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Guide for Federal Retirees and Medicare Part B

by Jagger Esch
written by Jagger Esch

Medicare Part B covers physician and outpatient services. Part B can include ambulance services and durable medical equipment as well as laboratory tests and x-rays.

While most seniors get Medicare Part A “premium free”, most seniors pay a monthly premium for Medicare Part B. Generally, Part B premiums are taken out of your monthly Social Security check or a retirement check.

To Take Part B or Not to Take Part B, that is the Question

If you don’t take Part B when you are first eligible there is a 10% penalty on the current year premium added for each year you delay enrollment. You will need to pay this penalty for as long as you have Medicare.

You won’t owe a late enrollment penalty if you qualify for a Special Enrollment Period (SEP). This allows you to enroll in Medicare Part B and enroll through an SEP if you have health coverage based on current employment (yours or a spouse’s).

It’s important to know that not all coverage qualifies you for an SEP. The following types of coverage won’t qualify you for creditable coverage based on current employment and wouldn’t exempt you from paying the Part B penalty if you delay enrollment:

    1. COBRA
    2. TRICARE and Medicare– (unless you, your spouse, or dependent child are an active-duty member.) If you’re Medicare-eligible, you must be enrolled in Part B to continue receiving TRICARE benefits.
    3. Veterans’ benefits
    4. Retiree benefits

If you have coverage through a current employer (yours or a spouse’s) you may decide that you don’t need extra coverage. There is no penalty for delaying Part B enrollment if you or your spouse have other coverage based on current employment.

You can sign up for Part B through an SEP anytime that you’re still covered by the group plan or in the eight months after your employment or group coverage ends.

If you’re an active duty service member, you may delay enrollment, keep TRICARE and sign up for Part B during an SEP without paying a late enrollment penalty.

If you are 65 or over and still employed by the federal government or are a 65-year-old retiree that has health care coverage through your new employer or you are covered under a working spouse exemption, you can delay applying for Part B without penalty and that makes sense for many.

You can delay taking Part B without penalty if you switch FEHB coverage to a federally employed spouse to keep the benefit premiums non-taxable and delay without penalty for the 65-year-old retiree’s Part B enrollment. Unfortunately, retiree’s FEHB premiums are considered taxable income unlike active federal employees.

Many retirees work at another job after they leave the federal service. Federal retirees can also delay taking Part B without penalty if they are covered under a working spouse exemption or if they are working for other employers that provide primary healthcare coverage where the FEHB becomes secondary.

You must evaluate your costs to see if accepting insurance from your new employer would reduce your costs. If you start your own business or work for another company that doesn’t provide primary health insurance, you will be assessed a penalty if you don’t take Medicare B at age 65.

Part B Premium Determination

Medicare Part B premiums are determined by your Modified Adjusted Gross Income (MAGI). The higher your income, the higher your Part B premium. For many beneficiaries, the government pays a large portion of the Part B premium, about 75 percent, and the beneficiary pays the remaining 25 percent.

If you’re a high-income beneficiary, you’ll pay a larger percentage of the total cost of Part B based on the income you report to the Internal Revenue Service (IRS). If you have a high income and are considering not enrolling in Part B because you think it will save you money, this isn’t the case.

When you postpone enrolling in Part B, you’ll be subject to a late enrollment penalty that will increase your Part B premium the entire time you have Medicare Part B.

If you’re unsure about whether you should enroll into Medicare Part B, talking to your benefits coordinator at the place where you work can help you determine the best decision for you.

 

 

 

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Medicare 101
Health Insurance

Medicare 101

by Jagger Esch
written by Jagger Esch

While most individuals embrace the aging process, Medicare is excellent coverage that many seniors look forward to obtaining. Medicare has been providing health insurance coverage since 1965 for individuals 65 and older as well as certain disabled Americans.

Over 15% of the country is currently enrolled in Medicare today and that’s a definite bonus after having worked for most of our lives. Being on Medicare means having Hospital and outpatient coverage for many services.

Although, many seniors are unaware of the coverage they have and what expenses they’re responsible for paying. Having a Medicare Supplement could help you plan your health care expenses better.

Traditional Medicare Benefits

Medicare consists of two main parts:

  • Part A (Hospitalization)
  • Part B (Outpatient and DME supplies)

 

Medicare Part A is typically premium-free and provides coverage for your hospitalizations and skilled nursing facility stays. Additionally, Part A benefits provide coverage for home health and hospice care.

Part B premiums are ever-changing, typically they go up annually based on inflation. However, the government takes into consideration individual incomes, paid taxes and annual expenses. Many people with Part B don’t pay the full Part B premium.

Extra Help is available to those that qualify.

Part B benefits cover your outpatient costs for doctors’ visits, lab work, diagnostic testing, physical therapy, and outpatient surgeries.

Regardless of whether Medicare Part A or Medicare Part B is being used, each plan only covers at 80%. The remaining 20% leftover is the Medicare beneficiary’s responsibility to pay.

Both Plan policies only take effect after the Part A and Part B deductibles have been met. Each year the deductible cost changes so you can log onto Medicare.gov to see the exact rate for each deductible.

How to Qualify for Medicare

To become eligible for Traditional Medicare benefits, individuals must be at least 65 years of age.

When enrolling in Traditional Medicare you have a seven-month Open Enrollment Period (OEP). The OEP begins the three months leading up to your 65thbirthday, continues through your birthday month, and the remaining three months after turning 65.

Failing to enroll for Medicare Part A or Medicare Part B during the Open Enrollment Period can result in penalty fees.

