Medicare also enroll in a Medicare Supplement (Medigap) plan to limit their exposure to out-of-pocket expenses.

Medicare Supplement

Medicare Supplement plans, also called “Medigap” plans, are also labeled with letters, like Plan F, Plan G and so on. You cannot have one of these plans without Original Medicare. Medigap Plans supplement the Medicare claims payment to fill in the gap for you. The Supplement is accepted anywhere that accepts Original Medicare and, similarly, allows participants freedom to travel across the country without worrying about whether a provider is in network. They provide coverage for the out-of-pocket expenses left by Original Medicare. When first enrolling in Medicare, there are no health qualifications, and you get to purchase any Medicare Supplement plan available. If you are outside of your initial election period, you may have to qualify with good health in order to get or change Medicare Supplement plans.

In my experience, Medigap plans are generally a good option for Medicare beneficiaries who want to keep Original Medicare but are concerned with the potential out-of-pocket costs they could be responsible for. Health and your individual desire to avoid networks play a large role in whether or not a Medicare Supplement is a good choice for you. Some beneficiaries choose to enroll in and pay for a Medicare Supplement policy even if they are in good health because they know they may not qualify for one in the future.

Medicare Advantage

Medicare Advantage Plans take you from the freedom of any Medicare provider into a network where, depending on the type of plan, you may only be able to obtain services from a privately contracted network of providers. You will still have to pay any premiums for Part A and B to be eligible. When shopping for these plans, it is important to know whether your doctor will be in-network. You will typically have to select a participating primary care doctor and have all referrals coordinated through him or her. Your specialists, too, must be part of the plan’s network.

Medicare Advantage plans tend to have lower premiums than Medicare Supplement plans or none at all. They are pay-as-you-go plans in which the maximum out-of-pocket cost per calendar year is as high as $6,700. While most Medicare Advantage plans, in my experience, do include built-in drug coverage, the drug component is not necessarily tailored to your specific list of medications. Seniors must be very careful to fully investigate how their medications will be treated.

Advantage plans can often have more out-of-pocket costs than Original Medicare with a Medicare Supplement. Typically, each doctor visit, test and hospital admission has a co-payment at the time of service. Medicare Advantage is also a calendar-year contract, so you can change from one Medicare Advantage plan to another without any health underwriting — but only during the Medicare Annual Election Period each year.

I believe that Medicare Advantage could be a good fit for beneficiaries who rarely travel, want low monthly costs and don’t mind paying more out of pocket at the time of service. Those who have health issues and want to choose their doctors and specialists may want to consider options other than Medicare Advantage.

Part D

Unlike Medicare Advantage plans with built-in drug benefits, stand-alone Part D coverage can be tailored to your specific situation. You can choose a unique plan based on your current medications and preferred pharmacy. This plan, like the others, can only be changed once per year during the Annual Election Period. Typically, you cannot have a Medicare Advantage plan and a separate Part D drug plan.

Regardless of whether you decide to pay a little more and have the freedom and flexibility of a Medicare Supplement or you decide to forgo the premiums and abide by the network and managed-care restrictions of a Medicare Advantage plan, I always recommend choosing a plan that limits the out-of-pocket expenses of Original Medicare. With Original Medicare alone, you are subject to unlimited coinsurance. But, of course, having some coverage is better than no coverage at all.

Everyone wants to know, “Which plan is best for me?” Some enrollees opt to speak to a representative who can show them all the options, look into their preferences and local market, and offer advice; either way, the answer to that question always depends on your current situation, your medications, where you live and your health, so evaluate how these factors fit into the plans available in your area.

Original Source: https://www.forbes.com/sites/forbesfinancecouncil/2018/09/13/what-you-need-to-know-before-starting-medicare-the-basics/#3e983db9552d

Original Date: Sept 13 2018

Original Author:

Avoiding the Medicare Late Enrollment Penalty

Three months before you turn 65 you should receive a packet of information that tells you exactly what you need to do during Medicare open enrollment to insure coverage.  Open enrollment only lasts for three months before the month you are set to turn 65 and for three months after.  If you choose to enroll in Medicare outside this period, you will be subject to a late enrollment penalty.

Late Enrollment Penalty

There are four different parts of Medicare which each have their own penalty for late enrollment.  These four parts are: Medicare Part A, Medicare Part B, Medicare Advantage, and Medicare Plan D.  There are penalties for each separate part of Medicare if you choose to enroll late.

