Senior Living: Two ways to get your Medicare

Senior Living: Two ways to get your Medicare
 

Contributing writer

At a family reunion, my Aunt Abby and Uncle Glen got into a squabble over the best way to get their Medicare benefits.

Uncle Glen is an Original Medicare man, and has been for a decade or so. Aunt Abby prefers Medicare Advantage, which is similar to a health plan she had before enrolling in Medicare.

Greg Dill

When they turned to me, asking me to referee and declare which form of Medicare is better, I gave them a big smile and answered, “Well, it depends.”

Original Medicare and Medicare Advantage have different benefits and costs that you should consider based on your personal needs. Medicare open enrollment season runs from Oct. 15 to Dec. 7, and it’s a good idea to know how the two types of Medicare work before you select one.

With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly. About 70 percent of all people with Medicare have Original Medicare.

The other way to get your benefits is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage plans may offer some services – such as dental, hearing, vision, and prescription drug coverage – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you may have to pay an additional monthly premium to the private insurer that covers you.

With Original Medicare, you or your supplemental insurance must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Original Medicare does not cover prescription drugs. If you want drug coverage, you can buy a separate Medicare Part D plan. Such plans are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

Medicare Advantage companies must cover all of the services that Original Medicare covers. (However, Original Medicare covers hospice care, some new Medicare benefits, and some costs for clinical research studies, even if you’re in a Medicare Advantage plan.) In all types of Medicare Advantage plans, you’re always covered for emergency and urgent care.

You can join a Medicare Advantage plan even if you have a pre‑existing condition – except for end-stage renal disease. People with ESRD usually are covered through Original Medicare.

Keep in mind that Medicare Advantage plans can charge different out-of-pocket amounts and have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in the plan’s provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a good comparison of Original Medicare and Medicare Advantage in the “Medicare & You” handbook. “Medicare & You” is mailed to all Medicare beneficiaries every fall. You can also find it online, at www.medicare.gov.

Original Source: https://www.presstelegram.com/2018/09/26/senior-living-two-ways-to-get-your-medicare/

Original Date: 9/26/2018

Written By: Greg Dill

Medicare Supplemental Insurance Plans: Read This Before Enrolling in Medicare Coverage

What is Medicare Supplemental Insurance, Medigap?

Once you have enrolled in both parts of Original Medicare, Part A and B, you will be eligible to purchase insurance that supplements your health insurance coverage that fills insurance gaps left by Part A and Part B.  The supplemental insurance plans are known as Medigap or Medicare Supplemental Insurance.

Why do you need Medicare Supplemental Insurance Plans?

There are a couple of reasons you may need to purchase Medigap including filling in the gaps left from what Medicare Part A and Part B don’t cover and for assistance with costs that are not covered by Medicare.

How does Medicare Supplemental Insurance Plans work?

There are ten different supplemental plans that are regulated by Medicare and our federal government.  Medigap plans are labeled Plan A through Plan N alphabetically.  Only certain plans are available depending on where you live in the United States.  The plans are all standardized and offer the same benefits no matter where they are purchased, meaning Plan A in Michigan offers the same coverage as Plan A in Texas.  There are changes however in the premiums paid and the insurance companies that are permitted to sell them.

Things you should know about Medicare Supplemental Insurance:

Qualify:  If you are over 65 years of age, are enrolled in Medicare Part A and Part B, are 6 months from the first day of the month you apply for Medigap your acceptance in Medigap is guaranteed.  If you enroll in Medigap during this period, open enrollment, of time then there is no need to have a medical examination to obtain coverage.

Coverage: Original Medicare Part A, Part B, and Medigap coverage applies to only one person.  Your spouse will need to have their own policy, separate from yours.

Purchase: Medigap participants may purchase plans from any private insurance company that is licensed in your state.

Payment: The monthly premium that you pay for Medigap is paid directly to the private insurance company.  The payment is in addition to any premium that you are required to pay for Medicare part B.  The payment for Medicare part B is paid directly to Medicare.

Not Covered: There are certain things that Medigap doesn’t cover such as: long-term care, vision, dental care, hearing aids, eyeglasses, or private-duty nursing.