Medicare Part A Penalty:

If you have Part A premium, an extra 10% is added for each year gone without Part A benefits. Based on how long one goes without Part A benefits will determine the number of penalty fees.

Medicare Part B Penalty:

With the Medicare Part B penalty, the monthly premium is increased an extra 10% for every year without Part B benefits. With the Part B penalty, the increased premium rates are paid for the entirety of having part B benefits.

Medicare is also available for certain individuals with end-stage renal failure and certain other disabilities. For those individuals who also receive social security benefits or certain Railroad Retirement Benefits, you’re automatically eligible and enrolled in Medicare Parts A and Part B after two years.

Part C Medicare Advantage Plans

Medicare Advantage Plans are provided by private insurance companies within your area. Premiums are based on the individual plans offered.

Part C Plans are oftentimes referred to as Medicare Supplement Plans as their benefits will take over coverage for that of Traditional Medicare Part A and Part B.

Oftentimes, Medicare Advantage Plans come with cheaper premium costs. So, those living on a fixed income find the sound of these policies appealing.

However, with the cheaper premium prices come at a price.

Medicare Advantage shortcomings include:

  • Restrictions
  • Referral requirements to see a specialist
  • Coverage limitations
  • Limited doctor, pharmacy and hospital networks
  • Limited coverage areas.

 

What seems like being more valuable, can end up costing more for the individual when it comes to their out of pocket cost. Coinsurance, deductibles and copayments are commonly discussed when you enroll in these plans.

Medicare Part D

Traditional Medicare offers no insurance benefits for prescription medications. With medications, especially brand name, the out of pocket costs at the pharmacy can be downright astronomical!

By obtaining a Medicare Part D Plan, AKA, a Medicare Prescription Drug Plan (PDP), you can get those medically necessary prescriptions at a lower price. In some cases, you can get them at no cost whatsoever.

Offered by the individual health insurance companies, you can pick the best Part D Plan to suit your prescription medication needs. Depending on the policy will depend on your premium prices.

Another bonus of enrolling in a Medicare Part D Plan is you will avoid the penalty fees.

Like the penalty fees of Original Medicare, failing to enroll during your 7-month initial enrollment period will result in an increase in the Part D premium charge.

Depending on how long one went without drug coverage will determine the additional premium fees each month.

Medicare Supplement Plans

There are also Medicare Supplement Plans, that like Advantage Plans, are purchasable through your local private insurance carriers.

With Medigap Plans, they work alongside the already excellent Traditional Medicare benefits. These plans provide extra coverage for those items not originally covered by straight Medicare.

Pending on which Plan is chosen, items like deductibles, coinsurance, copayments and other items not covered by Medicare can cost less for the beneficiary. In some cases, there are plans that offer complete coverage.

There are ten letter plans available to choose from and depending on your individual healthcare needs will depend on which plan best suits you.

For example:

Plan F

This plan provides 100% coverage of both your Medicare Part A and Medicare Part B deductibles.

It has the added benefit of paying for:

  • Medicare Part B’s copayments
  • Foreign travel emergency coverage
  • The remaining 20% coinsurance for your Part A and Part B fees

 

While Plan F is the most popular due to the great additional benefits, it also comes with a higher premium price tag.

High Deductible Plan F

There is also a Medicare Supplement Plan F High Deductible version that provides the exact same benefits, just with a deductible. The added bonus of this specific plan is there is a lower monthly premium so it’s cheaper for those on fixed incomes.

Plan G

This plan is another great Supplement Plan that’s also comparable to Plan F, however, there is no Medicare Part B deductible coverage.

Many times, the savings in Plan F premiums is more than the Part B deductible, meaning you get comprehensive coverage at a great price. Besides, Plan G typically has lower annual rate increases when compared to other plans.

Plan N

With this specific policy, it’s considered, “cost-sharing”. While the Medicare Part A deductible is completely covered, the beneficiary will be required to pay a small copayment for ER and doctor’s office visits.

It’s important to research all Medicare plans available, prior to picking your “perfect” plan. What works for one individual, may not work for another.

There’s plenty of information available regarding not only Traditional Medicare benefits, but also Medicare Advantage as well as Medicare Supplement Plans.

Medicare low Income Plans

While Medicare offers good healthcare coverage, those living on a fixed income may find it hard to afford monthly premiums, deductibles, coinsurance and copayments.

Even with lower premiums associated with Medicare Advantage plans or more coverage with Medicare Supplement Plans, the out of pocket costs can still be quite burdensome.

Those still struggling with healthcare costs there are Medicare Savings Programs that you may qualify for, applying is highly recommended when you meet the income requirements.

Additionally, each individual state has their own State Health Insurance Program, also known as SHIP. SHIP can provide financial assistance and relieve some of the stress associated with out of pocket costs for health insurance.

Changes in Medicare as of 2020

In the upcoming years there’s always the chance of change when it comes to not only premium and deductible prices, but also changes in policies.

The most major upcoming change will be the doing away with First-dollar coverage plans. What this means is that any of the Medicare Supplement Plans that leave a Medicare beneficiary without any out of pocket costs, will no longer be available.

This affects the 3 major first-dollar coverage Supplement Plans:

  • Medicare Supplement Plan C
  • Medigap F
  • High Deductible F policy

 

This change in 2020 is mainly due to congress feeling as though Medicare beneficiaries who have no deductibles or out of pocket costs, will then no longer overuse healthcare services they don’t necessarily need.

This upcoming change will only affect those eligible for Medicare benefits after 2020. Luckily for those who currently carry or are eligible prior to 2020, will be, “grandfathered in.” This means you may still reap the benefits of those first-dollar plans!