Medicare Part A

Most likely you will automatically qualify for Medicare Part A when you turn 65.  If you do automatically qualify, often there is not premium.   Automatic coverage occurs for recipients who have, or who have a spouse who has, worked at least forty quarters in the United States.  This equates to ten years of employment in the U.S.

If you have not met this qualification, then when eligible you will be required to pay for premium for Medicare Part A.  If you choose not to at the time, waiting until a later date, your premium will increase monthly by 10%.  The increased premium will need to be paid for double the number of years you could have had Medicare Part A but did not choose to sign up.

Medicare Part B

Medicare Part B is like Medicare Part A in that your enrollment in benefits are automatic.  Like Medicare Part A, if you are not enrolled automatically you will need to enroll in Medicare Part B when you become eligible.  If you choose not to enroll in Part B when you are first eligible you will be charged a late enrollment penalty for the entirety of your coverage. The penalty has the potential to increase by 10% for every year you did not sign up but were eligible to do so.

Medicare Plan D

Medicare Plan D, also known as prescription drug coverage, is one plan that you will not automatically be enrolled in.  It is encouraged that you enroll in prescription drug coverage with in the enrollment period.  If you do not and you are not enrolled in any other prescription coverage the penalty you pay multiplies 1% of the “national base beneficiary premium” times the number of months that you have not had prescription drug coverage.   The premium is rounded to the nearest ten cents.


If you qualify for a Special Enrollment Period, you may avoid the late penalty for Medicare Part A and B.  This special enrollment period occurs when seniors are still working at 65 and delay enrolling in coverage.  The same is true as well if you are covered under your spouse’s medical insurance.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.


Deciphering Medicare: What you need to know as election period nears

Part A. Part B. Part C.

For those new to Medicare, the pieces and parts of the various plans can be confusing. This 10-point primer is just what the doctor ordered to help anyone age 65 and older through the annual election period, Oct. 15-Dec. 7.


Original Medicare

Medicare is administered by the Centers for Medicare and Medicaid Services (CMS). Medicare is a federally funded program that provides health insurance for people over the age of 65 and for certain people under 65 with disabilities. Often this federal program is referred to as Original Medicare.


Parts A and B

Original Medicare includes Part A, which covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services. For more information about the services covered under this federal program, visit medicare.gov.

Original Medicare pays only about 80 percent of your medical expenses. Things like prescription drug costs aren’t covered by Original Medicare, which is why some people elect to purchase coverage through private insurance companies.


Part C

Medicare Part C, also called Medicare Advantage, is a health plan that provides all of your Part A and Part B benefits through independent coverage from insurance companies. These companies contract with the Medicare program, so while you are still enrolled in Parts A and B, you receive the benefits through the insurance company rather than through Original Medicare.

Medicare Advantage plans usually offer low or $0 premiums and may provide benefits beyond Original Medicare, such as vision, hearing and fitness benefits. Many also include prescription drug benefits as well.

Another option is to supplement the Original Medicare coverage you receive through the federal program with Medicare Supplement (also known as Medigap) or Prescription Drug Plans (Medicare Part D).

Similar to Medicare Advantage, these plans are offered by private insurance companies. With these plans you will receive Part A and B benefits through Original Medicare. The coverage from private insurance plans will pay for some of the out-of-pocket health care costs that are not covered.


Requirements for benefits

In order to be eligible for Medicare, individuals must be U.S. citizens or permanent legal residents, and reside in the United States for five continuous years. For more information about Medicare eligibility requirements, visit medicare.gov.

For most people, eligibility is the first of the month in which you turn 65. If you or your spouse plan on working past 65, and as a result you have health coverage, you can choose to delay enrollment. It is important to enroll in the initial enrollment period, or maintain coverage through your work or a spouse’s work when turning 65. If you fail to enroll during your Initial Enrollment Period, you may owe a late enrollment penalty. For more information, visit medicare.gov.


Election period

Each fall, Medicare Advantage and Prescription Drug Plans have an annual election period (AEP) during which you can change plans. This year’s annual election period starts Oct. 15 and runs through Dec. 7. For more information, visit medicare.gov. Additional information about Blue Cross and Blue Shield of Nebraska products can be found at medicare.nebraskablue.com.

