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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 Plans

How to Claim Medicare without Claiming Social Security

by Jagger Esch
written by Jagger Esch

Can you get claim Medicare benefits without claiming Social Security? You sure can, and we’re going to outline the reasons to consider this option along with some of the pros and cons of delaying your claim to Social Security benefits.

First, let’s look at some important information about Medicare and Social Security. Then, we can better understand why it makes sense to enroll in Medicare without claiming Social Security.

Medicare vs Social Security

Health insurance is offered through the Center for Medicare and Medicaid Services (CMS). Social Security provides people with a monthly stipend.

Medicare Part A is free for most recipients and Part B is usually deducted from your monthly social security check.

When beneficiaries enroll in Medicare at full retirement age, they may enroll through one of the online options. However, be careful if you do not want to activate your Social Security Income, or SSI benefit.

Follow the options that allow you to enroll in Medicare separate from your Social Security benefit.

Starting Medicare Benefits

With Medicare coverage, it’s important not to miss any of the deadlines or you’ll be penalized. The most important deadline is the Initial Enrollment Period, or IEP. This is a 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65 and the 3 months after your birth month.

Even if you have creditable coverage through an employer, you will still want to enroll in Part A.

Part A is the hospital coverage. Since you are not enrolling in Social Security, that automatic trigger will not occur. You, as the Medicare beneficiary will need to enroll in Medicare only.

Part B, the medical coverage does have a premium that is imposed. When you decide not to claim your Social Security Income benefits, you will need to complete the enrollment form for Part B, and you’ll need to pay the monthly premium.

For most beneficiaries, it’s easiest to have the bill set as an automatic draft from a bank account.

Medicare Part D is the prescription drug coverage and you will need to select a drug plan and pay that premium directly to your insurance company.

In addition to your drug coverage, you’ll need to consider what type of coverage you want to fill the holes left by Original Medicare. A licensed agent can help you review your options, enroll and assist you in getting your reoccurring premium payments set up.

It’s imperative that you address how you will pay for Medicare Part B as delaying your Social Security benefit prevents SSI from paying that premium out of your monthly check.

Social Security

In this instance the Social Security benefit would be the SSI or Supplemental Security Income, commonly known as retirement benefits. SSI will serve as a monthly income when you’re ready to apply and start receiving benefits. Social Security benefits can be claimed as early as age 62 or as late as age 70.

If you claim social security benefits before you reach full retirement age, you will receive a reduced benefit for a longer period. If you wait until full retirement age (66 years and 4 months) or later, you will receive a higher benefit for shorter period.

This is a situation where you have to make a best guess. Consider some of the following:

  • Are you working?
  • How is your health
  • Does your family history indicate longevity of life
  • Do you have other income to support you if you delay taking your SSI benefit

 

If you apply to start receiving benefits before full retirement age, you’ll receive a reduced monthlybenefit. Your monthly benefit amount will always be reduced. Hence the reason so many beneficiaries opt to delay filing a claim with Social Security.

Furthermore, if you can delay applying for Social Security benefits until after “full retirement age”, your benefits are increased based on your birth year and the number of months you delay.

Once you reach age 70, the benefit increase no longer continues to grow. Currently, beneficiaries who delay receiving Social Security Income benefits are making about 8% more per month.

My Dad and his decision

My own dad, Joe, is receiving his social security income and started taking benefits when he was 65 years old.

Having been diagnosed with COPD in his late 20’s, then Atrial Fibrillation in his 50’s and a few other health conditions, Joe crunched the numbers around age 62. He decided that in order to get the most money from his years of paying into social security, collecting at age 65 presented the best-case scenario.

One in every four 65-year-olds will live past the age of 90. While it’s a tough pill to swallow, Joe doesn’t expect to live to 90.

So, in order to maximize his retirement earnings, he filed his claim for SSI at age 65. Yes, he filed prior to full retirement age. However, he now has the time and income to enjoy his golden years.

This is the reason why

Most people outlive their retirement savings and studies show we’re living longer than previous generations. With this in mind, we need to prepare for a longer retirement period.

That means if you can delay receiving benefits past age 65, you would receive a higher monthly payment. For most folks, that higher monthly payment would kick in around the time their personal savings has been exhausted.