There will be other options available for those looking to enroll after 2020. You can still enroll in Medicare Supplement Plans with just some slight changes and a small overall increase in your out of pocket costs.

Getting good health insurance to converge should be simple. Traditional Medicare benefits, a Supplemental insurance plan as well as a Prescription Drug Plan can provide individuals with optimal healthcare coverage.

Medicare is readily available, easy to obtain and most providers take the insurance. Regardless of what you may have heard about Medicare in the past, take action and enroll in Medicare as soon as you become eligible.

The sooner you do the sooner you too can start benefiting from our government appointed healthcare!

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Health Insurance

Sosa Insurance Group Can Assist with Annual Enrollment Period for Medicare

by Guest Blogger
written by Guest Blogger
ATTENTION:
It’s that time of year again:
The Annual Enrollment Period for Medicare is here!

The Annual Enrollment Period (AEP) begins on October 15th and continues until December 7th. During this time, you can make changes to certain aspects of your Medicare health coverage:

  • Change from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan to Original Medicare.
  • Change from Original Medicare to a Medicare Advantage Plan.
  • Enroll in a Prescription Drug Plan or change your Prescription Drug Plan.
  • If you’re new to Medicare, you might have a different election period; reach out to us to review your options.

 

The Sosa Insurance Group, located at 450 Pleasant Valley Way in West Orange NJ, is dedicated to assisting our Medicare eligible consumers throughout their Medicare journey.

We specialize in Medicare Supplement, also known as Medigap, Medicare Advantage, Medicare and Medicaid, Stand-Alone Part D Prescription, Dental, as well as Final Expense, Individual and Long-Term Care Plans.

We also understand that everyone’s situation is different and you might qualify for a special enrollment. For example:

  • You are retiring and getting Medicare
  • You are disabled and under 65 and have Medicare
  • You are turning 65
  • You have Medicare and Medicaid
  • You are receiving Assistance for their part D prescriptions
  • Or you recently moved to the state of NJ and have Medicare

 

Below is a list of dates that we’ll be having informative meetings at our office where you can learn more about your options during AEP:

These are the dates we’ll be open during Oct 1st thru Dec 7th

  • Mondays starting on 10/19 from 9:30am till 7:00pm
  • Tuesdays starting on 10/20 from 9:30am till 3:30pm
  • Wednesdays starting on 10/21 from 9:30am till 7:00pm
  • Thursdays starting on 10/15 from 9:30am till 3:30pm
  • Saturdays starting on 10/03 from 10:00am till 5:00pm

 

Due to COVID-19, besides our normal face-to-face appointments either at the privacy of your home or at our local office, we are now also available virtually and remotely through ZOOM or by phone in order to assist our Medicare eligible consumers review the basics of Medicare and assist them in choosing the right plan for them.

These are the dates we’ll be having virtual meetings during Oct 1st thru Dec 7th

  • Every other Monday starting on 10/12
  • Every other Wednesday starting on 10/14
  • Every Saturday starting on 10/10

 

Call for details on times and Zoom information

You can also visit our website at www.thesosainsurancegroup.com 0r email us at info@thesosainsurancegroup.com and request a quote

Call us at
973-902-5445
to speak to one of our expert agents.

“We pride ourselves in assisting Medicare eligible consumers with selecting a Medicare plan option that will meet their needs,” said George Sosa, President of The Sosa Insurance Group.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Senior female patient shaking hands with doctor
Health Insurance

Association Helps Seniors Prepare For Medicare Annual Election Period

by Guest Blogger
written by Guest Blogger

Free Online Directory Lists Local Medicare Insurance Agents

To help Medicare eligible seniors the American Association for Medicare Supplement Insurance has added relevant information to the organization’s online Consumer Information Center.

“Medicare is enormously complex and finding the best option and cost can be overwhelming,” explains Jesse Slome, director of the national organization. “Medicare’s Annual Election Period (AEP) begins October 15th, a peak decision time for millions who are already on Medicare. In addition some 11,000 individuals turn 65 every day and become eligible for Medicare.”

10 Tips For Selecting Your Medicare Plan

The Association shares 10 tips and important considerations that can help a consumer find the best Medicare insurance costs. “Many Medicare Advantage plans now offer a zero plan cost which sounds great,” shares Slome. “But they may have a high deductible that can cost thousands of dollars when you have a hospital stay.”

Some Medicare Supplement insurance plans offer household discounts. The potential savings can be as high as 14 percent according to the Association’s Info Center. Another suggested tip is asking for the company’s history of premium rate increases; a valuable indication of what one might expect down the road. To read 10 Tips for Medicare Insurance Planning go to the Association’s website.

2020 Lowest and Highest Medicare Supplement Prices

The Association’s 2020 Medicare Insurance Price Index reports the lowest and highest prices for nearly 100 leading cities across the U.S. The index shows costs for Medigap Plan G, the most popular option selected by those signing up for Medicare Supplement insurance at age 65.

“The cost difference can be significant,” Slome points out. “In Atlanta, a 65-year-old woman might pay as little as $102-monthly or as much as $244-monthly for virtually identical insurance coverage. Over time the savings potential is well over $10,000 achieved simply by making the right choice.”

What’s Missing From The Government’s Medicare Website?

The Medicare.gov website is an outstanding resource but it can be overwhelming to navigate and there are some important things the government doesn’t tell you, Slome admits.

“It’s logical to think that buying direct from an insurer is going to be better and that it will save you money,” Slome explains. “But that’s simply not true. A local Medicare insurance agent can offer you the identical plan and costs, if any. More important, they can help you learn about and evaluate the pros and cons of all the options in your area.”