Original Source: https://www.omaha.com/sponsored/blue-cross/deciphering-medicare-what-you-need-to-know-as-election-period/article_0157f461-1687-5976-9a63-f369cd6d58cb.html

Original Date: Sept 10 2018


Making Sense of Long-Term Care Planning

Be nice to your kids

Our culture is in a bit of a conundrum. With the population growing older, an increasing number of clients require long-term care, or are tending the needs of aging family members.  Meeting needs in a manner that is comfortable for consumers can be challenging. What are the best words of advice for your clients?  The answer is, that depends.

Planning for Long-Term Care

Meeting needs. Many people don’t believe they will require long-term care. However, statistics speak volumes. As a Forbes article reports, 70% of older Americans will need long-term care in their golden years. With that in mind, clients need to consider how to meet their needs in the event they fall into that statistic.

Assessing circumstances. It’s often impossible to know for certain someone will require long-term care. However, to some extent, circumstances can predispose clients to needing assistance. Some factors include:

  • What lifestyle choices are your client making now that could factor into needing care?
  • Does your client participate in risky hobbies, or are there health-maintenance choices that could contribute to the onset of debilitating illness?
  • How could your client reduce risk of injury or illness?
  • Are there any home modifications the client should make to better accommodate changes in mobility?
  • Are there hereditary illnesses and conditions raising risk?

Options and conditions. Some experts note not everyone qualifies for some of the options available to cover long-term care. Alert clients that with certain health conditions they could be turned down for long-term care insurance. Lifestyle choices that impact health conditions can weigh into their projected need and planning.

Paying For Long-Term Care

Long-term care costs. In order to make sound financial decisions for meeting long-term care needs, start with a realistic understanding of the cost of long-term care. A quarter of all seniors will need to shell out over $50,000 for long-term care. If someone elects to pay for in-home care, the national median annual cost of an in-home aide in 2017 was around $48,000. Unless your client is very wealthy, chances are they will need a safety net in place to cover long-term care costs. When deciding how to move forward, discuss these factors with your client:

  • How close is the client to retirement?
  • What savings and insurance programs are available to help pay for long-term care?
  • Does the client have a plan to pay for the costs of long-term care?

Weighing options.  Many people are under the impression Medicare or Medicaid will pay for long-term care, so it’s important to explain to clients their ability to use Medicaid is linked with their assets, and the cap is at $2,000. Thankfully, there are a number of alternative means for covering care:

Long-term care insurance. Much is made about rising premiums on long-term care policies, however as Suze Orman points out it’s still financially advantageous for many of those who fall into the gap between qualifying for Medicaid and being wealthy enough to afford long-term care outright. What if it’s a financial stretch for your client to cover the premiums associated with long-term care? One suggestion for those who struggle to meet premiums is to opt for a policy with a lower benefit.

Supplemental insurance. Some clients may benefit from Medicare Supplement insurance or Medicare Advantage plans. Medicare Advantage plans are an alternative to Medicare Part A and Part B. Medicare Supplement insurance helps pay for deductibles, co-payments and other out-of-pocket expenses.

Prepayment of funeral costs. Even with a sound plan in place, many families are strapped when loved ones pass away. One way to ease some of a family’s financial burden is with a prepaid funeral plan, such as:

  • Joint savings account, allowing family members to tap funds, which potentially would otherwise be frozen.
  • Pre-need insurance plan through a funeral home; details vary, but these plans are straightforward.
  • Purchase a final expense insurance policy, which usually covers funeral and end-of-life expenses.

Sensible decisions. Nobody wants to believe they will need long-term care. However, most people do eventually require assistance. Talk with your clients and find the best way to meet their needs.

Original Source: https://www.thinkadvisor.com/2018/09/04/making-sense-of-long-term-care-planning/

Original Date: Sept 4 2018

Original Author: June Duncan

History of the American Medicare Program

Teddy Roosevelt who ran for president in 1912, began talks regarding a national health care program for all Americans to help defer the rising costs of American health care. However, it wasn’t until 1945 that President Truman sent a message to congress asking them to come up with a National Health care fund open to all Americans. Truman’s vision was for National health care plan allowed for Americans to get health care coverage for doctor visits, hospital stays, Laboratory stays and dental care. He campaigned tirelessly to make National health care a reality, but his efforts were destined for failure.

It wasn’t until 20 years later in 1965 under President Johnson that a National Health care program was actually signed into law. However, this health care program wasn’t for all Americans it was limited to only those people over the age of 65.

As of 2017 58.5 million Americans receive Medicare insurance and Medicare covers about 20% of the total amount of monies spent on health care in the United States.