Although you’re evaluating your life expectancy, you need would do well to keep in mind the life expectancy of your spouse. Especially if that spouse plans to collect Social Security Income based on your benefits.

Deciding when to collect your Social Security Income benefit will impact your retirement income as well as your spouse’s retirement income.

If your spouse plans to make a claim for Social Security Income based on their own benefits, then this is a moot point; your spouse would need to make these same decisions that you now face.

The short and skinny, there is no right or wrong answer. It’s never too soon to start considering your personal situation and begin evaluating where you are in life right now; measure that against how you want to live when you retire.

Every person is unique, and you need to weigh your options before deciding. Take heed of the call to action sang by the band Rush, “If you choose not to decide, you still have made a choice”.

It’s a lot to take in and it should take you more than an afternoon to decide if it’s in your best interest to claim Medicare without claiming your Social Security retirement income.

When in doubt, break out a pencil and paper and crunch the numbers.

Tip the scales in your favor and start planning for your future while it’s still in the future. After all, Medicare and Social Security have been planning how to fund your retirement since your parents were still part of the work force.

 

 

 

 

 

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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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Durable Medical Equipment & Medicare
Medicare Plans

Durable Medical Equipment & Medicare

by Jagger Esch
written by Jagger Esch

Many baby boomers rely on Durable Medical Equipment (DME) supplies for their daily activities. Medicare covers medically necessary supplies such as a wheelchair, CPAP machine, or oxygen tank.

So, if you’re wondering about Medicare coverage on your Durable Medical Equipment; ask yourself this; is this medically necessary and is my doctor going to write a prescription for this?

If you can answer yes, then coverage will be likely.

Will My Medicare Coverage Pay for Durable Medical Equipment?

Durable medical equipment is covered under Medicare Part B. The yearly Part B deductible is applicable and then Medicare pays an 80% coinsurance.

That means the Medicare Beneficiary is responsible for the remaining 20%.

If you’ve purchased secondary coverage through a private insurance company, they may pay the remaining 20% of the equipment costs.

Of course, that is provided you have met the Medicare requirements; like paying any applicable deductibles or premiums.

How Do I Get Medicare To Cover My Durable Medical Equipment?

Medicare requires standard information to be included with all prescriptions for durable medical equipment.

Typically, a face to face office note detailing medical necessity and a prescription.

Occasionally, Medicare may require additional testing or documentation. The DME provider should be able to guide Medicare Beneficiaries through the process.

You can expect equipment to be covered if it provides a therapeutic benefit for a condition or illness and will be used in the home.

Keep in mind that Medicare will cover the base model, any upgrades will be billed to the Medicare Beneficiary.

What If I need Durable Medical Equipment To Be Discharged From The Hospital?

When being sent home from the hospital, most people need a few supplies to make the transition smoother.

The most common prescribed items at the time of hospital discharge are hospital beds, wheelchairs, and bedside commodes.

The items that are necessary for Medicare Beneficiaries to continue recovery in the comfort of their own home, are typically covered.

These items will be covered by your Medicare Part B when the prescription is submitted along with the provider’s progress note detailing your condition and the medical necessity of the equipment.

Depending on the length of need, Medicare may rent or buy the equipment being ordered.

What If I Can’t Get Around My Home?

In some cases, a Medicare Beneficiary may have a long-term need for mobility. This could be due to a disability that is classified as temporary or permanent.

In either event, Medicare will cover a Power Mobility Device (PMD) provided specific criteria have been met.

For example, Medicare will require a face to face office note detailing the disability along with the doctor’s recommendation the patient will benefit from the device.

Provided the PMD is primarily used in the home, it will be considered a covered expense. Just to be clear, the Power Mobility Device can used outside the home.

Other items that improve mobility are:

 

There are numerous types of walkers and your practitioner will be able to assist you in determining which one would best meet your needs.

What If I Have A Need for Supplemental Oxygen, A Nebulizer or A Ventilator?

These items are all considered durable medical equipment and are covered under your Medicare Part B coverage.

As you know, anything considered a covered expense by Medicare will be considered payable by your Medicare Supplement Plan.

Oxygen is covered when the doctor details in the face to face office note the specific reason for supplemental oxygen. Oxygen is prescribed for persons with conditions such as COPD, also known as emphysema.