The Association’s website contains 18 things every consumer should know that the Medicare.gov website might not clearly explain. The information was shared by leading Medicare insurance professionals. “These knowledgeable pros don’t charge to educate local seniors. Speaking to one during Medicare’s Annual Election Period might be the most important thing you do,” the Association director advises.

Free Directory Lists Local Medicare Insurance Agents

The Association makes available a free online directory of Medicare insurance agents who offer Medicare Supplement, Medicare Advantage and Prescription Drug Plan options. Access is free and completely private.

The American Association for Medicare Supplement Insurance (AAMSI) is a national organization based in Los Angeles, CA. AAMSI advocates for the importance of planning and supports insurance professionals who offer Medicare plan options. For more information, visit the organization’s website at www.medicaresupp.org or call 818-597-3205.

10 Medicare Tips

Medicare insurance prices 2020

Medicare.gov

Find A Local Agent

www.medicaresupp.org

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Hand of young affectionate and careful woman on that of her senior father
Health Insurance

Long-Term Care Insurance: 3 Common Misconceptions

by My Senior Health Plan
written by My Senior Health Plan

Like any insurance plan, long-term care insurance provides financial relief when you need it most.

However, long-term care insurance is expensive. Given the expense, people put off buying a long-term care (LTC) policy or even making a plan for their future care needs.

But if they do need it (and the odds are higher as people age), and care facility costs and home-care provider fees start to build up, the premium can provide financial support and peace of mind.

Here are three common misconceptions why people think they don’t need an LTC plan and why rethinking that approach is important:

  1. “I’m healthy. I don’t need long-term care insurance.”

At age 66, Bill is in great shape. His vitals are good, and his weight is in a healthy range. He runs an annual half-marathon and lifts weights at the gym.

Additionally, neither his parents or grandparents required nursing care at home or in a facility. They all lived into their 80s and 90s, happy and healthy. With his stellar family history, Bill feels confident he won’t need long-term care. He plans to enjoy life!

While Bill is healthy and takes care of himself, it doesn’t make him exempt from needing care as he gets older. A fall or unexpected health problem could require paying for long-term care.

That might include hiring a home health aide to help with personal needs (e.g., bathing and dressing). At an approximate rate of $20 per hour, the costs add up over the weeks, months and years.

Like many, Bill is taking the I won’t need it approach. However, at the very least, he needs a plan. That includes talking to loved ones about long-term care:

Who will provide the care (his spouse, adult children, a home health aide)?

How will the costs be covered, including family members who may have to work less to help him?

  1. “I’m financially savvy and have a large retirement nest egg.”

Jackie and her husband have a substantial retirement portfolio. Having had a career in finance, she understands the cost benefits of LTC insurance. However, she’s reluctant to buy an LTC policy, as it will put a dent in their disposable retirement income.

Additionally, with the escalating cost of medical care, she’s not confident that the LTC policy will cover their care costs in 20-25 years. Going without LTC is a risk she’s willing to take.

One misconception about LTC insurance is that people will only need it in their later years. They tend to think of it as end-of-life care. However, LTC is the care you could need tomorrow while in your first years of retirement.

For example, if Jackie’s husband should need long-term care due to an accident or an unfortunate diagnosis, even with substantial retirement savings, her financial independence could be jeopardized.

She may want to weigh up the cost of care—that could run into high six figures and beyond—versus paying anywhere from $90 to $200 per spouse, per month.

  1. “I won’t qualify because I have existing conditions.”

Cody’s mom Jean has a chronic—but stable—health condition. Cody figures that the existing illness will disqualify her from long-term care insurance.

Unlike some insurance policies, LTC policies do cover people with chronic health problems. That may include diabetes, heart disease, and clinical depression. In fact, the underwriters’ lists of approved chronic conditions are substantial!

As long as the qualifying illness is stable, the insurance underwriters should approve the application.

In Cody’s mom’s situation, rather than dismiss LTC insurance due to her existing condition, Cody can work with an insurance specialist to explore their options. The specialist will walk him through carriers’ underwriting differences to find the plan that best fits his mom’s health and financial needs.

Who will benefit most from an LTC policy?

Should you need long-term care, a policy will provide financial support, allowing you to access the help you need. Also, it will relieve family members (spouse, children, grandchildren) of the economic and personal burden associated with your long-term care needs.

Ultimately, even some coverage is better than none. Also, buying long-term care insurance is as much for you as for your loved ones.

Now is an excellent time to start a conversation about your long-term care needs.

Aaron is MySeniorHealthPlan.com’s retirement specialist. He can help you explore your options and find a policy that fits your financial needs.

Call Aaron today: 1-877-255-6273

 

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Health Insurance

Center for Medicare Services (CMS) Modernizing with Technology

by Jagger Esch
written by Jagger Esch

For some Medicare beneficiaries, technology changes and advances are beyond their years. However, times are changing, and many beneficiaries are eager to embrace the change.

The Center for Medicare and Medicaid Services (CMS) is the largest single healthcare insurer nationwide. CMS pays upwards of $1.5 billion worth of claims, every day.

The digital age is upon us, our healthcare coordination wants us to know about the benefits and efficiency in using technology with healthcare. Lately, health care has taken up a large share of the U.S. economy and it’s still growing.

In fact, by 2026 it’s predicted that one in every five dollars spent in America will be on health care. As the cost of care rises, the healthcare system is working towards becoming more efficient by accommodating Medicare’s technologically inclined beneficiaries.

CMS is Keeping up With Technology

The CMS is doing more to reach those tech-savvy seniors. As the federal government plays a large part in healthcare delivery and payment, CMS is trying to give easier and more efficient ways for care coordinators to use technology to their benefit.