Over the years there have been many changes to Medicare program one of the most notable was that in 1972 Medicare insurance was expanded to cover individuals under the age 65 allowing many more Americans to take advantage of this National health care program.

However, while Medicare cuts down on Medical expenses for millions of Americans it is not free. This program or part B of the plan calls for the paying of premiums for medical care as well as requiring people to have a deductible and to co-pay for certain services.

In the 1980’s Medicare Supplemental Insurance (Medigap) was introduced helping to cover some of the expenses that Medicare does not cover. While the Medicare Supplement Insurance is not part of Medicare and does require people to carry a Medigap policy issued by licensed insurance carriers to which policy holders need to pay monthly premiums it does help defer some of the medical costs not covered by Medicare including paying some of those deductibles and co-pays making medical care even more affordable for older individuals.

Improvements or changes in the Medicare program and Medicare supplement insurance are sure to continue.

Medicare Plans

There are several different Medicare plans, but the three plans most people are familiar with are:

  • Plan A- Under Medicare Plan A Medicare pays for hospital stays, doctor services and procedures. The procedures under this plan may include certain diagnostic test needed to determine your medical problems as well as certain surgeries. Plan A also covers Hospice care and Home health care needs.
  • Plan B- Plan B covers such things as check-ups and screenings, supplies necessary for a given medical condition, ambulance services and mental health care. You may have to pay a 20% co-payment for some of these services.
  • Plan D- covers prescription drugs. The drugs covered under this plan are prescription drugs are FDA approved and used to treat a certain condition.

Although Medicare and its supplement insurance programs don’t fulfill the dream of President Truman to have a National Health care program for all Americans it does provide good basic health care for millions of Americans each year.

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!




What to ask about your employer health coverage after age 65

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil; and he will answer as many as he can.

With more people continuing to work once they turn 65, it’s essential to understand employer health coverage rules and how they interact with Medicare. This is true for employees and, perhaps even more so for their spouses.

Generally, employer plans with more than 20 employees must continue to offer health coverage to active employees and their spouses if the employee continues working when they turn 65. In this case, the employee usually has the choice to get Medicare, either in combination with the employer plan or in place of it.

Small employer plans with fewer than 20 employees, by contrast, usually require active workers to get Medicare when they turn 65. At that time, the employer plan moves from being their primary to their secondary insurer, and Medicare becomes their primary insurer.

As secondary insurance, the employer plan provides the kind of supplemental coverage that people with original Medicare rely on Medigap plans to provide. If a person at a larger employer plan decides to keep the employer plan and also get Medicare, Medicare will provide secondary coverage that can help pay large deductibles that many employer plans now require.

It’s important also to understand how or even whether employer plans would continue to cover prescription drugs, and if a Medicare Part D plan is needed.

These questions should be easily answered by an employer’s benefits department or by the private health insurer that oversees the employer plan. Sadly, my inbox is filled with reader questions arising from a lack of employer-plan knowledge. I’d like to say that this is always because readers failed to get good information from their employer plans. But in all too many cases, it’s clear that readers didn’t seek help from their employer plans or even think to ask how they worked with Medicare.

Here is a cautionary tale from Cathy in Oklahoma that shows what happens when there is a big information disconnect between employers and their employer insurance plan. Her rising sense of disbelief and distress are palpable, and I greatly appreciate her sharing this story:

My husband is full retirement age but still working and covered by a Federal Employee Health Benefits (FEHB) plan through his job at the Post Office. I am not working so I am covered by his health plan and will turn 65 this summer. I expected that when he retired, we would keep his current insurance and it would function as our Medicare supplement along with Part A of Medicare.

Several insurance agents offering Medigap supplement plans have told me it will be more expensive to keep his FEHB plan than to purchase a plan from a commercial insurer. My husband needs an outpatient procedure within the next month and I was waiting to schedule a hysterectomy until after I turned 65, expecting that, between Medicare Part A and our postal plan, we would owe nothing out of pocket but a deductible and the insurance premiums he is currently paying.

However, we just learned that as long as he’s still working, his postal insurance remains the primary payer for both of us even though he has Medicare Part A and I am applying for it now. I was also told that Part A does not cover hospital expenses for outpatient procedures but only inpatient care and only if the patient is hospitalized for at least 48 hours. In short, we thought one of the few perks in turning “Medicare age” was paying nothing out of pocket for our health care except for Medicare deductibles and a continuing premium for his postal insurance with all medical expenses covered.