Nebulizers are used to atomize liquid medicine so the beneficiary can inhale a mist that will help open the alveoli, or air sacs. Nebulizers are commonly used by persons with asthma and infants.

Ventilators come in many forms and offer different treatment options. Medicare Part B will require a prescription, a face to face office note from the doctor detailing the condition, and the reason this DME is being ordered.

Ventilators can be either invasive or noninvasive.

  • An invasive ventilator does require an endotracheal tube which is inserted either through the nose or mouth.
  • A noninvasive ventilator requires only a mask.

 

Both types of ventilation therapy provide a volume and pressure to assist the user and provide support breathing.

What Is the Most Common Durable Medical Equipment Ordered?

Diabetic equipment is the most common equipment prescribed under Medicare Part B. Monitors and strips are covered.

Prosthetics and orthotic equipment that supports the lumbar or cervical spine are frequently prescribed. Personal care items such as bath chairs and dressing aids are also commonly prescribed.

What About My Sleep Apnea?

Medicare Part B does provide coverage for machines that correct obstructive sleep apnea.

These items are called CPAP and BiPAP machine. Depending on the type of sleep apnea, a doctor would allow the machine to correct the Medicare Beneficiaries condition.

Diagnosing sleep apnea is a quick process, but most people don’t know what symptoms should be cause for concern.

Sleep apnea is caused by either a physiological condition where the weight of the neck closes making the person stop breathing or breathe very slow, or a condition where the brain forgets to breathe.

Both are cause for concern because they put added strain on your heart and brain.

Signs to report to your doctor are snoring, insomnia, morning headaches or persistent daytime sleepiness.

What About the Monthly Supplies I Need for Upkeep?

Recurring supply needs are covered by your Medicare Part B coverage. Your DME company will be able to advise the frequency with which you can replace any durable medical equipment supplies.

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What Happens If You Delay Medicare Coverage? ‎
MedicareMedicare Plans

What Happens If You Delay Medicare Coverage?

by Jagger Esch
written by Jagger Esch

When most people start Medicare, it begins on the 1st day of the month of their 65th Birthday. Of course, this is not what is the best for everyone. Frequently, people are choosing to continue working later into life. What Happens If You Delay Medicare Coverage?
In many cases with group insurance there is no need to start their Medicare Part B coverage. These Medicare Beneficiaries have a few options, and can delay their Part B enrollment with no penalty.
If you do not have creditable coverage and you decide to delay your Part B enrollment, you will have to wait until the General Enrollment Period. The General Enrollment Period starts on January 1st and runs through March 31st.
When you enroll during the General Enrollment Periodyour Part B start date will be July 1st. If you do not have creditable coverage, you will be subject to the Part B late enrollment period.

What is Creditable Coverage

Creditable coverage is defined as coverage that is expected to pay on average as much as the standard Medicare prescription drug coverage. There are a few disclosure requirements:

Written Disclosure

The first disclosure requirement is to provide a written disclosure notice to all Medicare eligible individuals annually who are covered under its prescription drug plan, prior to October 15th each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan.
This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents.
The Medicare Modernization Act (MMA) imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit. Accordingly, this information is essential to an individual’s decision whether to enroll in a Medicare Part D Prescription Drug Plan.

Requirement for Entities

The second disclosure requirement is for entities (private health insurance companies) to complete and submit the Online Disclosure Form to the Centers for Medicare and Medicaid Services to report the creditable coverage status of their prescription drug plan.
The Online Disclosure Form should be completed annually no later than 60 days from the beginning of a plan year (contract year or renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status. — This requirement does not pertain to the Medicare Beneficiaries for whom entities are receiving the Retiree Drug Subsidy (RDS).

Delaying your coverage in Initial Enrollment Period

Your Initial Enrollment Periodusually starts 3 months prior to the month of your 65th birthday, the month of your birthday (or the month you get your Medicare Part B), and continues for the 3 months after. Most Medicare Beneficiaries will start their Medicare Part B coverage the month of their 65th birthday.
However, some people will procrastinate. When this happens, the result can be a Medicare Beneficiary experiencing a lapse in coverage, that could potentially last for a month or two.
If you enroll before the month you turn 65 your Medicare coveragewill start the 1st of the month of your 65th birthday, unless your birthday is on the first day of the month, in that case it will start the 1st of the month prior to your birth month.
If you were to wait until the month your turn 65, your Part B will start one month after you enroll. If you wait until the month after, your Part B will not start until 2 months after you enroll. Waiting until the 2nd or 3rd month after you turn 65, it won’t start until 3 months after you enroll.