In early 2019, they created a podcast as well as an app that will help inform beneficiaries about Medicare and provide patients with a digital option to view their health status.

As significant advancements are made in biomedicine – health care delivery is changing for the better. These new technologies can improve the efficiency in healthcare by pushing cost-effective care; in turn, patient outcomes will see an improvement.

The focus is on encouraging innovation and making a new pathway for treating patients. CMS wants to ensure that beneficiaries can access the newest medical technologies; this will improve not only the quality of care received but lower costs while doing so.

Modernizing Medicare due to Latest Technology Advances

In October 2018, the CMS announced they’d revise Medicare’s local coverage determination process. This means more access to new technological health care services.

Medicare was signed into law in 1965, I bet they couldn’t imagine the technological developments or new therapy options we’re seeing today.

Medical technology is developing and at a fast pace. Meanwhile, Medicare’s payment systems are not. Some of Medicare payment policies haven’t seen an update in as long as 10+ years.

As you can imagine this could cause some issues. There’s a good chance some consumers will experience gaps in coverage while waiting for the FDA approval of technology and Medicare paying for the technology.

CMS is still sorting out issues and working on improving the process for covering items/services that will potentially improve the care of all patients. The goal is to help beneficiaries experience a health care system that provides the technology we’ve all grown accustomed to in other aspects of our lives.

For instance, CMS released the Blue Button 2.0 application programming interface (API). This API gives Medicare beneficiaries a digital platform to get their claims data in digital form. This means you can safely and securely use your medical information in third-party electronic applications (apps).

As almost everyone has one, smartphones are basically a way of life at this point. Due to smartphone popularity, app developers are creating programs that use claims data from Blue Button 2.0.

This is giving beneficiaries the ability to understand their health report and manage their health status in the palms of their own hands; and better yet, at their own convenience.

“What’s Covered” app

Early February 2019, the Centers for Medicare and Medicaid Services released a new app. Giving consumers a more modern Medicare experience; this app has direct access through a mobile device to some of Medicare’s most popular content.

The app is called “What’s Covered”. It gives people with Original Medicare and their caregivers an efficient way to check if Medicare covers a certain medical service and/or item.

The What’s Covered app is allowing consumers to use their mobile device to receive more consistent and accurate Original Medicare coverage information.

Some of the most searched questions for the CMS is “What does Medicare cover?”

Having access to this information while you’re at the doctor’s office, hospital, or anywhere you have a mobile connection for that matter, will help you become more educated on your coverage. In turn, will result in a better quality of care for beneficiaries and providers as well.

You can download the What’s Covered app for free in either the Apple App Store or Google Play.

Medicare goes digital: eMedicare

In 2018, the eMedicare initiative was launched by CMS to provide cost and quality information to Medicare beneficiaries. eMedicare is an app that comes with many tools for consumers to use to help them make better health care decisions for themselves and/or their loved ones.

This includes interactive online decision support designed to help you understand and evaluate your coverage options with Medicare. You can also compare costs between Traditional Medicare and Medicare Advantage plans.

Moreover, you have the option with this new online service to see how the different coverage choices will change their anticipated out-of-pocket expenses.

Transparency tools are available so beneficiaries can compare rates of specific procedures. The Medicare Plan Finder has a new web chat option within the app as well.

Of course, those with Medicare may still receive paper copies of the “Medicare and You” handbook as well as Medicare Summary Notices.

Meanwhile, eMedicare is still expanding and improving current consumer service options.

CMS Launches Podcast

February was full of CMS technological launches. The Centers for Medicare and Medicaid Services launched “CMS: Beyond the Policy,” a new podcast.

The podcast will feature updates and changes to policies and programs regarding Medicare.

These topics are presented in a conversational format, making it easily accessible to consumers. The intention of this podcast is to reach more consumers to explain the policies and programs in a fashion that’s more easily understood.

CMS Administrator Seema Verma said:

“The new Beyond the Policy podcast demonstrates our commitment to transparency and outreach by presenting CMS-related policies, updates, and innovations on as many platforms as possible…This program is a direct response to stakeholders’ suggestions that a podcast would be a modern, user-friendly way to stay informed about CMS.”

New podcast episodes will be periodically released; they’ll cover a wide range of topic experts, stakeholders, and CMS Administrator Verma as well.

You can download podcasts on iTunes here, or on Google Play here.

Digital Technology Coordinates Quality Care

According to CMS, Medicare and Medicaid patients with multiple chronic conditions make up about 15% of all beneficiaries. However, at least half (50%) of all costs spent by CMS is due to these patients.

The federal government is seeking out options to better coordinate care for chronic disease management; one option is the accelerated use of telehealth services.

For instance, one way how CMS is keeping up with technology is the new rules for telehealth services.

These new rules are making it easier for consumers to receive treatment. It’s also making it more efficient for providers to acquire authorization for the treatment of opioid patients and for those suffering from behavioral disorders.

As CMS becomes more patient-centered, they’re pushing to create pathways for success. Better coordinated care means adopting payment options for virtual care. Like, paying providers for submitting remote evaluations of photos or recorded videos submitted by their patients.

The Future of CMS Technology

CMS realizes that technology is the way of the future. As the demand grows, they work towards incorporating innovation and technology when managing patient care.

Advancements such as telehealth are beneficial for providers and consumers combined. This digital and remote option gives consumer freedom and convenience.

Whereas the provider can treat patients more efficiently because not all medical related services require an in-office doctors visit.

The population of people with Medicare is growing, in fact, the population is expected to see a 50% increase by the year 2030.