Return Policy: You have the right to cancel your Medigap insurance policy without penalty within 30 days of purchase.

Renewable Plans:  Medigap insurance policies are guaranteed even if you have health problems during the period in which you were covered.  This means insurance companies are not able to terminate your Medigap policy as long as you continue to make the monthly payment for the premium.

Preventative Maintenance:  Medicare pays for the entire proposed medical service if it is deemed it will help avoid future health issues.  If the doctor you are seeing accepts the amount that Medicare approves for the service, you will not have to pay a penny for the preventive services.

Prescription Drug Coverage:  Up until 2006 many Medigap plans covered prescriptions however, as of January 1, 2006 Medigap plans are no longer allowed to offer prescription drug coverage.  If you want prescription drug coverage you will need to purchase Medigap Part D, which offers this coverage at an additional premium.

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/.

Medicare supplement plans are changing: What you need to know

CHICAGO (Reuters) – If you are buying a Medicare supplemental policy in the United States, make sure you choose your insurance carefully over the next few months.

At the end of 2019, the doors will close on Plan F, which is considered the Cadillac plan of supplemental insurance policies known as Medigap. Designed for people who do not like healthcare cost surprises, it is the most popular of supplemental plans used to pay for services that Medicare does not cover.

But unless prices increase significantly, the existing Plan G may be a better deal.

The government is cutting off access to Plan F for new Medicare enrollees to control costs. Eight other supplements (here) will remain open.

Insurance experts expect Plan G to become the new draw for people wanting the most coverage without surprises.

Although Plan F is the most expensive option, retirees pay top dollar because they can go to any doctor or hospital that accepts Medicare patients. There is no surprise bill afterward – no deductible, co-payments or coinsurance.

Participants already in Plan F when the doors close at the end of next year will be able to stick with the plan (here). But if you turn 65 any time after the beginning of 2020, you will not be able to buy Plan F.

In addition, if you are in Medicare now and buy a Medicare Advantage plan or another Medigap insurance plan, switching after Jan. 1, 2020 could be difficult. Most states allow insurance companies to screen for conditions ranging from diabetes to heart attacks and cancer. On that basis, you could be turned away from Plan F or face high premiums.

Plan G is currently identical to Plan F except for the $183 deductible participants must pay at the beginning of the year.

Rates differ by state and insurance company, but the national average for Plan F premiums is $185.96 a month, compared with $155.70 for Plan G, said Kris Schneider, vice president of consumer and carrier engagement for AON Retiree Health Solutions.

“Buying G is a no -brainer,” said Jeff Goldman, an insurance agent at G.M. Goldman & Associates in Skokie, Illinois. “You save about $350 a year on premiums, so it makes no sense to buy F to cover the $183 deductible.”

Experts are not sure what will happen to costs once insurance companies see the effects of the 2020 changes. Some expect Plan G rates to jump because under Medicare rules, the plan must accept new enrollees regardless of health conditions.

Others estimate Plan F premiums to soar because new healthy 65-year-olds will no longer come into the plan, resulting in an older, sicker pool of people to cover.

“I see no way around Plan F rates continually increasing, perhaps exponentially after 2026,” said Adam Wasmund, chief marketing officer of Jack Schoeder & Associates, which advises health insurance brokers.

There will be more clarity as state regulators approve rates and insurance companies examine the claims of participants in both Plan F and Plan G. But Wasmund is concerned that the federal government could raise Plan G deductibles in an attempt to curb more Medicare usage in the future.

“Could the deductible be $200, $1,000 or $2,000?” said Wasmund. “Who’s to say what the government will do?”

(The opinions expressed here are those of the author, a columnist for Reuters.)

Original Source: https://www.reuters.com/article/us-column-marksjarvis-medigap/medicare-supplement-plans-are-changing-what-you-need-to-know-idUSKCN1LZ18F

Original Date: Sept 19 2018

Written By: Gail MarksJarvis

What You Need To Know Before Starting Medicare: The Basics

Getty

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.

Exceptions

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.

+9 

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.

+9 

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.

+9 

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.

+9 

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.

+9 

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!”