Omission of Medicare Part B Can be Problematic

While not having Medicare Part B coverage for a few months may seem like an insignificant gamble. Saving a few premium dollars is certainly not worth the risk imposed on oneself. If you were to get sick, you would be responsible for 100% of the doctors bills.

I Have Group Coverage, Do I Need to Take Part B

When you have group coverage, depending on several factors, you can delay your Part B coverage without being subjected to a penalty. The predominate question is, “does my group plan qualify as creditable coverage?”. To answer this question you should contact the benefits administrator for your employer.
The benefits administrator will be able to advise if you can stay on your group coverage without needing to enroll in Part B. Remember that some group coverages require you to pick up Part B in order to stay on their coverage.

Penalty

If you delay your Medicare Part B and do not have creditable coverage, coverage that pays on average as much as Original Medicare, you will be subject to a Part B late enrollment penalty.
The Part B late enrollment penalty is equal to 10% for each consecutive twelve months you have been eligible, but elected to delay your enrollment into Medicare Part B. This penalty will continue as long as you have Medicare Part B.

What Happens If You Delay Medicare Coverage?

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Medicare Plans

Healthcare Coverage for Rheumatoid Arthritis

by Jagger Esch
written by Jagger Esch

Anyone with a chronic health condition knows it’s important to have healthcare coverage. For those with Rheumatoid Arthritis, healthcare coverage is vital.

Rheumatoid Arthritis (RA) is an autoimmune disease affecting approximately 1.5 million people in the United States. It happens to be the most common inflammatory joint disease, affecting 1-2% of the worldwide population.

The chronic inflammatory disease causes the immune system, which usually protects the body, to attack its own joints.

One of the biggest concerns for most suffering from a chronic illness is health insurance coverage. The second being out of pocket costs.

Medicare Coverage for Rheumatoid Arthritis

Looking for a health insurance plan can be a daunting experience, to say the least. Looking for a plan that includes major medical, hospitalization coverage and prescription drug benefits can be even more intimidating.

Finding a plan that’s affordable and one that meets your needs can be downright stressful! While researching Rheumatoid Arthritis coverage, you’ll want to look at the different types of insurances.

There are a variety of policies available, talking with a licensed insurance broker in your state will allow you to confidently choose which policy is most beneficial to your individual healthcare needs.

There are many different types of insurance, each offers coverage a little differently and it’s up to you to make the final decision on the best policy for you.

Coverage from a Medicare Advantage Plan

Medicare Advantage Plans will take over for Traditional Medicare benefits. They sometimes offer additional benefits like vision, dental and prescription drug coverage which isn’t normally covered with regular Medicare.

These plans contract with a group of healthcare facilities and pharmacies to provide services to beneficiaries. While premiums are generally lower, the policy limitations tend to outweigh any of the Advantage Plan benefits.

Health Maintenance Organizations aka HMO’s are the most common forms of managed care.

With most HMO policies come restrictions, such as:

  • Network of Doctors
  • Pharmacy Networks
  • Hospital Network
  • Referrals are Required
  • Limited coverage area

 

While this can limit who you see and what treatment you can obtain for your rheumatoid arthritis, HMO policy premiums are usually lower than other insurance types.

Another plus for HMO policyholders is there is little or sometimes no out of pocket cost for services in-network.

Medicare Advantage Private Fee-For-Service (PFFS)

This is traditional health insurance in which the policy either pays the medical provider directly or reimburses the beneficiary for services rendered.

With Private fee-for-service plans, you’re given the option to treat with the provider and facilities of your choice.

Medicare Advantage Preferred Provider Organization (PPO)

These policies are like HMO type policies; however, PPO’s offer more flexibility. There’s a list of providers you can choose, but you may also treat with, “out of network” providers.

You may have a higher out of pocket cost when treating out of network. Like HMO policies, PPO policies also require deductibles and copayments for the beneficiary.

Whether using an HMO, PPO, fee-for-service or Medicare, most plans allow treatment for autoimmune diseases.