As of the year 2016, about 65% of Medicare beneficiaries stated that they use the internet or internet services almost daily.

Beneficiaries are becoming more digitally inclined; the demand for technology-related health and medical services is growing. You can expect to see more of these medical services options become available over the next few years.

This is great news! New digital and remote treatment options will result in a more efficient healthcare system.

Center for Medicare Services (CMS) Modernizing with Technology

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Preventative Care Covered by Medicare
Health Insurance

Preventative Care Covered by Medicare

by Garrett Ball
written by Garrett Ball

Preventive care is, without a doubt, a significant factor in your physical well-being. This is also true, maybe even more so, as you age. Fortunately, after years of having limited coverage of preventive care, Medicare does now cover more preventive care. The key for the Medicare beneficiary is being aware of these and taking advantage of them. Preventative Care Covered by Medicare

Annual Visits Covered by Medicare

“Welcome to Medicare” Visit – Each Medicare beneficiary is entitled to a “Welcome to Medicare” visit within their first 12 months of being on Medicare Part B. During this visit, your provider will help you map out your current health situation and any future follow-up or ongoing needs (What Does the Welcome to Medicare Visit Cover?). Make sure your provider knows that this is your “Welcome to Medicare” visit, as this is coded differently than the annual wellness check (see below) and can cause problems if not handled correctly.
Annual Wellness Check – After your initial visit, each Medicare beneficiary can also do an annual wellness visit. During this visit, which is completed with your primary care doctor, you will review any further preventive care needs as well as your current health concerns or questions.

Preventive Services That Medicare Covers at 100%

Now, Medicare covers many preventive care services at a 100% level, as long as they are deemed to be “medically necessary”. Keep in mind that what Medicare considers “medically necessary” is person-specific in some cases – it can be based on your past health history, family history and other medical variables. Here is a list of medical preventive services that are covered by Medicare Part B at 100%:

  • Abdominal Aortic Aneurysm (AAA) Screening: This is for at-risk beneficiaries. You are considered at-risk if you have a family history of AAA or are a tobacco user
  • Alcohol Misuse Screening and Counseling: This is designed to eliminate/reduce alcohol use for someone considered to be misusing alcohol by their primary physician
  • Bone Mass Measurements: Medicare covers a bone density measurement every two years for people at risk for osteoporosis. Those classified as at risk for purposes of this screening are: estrogen-deficient women, those with vertebral abnormalities, those taking steroid treatments, those with hyperparathyroidism, and those that take an osteoporosis drug
  • Cardiovascular Risk Reduction: ALL Medicare beneficiaries are eligible for this visit. Doctors should screen for blood pressure and provide behavioral counseling and diet-related tips
  • Colorectal Cancer Screening: Medicare covers this for people age 50 and over. This includes a fecal occult blood test, flexible sigmoidoscopy (once every 4 years), and/or colonoscopy (once every 10 years or once every two years for those that are high risk)
  • Depression Screenings: Covered annually for all Medicare beneficiaries and must be performed in a primary care setting
  • Diabetes Screening: This is covered by Medicare either once or twice a year, depending on your risk factors, current health and whether you have been diagnosed as pre-diabetic
  • HIV Screening: Medicare covers this annually for all beneficiaries
  • Heart Disease Screening: Medicare covers this once every five years to test for cholesterol, lipid, and triglyceride levels
  • Mammograms: All women (over age 40) are eligible for an annual screening
  • Medical Nutrition Therapy: Medicare covers medical nutrition therapy, which may include dietary counseling for those with certain chronic diseases or risk factors
  • Obesity Screening/Counseling: Medicare covers screening for those that are classified as obese to help you lose weight. The baseline used for this is a body mass index (BMI) or 30 or more.
  • Pap Smears/Pelvic Exams/Breast Exams: If you are considered low risk, Medicare covers this every two years. If you are considered high risk, Medicare covers one exam per year.
  • Prostate Cancer Screenings: Medicare covers a blood test for prostate cancer for all male beneficiaries once per year
  • Smoking Cessation: Medicare covers two counseling attempts at quitting smoking per year
  • Vaccines and Immunizations: Medicare covers flu shots (once/year), pneumonia shots (once/lifetime), hepatitis B, and shingles (covered through Part D with some cost-sharing)

Preventive Services That Medicare Covers at 80%

There are other preventive care services that Medicare covers at 80%. If you have a Medigap plan, your plan may pick up the remaining 20% depending on which plan you have. Here is a list of those preventive services:

  • Colorectal Cancer Screening: This applies to Barium enema once every 48 months (or once every 24 months for someone classified as high risk)
  • Glaucoma Screening: Medicare will cover this at 80% if you are at risk (family history, diabetes, etc)
  • Prostate Cancer Screening: Medicare covers the digital rectal exam once a year for all male beneficiaries over age 50
  • Diabetes Self-Management Training: Medicare covers up to 10 hours of training during your first year if you are at risk of complications of diabetes or have recently been diagnosed

 

Overall, Medicare is covering much more preventive care than it has in the past. It is up to each Medicare beneficiary, in conjunction with their medical providers, to stay on top of this. Make sure you take advantage of the preventive care options that you have at your disposal as a Medicare beneficiary. Preventative Care Covered by Medicare

Preventative Care Covered by Medicare

Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare Preventative Care Covered by Medicare

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Health Insurance

How to Protect Yourself from Insurance Fraud

by Jagger Esch
written by Jagger Esch

When discussing the financial world, insurance is probably one of the safer aspects according to statistics. This doesn’t mean immunity from insurance fraud.

For seniors, this is a cause of concern as many don’t use a computer regularly.