Would it benefit us to shop for a Medigap plan and ditch the postal insurance coverage and those higher premiums as soon as I have my Part A coverage? Also, in this climate of legislative hostility toward entitlement programs like Medicare and Social Security, as well as looming deficits in those programs, there’s a nagging concern that despite a higher cost we might want to keep the FEHB coverage since if we discontinued it he would have to be covered for a continuous five-year period before retirement to pick it up again. Is there any indication that FEHB coverage might be safer from unexpected twists and turns of insurance upheavals than regular insurance?

Cathy’s understanding of Part A is generally correct. Outpatient medical expenses are covered under Part B of Medicare. The key to whether a hospital stay is covered under Part A or B is not the duration of the stay but whether the hospital admits someone as an inpatient or as an outpatient for what is often called an observation stay. Even though the care for both types of stay can be identical, the Medicare coverage is different.

As for getting supplemental Medicare insurance, I doubt this is the way to go. Medigap plans require people to first get original Medicare. So, if Cathy’s husband dropped the FEHB plan, he’d still need to pay monthly premiums for Part B plus any Medigap premiums plus premiums for a Part D prescription drug plan.

The information that Cathy needs is what her husband’s FEHB plan will not cover, so she then can decide if original Medicare makes sense. This usually would be in addition to the FEHB plan. Many federal retirees are quite happy relying solely on their FEHB coverage, but some do add Medicare to augment their coverage. Getting rid of FEHB benefit is rarely the best option.

The key takeaway is that people simply must find out the specifics of what employer plans cover and what Medicare covers. They then can make informed decisions about what to do as they approach their 65th birthdays. These details can be confusing and may be hard to extract from employer insurers. But going through even an aggravating experience is much better, and usually cheaper, if it occurs before people get locked into nasty health-insurance mistakes.

Original Source: https://www.pbs.org/newshour/economy/making-sense/what-to-ask-about-your-employer-health-coverage-after-age-65

Original Date: Aug 15 2018

Original Author: Philip Moeller

What is Medigap insurance – and do I need it after I retire and have Medicare?

medicare supplement insurance

We all want to cut our expenses when we retire to help us have a comfortable standard of living on our more limited income. Generally, the last thing we want is to add another new expense.

And many people intentionally wait to retire after they turn 65, so they will have Medicare to cover their health expenses. But the free part of Medicare alone may not cover everything you’ll want and need as you age during your retirement.

For example, if you want prescription drug coverage, you’ll also want to purchase a Medicare Part D plan. And that’s still true even if you buy a Medigap policy, since any Medigap policies sold since 2006 cannot include prescription drug coverage.

Medigap (also known as Medicare Supplemental insurance) is intended to supplement your Medicare. It should help you to pay some of the expenses not covered by Original Medicare, such as copayments, coinsurance, deductibles, and medical care in foreign countries (some plans cover this, others do not).

It only covers one person, so if you and your spouse both want Medigap coverage, you’ll need separate policies. And the premium you’ll pay for your Medigap policy is in addition to the premium you pay to Medicare for your Medicare Part B – it’s an additional expense, not a replacement. And it’s an expense you’ll be paying to a private insurance provider – not to Medicare.

To qualify, you must already have Medicare Part A and Part B. Part A (hospital insurance) is the part of Medicare which is free for some people. Part B (medical insurance) helps with some of the doctor expenses you’ll incur for ongoing healthcare and for on-demand visits when you are ill. The standard Part B premium in 2018 is $134 per month but it may be higher or lower depending upon your income. And it has an annual deductible, after which you’ll still need to pay 20 percent of doctor visit costs.

It’s important not to confuse a Medigap policy with a Medicare Advantage Plan (Part C). They’re not the same thing.

If you already have a Medicare Advantage Plan, be sure you are able to leave it before signing up to begin your new Medigap policy. It is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare.

A Medigap policy is just one of the expenses you may need to contemplate when deciding when to retire and how much you’ll need for ongoing expenses thereafter. At Texas Financial and Retirement we work to develop a retirement plan customized to each individual family’s needs. We help you to consider all of the expenses you may have during your retirement, so you can maximize the benefits of your retirement income and “get retirement right!”

How Medicare’s Private Plans Surpass the Traditional Program

Medicare Advantage, a system of competing private health plans, is surpassing the traditional Medicare fee-for-service program in delivering high quality, cost-effective medical care for senior and disabled citizens.