The biggest issues regarding insurance fraud among consumers are stolen social security numbers, fake insurance policy placement, and scams looking to steal any personal information possible.

The good news is you don’t have to be caught off guard. Be proactive and protect yourself against insurance fraud. Also, don’t be afraid to report fraud.

Tips to Protect yourself From Insurance Fraud and Scams

Applying for or changing insurance policies and sorting out life insurance options will have you contacting many different agents.

We’ve put together some tips to help keep your personal information more secure during this process.

Research Agent Licenses

When working with any new insurance agent you should investigate their insurance agent license information, before you give any personal information out.

Make sure your agent is legitimate; remember all non-fraudulent agents and brokers in the US are licensed.

To inquire about an insurance agents’ license information, go to your state insurance regulator’s website.

While doing your research, if you uncover their license doesn’t exist or has been suspended – stop working with them and look for another agent.

Lock your Credit, Protect your Social Security

For the longest time, most insurance companies required social security numbers on all insurance applications. Luckily for us, times have changed.

While new regulations for some property and casualty insurers don’t require social security numbers on applications anymore. Most property and life insurers however, will still require SS numbers.

Meaning, if you’re simply looking for a quote, don’t give them your social security number; it’s not required. Any credible insurance agent won’t be shocked if you request to wait until the end to give them your SS number.

Not many agents will tell you this, but the only true effective way to completely protect your social security number, is to totally freeze your credit.

Due to recent new federal legislation regarding SS numbers, everyone in the United States can freeze their credit file, for free.

Once you have gone through the difficult process of freezing your credit, you can stop worrying about fraud; get some peace of mind.

The problem is, after you freeze your credit, unfreezing it to re-gain access – is just as difficult.

Be wary of writing out checks directly to Insurance Agents

When making payments, you should be adamant about writing out payments to the name of the insurance company itself, rather than the agent. Sometimes, there’s one-off situations that require you to break this rule.

Although it’s rare, specific types of insurance will have you write out checks to an agency.

If your agent asks you to make a check out into their name, a red flag should go up.

To be safe, call the insurance company directly and ask if you can pay them directly. Sometimes the only option is to write a check directly to the agent. In this case, you should inquire about a fidelity bond.

Premium Embezzlement

To branch off when discussing insurance agents and fraud issues, premium embezzlement is a thing and yes, it does happen.

Some individuals who work for a licensed and credible insurance firm are simply up to no good. Reports have been made that they’ve scammed consumers for their personal gains.

One way of scamming might be, a fraudulent agent will collect your premium payment and instead of giving it to the insurance company – they just pocket your money.

Meanwhile, as a consumer, you believe your premium has been handled accordingly and count on using your coverage when needed. Unbeknownst to you, your premium was never actually paid.

On the contrary, your insurance company assumes you’re not keeping up your end of the deal; resulting in cancellation or may not renew your policy.

You should be receiving a copy of your policy, an insurance ID card and/or receipts of payments made. If you haven’t gotten proof, or you stop getting proof of payments made, this is a sign that your premiums haven’t been submitted.

Contact your insurer immediately and get to the bottom of this as quickly as possible to prevent a loss in your coverage.

Medicare Insurance Fraud

Medicare’s Affordable Care Act doesn’t require beneficiaries to get a new ID card. If you’re contacted by someone impersonating a government or Medicare professional and are asked to pay for a new insurance card, it’s a scam.

If this happens, don’t share any personal information with them; hang the phone up immediately, and contact your non-emergency local police department to report the call and phone number.

Check financial strength ratings

Ratings and reviews can still be protection by making you aware of any shady behavior other consumers may have experienced.

A variety of governmental state agencies regulate all insurance nationwide. Meanwhile, their financial portion is rated by 4 private rating agencies.

However, these agencies are NOT associated with the government.

Each rating agency has its own rating system; insurance specialist AM Best is the easiest to comprehend. AM Best rates insurers with metric on their Financial Strength Rating.

Consumers want to look for A- and above.

It’s important when buying any sort of cash value life insurance and when considering annuities, to check all prospect ratings.

Don’t Trust Phone Calls and Check Website Credibility

Just because you saw it on a website, or you get a phone call with information – doesn’t mean it’s factual.

A good rule of thumb is, if it’s important enough you’ll receive an official notification in the mail. No insurance underwriter is going to call you and ask for your social security number or your bank account information.

The bottom line is that you don’t just give up that information over the phone when asked.

Even if you get a letter from your insurance company requesting personal information in the mail, call your agent or insurance company and confirm the request is authentic.

Should you get a phone call inquiring your personal info, promptly hang up and call the number on the back of your insurance card.

Be Cautious of “Phishing” Scams

These same rules apply for websites and emails. Sharing information online should be done with caution.

An insurance company doesn’t typically email you asking for additional information, unless you’re signed up for online billing.

The danger with phishing emails

Some emails appear to be from a legitimate source; these emails are phishing scams.

E-mail scams try to get you to volunteer your personal or account information, like your passwords, credit card and bank numbers, and social security numbers.

Be careful what links you click on and don’t send your personal information to anyone until you’ve verified the source. If you’re unsure, then explore.

Steering Clear from Fraud

There’s not a single guide on the market that can completely keep us protected from any type of fraud or scams.

These tips should help you feel safer and provide you some tools when combating shady situations.

Not everything is what is seems. Insurance scams and fraudulent activity has gotten more convincing with the advances in technology.

It has become harder to detect, stay alert and protect your personal information; after all, it does belong to you. With these tips you can protect yourself from insurance fraud in the future.