The prominent research firm Avalere recently published a major study showing that Medicare Advantage generally outperformed traditional Medicare. This was especially so in caring for the most challenging patients who suffer from chronic conditions and complicated medical problems.

Major structural differences between traditional Medicare and Medicare Advantage largely account for the differences in performance.

Traditional Medicare, enacted in 1965, pays doctors and other medical professionals on a fee-for-service basis, meaning that the government reimburses medical professionals a specific fee for every one of thousands of services provided to Medicare patients.

After almost two futile decades of trying to control costs, in the 1980s Congress overhauled hospital and physician payment. In 1989, Congress created a new physician payment system in which the government would reimburse Medicare doctors based on a calculation of the putative value of individual medical services—including the resources and time required to provide them—and capping the payment.

This bizarre reimbursement formula, plus subsequent payment updates, proved faulty. Medical stakeholders compromise the entire process because they also are involved in setting the prices of Medicare’s services and continuously fight to evaluate their own services higher, leading to questionable fee schedules, confusion, and inefficiency.

For years, traditional Medicare’s payment system generated perverse incentives, allowing hospitals, for example, to overtreat their patients, delivering more care and more services, more reimbursements, and higher revenues.

Congress created Medicare Advantage in 2003 as a new and improved market-based alternative to traditional Medicare, where private health plans, paid on a defined contribution basis, would provide comprehensive as well as tailored benefits and services to senior and disabled citizens.

Medicare Advantage turned out to be immensely popular, evident by sharply increasing annual enrollment. Today, those plans enroll 36 percent of all Medicare beneficiaries and the number should reach 41 percent by 2027.

Since its inception, Medicare Advantage has not escaped criticism. Initially, critics focused on failure to achieve cost savings. They also charged Medicare Advantage plans with using schemes such as gym memberships in selectively choosing healthier patients.

In fact, many of these early studies were narrow in scope. By contrast, the Avalere study used a much broader dataset known as the MORE2 Registry to generate representative samples of 1,813,937 Medicare Advantage beneficiaries to compare against data from the Centers for Medicare and Medicaid Services for 1,376,573 traditional Medicare beneficiaries.

Medicare Advantage does not enroll healthier beneficiaries. In many cases, the plans had fewer healthy beneficiaries. The Avalere data: 36 percent of Medicare Advantage beneficiaries enrolled with disabilities, compared to 22 percent in traditional Medicare.

Perhaps more importantly, in comparing beneficiaries with complex medical conditions (two or more of the following: hypertension, hyperlipidemia, and diabetes), the Medicare Advantage population essentially mirrored the traditional Medicare population.

While 30.6 percent of the Medicare Advantage population suffered from all three medical conditions, 27.9 percent of the traditional Medicare population also did. Among Avalere’s total study population, the traditional Medicare population was not “sicker” than the Medicare Advantage population.

Of special interest to Washington policymakers, Medicare Advantage still achieved better outcomes for beneficiaries than traditional Medicare did with equivalently sick, chronically ill populations.

For example, 8.2 percent of Medicare Advantage beneficiaries with complex diabetes had complications, compared with 17.1 percent of traditional Medicare beneficiaries. And Medicare Advantage beneficiaries with clinically complex diabetes had 5.7 percent lower costs than those in the Medicare fee-for-service program.

Medicare Advantage plans also had far better results in caring for dual-eligible beneficiaries with chronic conditions. The plans achieved a lower total cost of care, with more office visits but fewer hospitalizations than beneficiaries in traditional Medicare. Dual-eligible beneficiaries also received more preventive care services than traditional Medicare beneficiaries, resulting in lower aggregate costs for “high need” patients, less use of high-cost health care services, and higher quality results.

Avalere’s results confirm previous findings in the professional literature. For instance, a large 2015 study in the American Journal of Managed Care found that relative resource use, the medical resources used to treat disease, was lower in Medicare Advantage compared to traditional Medicare patients with diabetes and cardiovascular conditions.

The study also found that patients with Medicare Advantage plans received better quality ambulatory care. This echoed the Avalere finding that Medicare Advantage spent proportionally more money on office visits than inpatient hospital services, compared to traditional Medicare.

Health Affairs study found that the increasing proportion of enrollees on Medicare Advantage was associated with a decrease in per capita spending under traditional Medicare.

Counties that had larger increases in Medicare Advantage spent less per patient on Medicare, suggesting that it delivered more cost-effective care than traditional Medicare and was able to generate cost savings throughout the system.

The availability of more comprehensive data shows that Medicare Advantage is, in fact, a genuine advantage for Medicare beneficiaries. As this latest Avalere study indicates, Medicare Advantage is more cost-effective than traditional fee-for-service Medicare, especially in treating patients with complex medical problems.

Congress and President Donald Trump should recognize the success of the Medicare Advantage program and its superior performance in serving Medicare beneficiaries in a cost-effective fashion while increasing their quality of care.

Future reform of Medicare is necessary, and Washington policymakers should build upon this successful expansion of personal choice and market competition.

Original Source: https://www.dailysignal.com/2018/08/06/how-medicares-private-plans-surpass-the-traditional-program/

These are the biggest mistakes people make with Medicare

How you can avoid them

Prescription medicine is the most significant medical expense for most Medicare beneficiaries.

This article is reprinted by permission from NextAvenue.org.

Most Americans in, or near, retirement know too little about Medicare, causing them to pay far more out-of-pocket for retirement medical care than they should and make big Medicare mistakes.

Many people believe Medicare — the federal health insurance program for people 65 and older — covers all or most retirement medical expenses. It doesn’t. The average Medicare beneficiary pays $8,000 or more for medical expenses annually, or about half the medical costs he or she incurs. And at least 90% of Medicare beneficiaries pay more out-of-pocket for their medical care than necessary, according to Katy Votava of Goodcare.com, an independent consulting firm specializing in the economics of health care.

Fortunately, you can reduce out-of-pocket payments for retirement medical care whether you enroll in traditional Medicare (also known as Medicare Part B) or in a Medicare Advantage plan (also known as Medicare Part C), offered by private companies to cover Medicare benefits.

Traditional Medicare

Let’s first look at the Traditional Medicare option.

Traditional Medicare has premiums, deductibles, copayments and coinsurance. But dental, vision, prescription drugs and some other types of care aren’t covered.

You can decide to enroll only in Medicare Part B. Then, you’ll pay out of pocket for everything it doesn’t cover. You’ll also have a lot of uncertainty about your future health care spending.

Before deciding to sign up for only Medicare Part B, consider its two biggest gaps: prescription drugs and coinsurance (when you and your insurance plan share the cost of a medical service; for most Medicare Part B services, you pay 20% and Medicare pays 80%).

Prescription medicine is the most significant medical expense for most beneficiaries, and the fastest rising. Over the past five years, according to a 2018 report from Sen. Claire McCaskill (D-Mo.), the prices for each of the 20 most prescribed brand-name drugs for Medicare Part D beneficiaries increased 12% a year, on average — about 10 times higher than inflation.

Even if you don’t need prescription medicines now, you’re likely to in the future. You’ll be on your own for those costs if you have only Medicare Part B.

The coinsurance gap also is potentially substantial. When you need an expensive procedure, such as a hip replacement or heart surgery, you owe 20% of the total cost. That can be tens of thousands of dollars, or more.

Two steps to cover gaps in health coverage in retirement

Two steps can help you cover a large part of these two gaps as well as other gaps in traditional Medicare:

Step 1: Purchase a Medicare Supplement (or Medigap) insurance policy.

There are 10 standardized Medigap plans, identified by letters, with varying amounts of coverage. Choose the plan that meets your needs and budget.

For example, Plan F provides the broadest coverage, which means you’ll have few out-of-pocket expenses with this one. Medicare Plan F will be eliminated beginning in 2020, but you’ll be able to renew an existing Plan F if you enroll before 2020.

Plan G has the next broadest coverage and will continue in 2020 and after. The only difference between Plan F and Plan G is that Plan G doesn’t cover the annual Part B deductible, which is $183 in 2018. Other Medigap plans cover fewer of the gaps, but they are likely to charge lower premiums.

After deciding on the Medigap plan you want, shop around. Since the plans are standardized, insurers compete on premiums and service, not coverage. Surveys have found that premiums on identical Medigap policies differ by as much a 100%.

Step 2: Purchase a Medicare Part D Prescription Drug policy.

Part D policies aren’t standardized. In most areas of the country, you can find policies with a range of premiums, deductibles, and copayments. But the most important feature is the covered medications, known as the formulary. Insurers decide which medicines they’ll cover, so you need to compare the specific medications covered by a policy with those you are taking or think you might need in the future.