 

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Health Insurance

Diabetes and Medicare Coverage

by Jagger Esch
written by Jagger Esch

Receiving coverage for Diabetes is especially important for those on Medicare. Having additional insurance coverage makes managing diabetes easier.

Diabetes is a medical condition in which the body doesn’t produce enough insulin, which ultimately leads to an increased amount of glucose in the blood.

Insulin is a hormone produced by the pancreas which in turn produces glucose (sugar). Glucose is needed to produce energy for the body’s cells function properly.

When the body is unable to do so on its own, it will need assistance in moving the sugars out of the blood stream and into the tissues after eating.

Diabetes Better Explained

There are two types of Diabetics:

Type 1 Diabetes

  • Commonly referred to as juvenile diabetes
  • Insulin-dependent
  • Considered an immune disorder (The immune system attacks the cells within the pancreas that produce insulin.)

 

With type 1 diabetics, it’s a chronic condition without a cure. Insulin injections are required for management of the disease.

Type 2 Diabetes

  • Is more common later in life.
  • The leading causes for type 2 diabetes include:
    • Poor diet
    • lack of exercise
    • an unhealthy lifestyle
  • Type 2 diabetes is insulin resistant

 

The body will still produce insulin, it just doesn’t use it properly. Type 2 diabetes can be treated with both injectable insulin and oral medications.

The good news is that with type 2 diabetics, the disease can be managed with medications, exercise, weight loss and eating diabetic friendly recipes.

In some cases, type 2 diabetes can even be reversed.

Treatment for Diabetes Management

There are different types of treatments available for management of both types 1 and 2 diabetes.

For most diabetics, their blood glucose is monitored daily from a meter and then their insulin dosage is calculated accordingly by using a sliding scale.

Insulin in injectable form comes in:

  • rapid-acting
  • short-acting
  • intermediate-acting
  • long-acting

 

With injectable insulin, a needle and syringe are used to draw the medication up, and then injected intramuscularly.

Pre-filled insulin pens are also available for multi-use and easy disposal. An added benefit of the insulin pens is the simplicity and convenience.

Insulin pumps are available and deliver small amounts of medication throughout the day.

These pumps can be worn outside of the body. A small tube connects to the pump and delivers medication to a needle placed underneath the skin.

Another type of pump is attached directly onto the body and delivers medication through a self-adhesive pod.

Artificial Pancreas

Individuals with an artificial pancreas will still need to manually adjust the amount of insulin the pump delivers.

But the good news is, the artificial device frees up time by keeping the blood glucose levels stable and even works while you’re sleeping.

With the pancreatic transplantation, the already destroyed islets are replaced with new islets to reproduce the insulin.

The procedure itself is taken from the pancreas of an organ donor and then transferred to the individual with diabetes.

This procedure is still under investigation, individuals interested in this procedure must be enrolled in the islet transplantation research study.

Diabetes and Medicare Coverage

By now, most individuals with Traditional Medicare know that Type A covers your hospital benefits and Type B covers your outpatient benefits.

Medicare Type B will typically provide 80% coverage of any of your doctor’s visits and outpatient treatments, lab work, physical therapy and diagnostic testing.

Your Medicare Part A benefits will also come in handy at 80% coverage for any surgical procedures done in a hospital setting.

So, individuals interested in bariatric surgery or an artificial pancreas may be eligible for insurance coverage for the procedures.

Medicare Part D Prescription Drug Coverage for Diabetics

As anyone with diabetes knows, home self-care is of vital importance when managing the disease.

Blood glucose monitoring strips, glucose monitors, lancets and external insulin pumps are all considered Durable Medical Equipment.

Once a physician deems any of the above devices as medically necessary, your Medicare Part D will pick up a portion of the cost.

Unfortunately, neither Medicare Part A or Medicare Part B have prescription drug coverage. Meaning, you’ll need to obtain a Medicare Part D Plan.

Part D will provide you with coverage for:

  • Medications (which can be pricey)
  • And supplies like
    • Syringes
    • Needles
    • alcohol swipes
    • And gauze!

Additional Medicare Help for Diabetics

There are a variety of other Plans available in which you can enroll for additional Medicare coverage.

Medicare Part C, also known as Medicare Replacement Plans can provide more coverage than what Traditional Medicare benefits offer.

However, these Plans usually come with policy limitations and most often require prior authorization.

Medicare Supplement Plans can also be purchased and will work in conjunction with your already excellent Medicare benefits.

These Plans provide additional coverage and individuals end up with less out of pocket expenses.

Diabetes and Long-term Care

After being diagnosed with diabetes, aftercare is extremely important.

Not only will you need to make sure your disease is well maintained by taking your medications and living a healthier lifestyle, but, routine eye exams, foot care for neuropathy and diabetic ulcers and other treatments are medically necessary.

Additionally, with diabetes the circulatory system is affected as well as the kidneys and central nervous system.

Diabetes can also cause:

  • Cardiovascular disease
  • Hearing impairment
  • Alzheimer’s disease.

 

You’ll want to closely follow the care plan created by your healthcare provider so that potential life-threatening complications don’t arise.

Medicare benefits will provide coverage for your routine follow-ups with your endocrinologist and any other specialists needed to co-manage this life-altering disease

With Diabetes becoming more popular, preventative measures have become utmost importance among Americans.

Nearly 10% of the world’s adult population has been diagnosed with Diabetes.

Inactivity and increased obesity are a major contributing factor as to why the disease has been on the steady incline.

Over the age of 65 it’s vitally important to have Medicare coverage to make sure all your healthcare conditions can be well controlled.

While this disease can be life-changing, remember, you remain in control of your life. Take control of your diabetic health so you can live a long, happy, and healthy life!

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