Details about Medigap and Part D policies available in your area can be found at medicare.gov or by calling 800-MEDICARE. You also might receive help from your local Area Agency on Aging or you can consider working with a financial professional with expertise in Medicare.

Medicare Advantage plans

Now back to Medicare Advantage plans: Enrolling in a Medicare Advantage plan is the alternative to traditional Medicare. About a third of Medicare beneficiaries are enrolled in Medicare Advantage plans, and that’s expected to grow to 40% in the next few years.

Most Medicare Advantage plans offer in one package all the elements of traditional Medicare, Medigap and Part D. Many also add vision and dental benefits and often other benefits. Medicare Advantage plans tend to be managed care plans in which doctors and care are more coordinated and proactive than under traditional Medicare.

Importantly, a Medicare Advantage plan has an annual limit on a beneficiary’s out-of-pocket spending for covered care.

With Medicare Advantage plans, you’re likely to receive broader coverage than Traditional Medicare at a lower cost. But you’ll also give up some flexibility and choice.

Under Medicare Advantage plans, you generally see doctors and other health providers that are in the plan’s network. Care by specialists usually isn’t covered unless it is approved in advance. When you see an out-of-network provider or seek care without prior approval, you might pay extra or find the care isn’t covered by the plan at all. (Under Traditional Medicare, the plan pays the doctor of your choice if the physician participates in Medicare. You can also decide whether to see a specialist and which specialist to see. If Medicare Part B covers the treatment, Medicare pays its share.)

Prescriptions are covered under Medicare Advantage plans, but with the same caveats as for Part D plans. Before choosing a Medicare Advantage plan, review the formulary and other details to ensure that your prescriptions will be covered.

Medicare Advantage plans aren’t all the same, so if you’re attracted to the concept and more than one is offered in your area, compare their coverage and cost details.

Also, be aware that Medicare Advantage plans aren’t available nationwide. If you move, your plan might not be available in the new area. You’ll then have to find a new Medicare Advantage plan or opt for Traditional Medicare.

Whichever route you choose, keep in mind that neither Medicare option covers much long-term care. You’ll need to make other plans to pay for long-term care costs.

Original Source: https://www.marketwatch.com/story/these-are-the-biggest-mistakes-people-make-with-medicare-2018-07-23

Original Date: July 23 2018

Written By: Bob Carlson

Benefits of Working with a Medicare Supplemental Insurance Plan Agent

Medicare supplemental insurance plans can be downright confusing, which is why it is always best for a person to utilize an agent throughout the entire process of finding a plan.  A Medicare supplemental insurance agent knows the details of each plan and can help a person choose the one that fits their needs the best.

Here are 6 Benefits of Working with a Medicare Supplemental Insurance Plan Agent:

  • Saves Time

Since the Medicare supplemental insurance plan agents know all the lingo and idiosyncrasies of each plan, they can save a person a lot of time during the researching process.  A person can simply go talk to a Medicare supplemental insurance plan agent instead of spending hours doing their own research to come up with the same results.

  • Learn More

Medicare supplemental insurance plan agents take their jobs seriously, and they want everyone that they talk to, to learn as much as they can about the different types of available plans.  Everyone will know all their options and how they work side by side with Medicare Parts A and B.

  • Saves Money

There are never any fees when a person works with a Medicare supplemental insurance plan agent, so no one needs to worry about receiving a large bill at the end of the session.  Plus, these agents can give a person multiple quotes for different policies, so that they can choose the best coverage for the lowest rate.

  • Receive Unbiased Advice

No Medicare supplemental insurance plan agents make more money selling one plan over any of the others, so everyone can remain confident that they are receiving unbiased advice during their meetings.

  • Purchase a Medicare Supplemental Insurance Plan at the Right Time

Medicare supplemental insurance plan agents will ensure that everyone knows when the best time is to purchase their plan.  It is important for a person to apply for coverage during their initial enrollment period, because during that time they cannot be rejected, charged a higher premium, or have the start of their coverage delayed.

  • No Second-Guessing Choices

There is never a need for a person to second guess their choices when they work with a Medicare supplemental insurance plan agent, because they know that they are receiving the best coverage for the lowest price without overlooking anything important.

Anyone that is in the process of purchasing a Medicare supplemental insurance plan or who will be in the future, will want to set up a meeting with an agent sooner than later.  After all, why should anyone do a ton of work, when someone has done it all for them already?

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!