Original Medicare Coverage for RA

Traditional Medicare offers coverage for your hospital (Medicare Part A) benefits and your outpatient care.

Whether using Part A or Part B benefits, Medicare covers treatment at 80%. The Medicare beneficiary is responsible for the remaining 20% once the policy deductible has been met.

There are additional ways in which Medicare beneficiaries can save on RA treatment.

Medicare Supplement Coverage for Rheumatoid Arthritis Treatment

A better option to consider is a Medicare Supplement Plan. These plans work in conjunction with the already excellent Medicare perks.

These policies help offset the leftover out-of-pocket costs associated with Medicare.

Deductibles, copayments, coinsurance and other out of pocket costs for any RA treatments may then be covered in full and cheaper for the beneficiary in the long run.

As rheumatoid arthritis is a chronic ailment, you’ll be looking at a lifetime of different treatment options to manage the condition.

You’ll want to make sure whichever policy you choose will benefit you for the foreseeable future.

Medicare Coverage for RA Treatment

Thanks to the Affordable Care Act passed in 2010, the comprehensive health care reform law has made health insurance more affordable to Americans.

Another added benefit is that you cannot be denied health insurance coverage for pre-existing rheumatoid arthritis. Additionally, your carrier cannot drop your coverage if you were to develop RA while already insured.

For those suffering from rheumatoid arthritis, this means insurance coverage will include:

  • Disease management
  • Emergency Room visits/ hospitalizations
  • Preventative care
  • Counseling for weight loss and nutrition
  • Mental health services

 

Those individuals with Medicare, Medicaid or who have insurance through a workplace, the same above benefits apply. This is good news for those with RA as most treatment options will be covered.

Things to Consider Before Buying Insurance

You can contact your individual healthcare provider or insurance carrier to see exactly what RA treatment options are covered. They should also be able to discuss any potential out of pocket costs to you.

Some key facts to consider when searching for insurance include:

  1. Make sure there is prescription drug coverage. RA medications, especially IV infusions and Biologics can be costly. Without proper prescription benefits, the out of pocket costs can be extortionate.
  2. Benefits that cover occupational and physical therapy. Therapy has been proven to help prevent joint pain and further damage caused by RA.
  3. Access to specialists. Once diagnosed with RA, it’s crucial to establish with a rheumatologist to start beneficial treatments. Proper care is essential to maintain your disease and to prevent further joint deformity

 

While having rheumatoid arthritis can be overwhelming, getting treatment shouldn’t be. With the ever-changing healthcare system and evolving treatment options, insurance coverage is more important than ever.

Care is available for RA and the sooner you start treatments, the better and more manageable the disease will be!

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Medicare Plans

Understanding the 2020 Policy Changes to Medicare

by Jagger Esch
written by Jagger Esch

The beginning of a new decade is upon us, and significant changes are happening. Understanding the 2020 Medicare Advantage Open Enrollment Period could bring you great benefit.

The enrollment period provides an extra opportunity for you to get the best coverage. Medicare is full of many parts, and it may be challenging to keep up with all the new rules.

Different enrollment periods have varying guidelines. Regulations include specific dates.

Beneficiaries can forget about the old Medicare Advantage Disenrollment Period. The new and improved Medicare Open Enrollment Period is the replacement.

The last time to enroll, according to federal law, allows you a final chance to switch Advantage plans. Yet, you must be a Medicare Advantage enrollee to use this option.

Understanding the 2020 Medicare Advantage Open Enrollment Period

The new chance to switch Medicare Advantage plans is happening right now in 2020. It starts January 1 and runs until March 31.

Beneficiaries with an Advantage plan may now use this time to switch. Another option is to drop a current Advantage policy and go back to Medicare and buy Part D.

In 2010, the ACA law put an end to the Medicare OEP. Replacing the OEP was the Medicare Advantage Disenrollment Period. The dis-enrollment period began on January 1 and only ran until February 14.

So, what makes this period different? Well, this period only allowed beneficiaries to return to Medicare. The Medicare Advantage Open Enrollment Period allows a one-time switch between Advantage plans.

What is the Medicare Advantage Open Enrollment Period

The Open Enrollment Period allows you to switch from one Advantage plan to another. Although, you may not use this period to switch from one Part D drug plan to another.

Think of this as your chance to make any last-minute policy shifts.

Life happens at the most inconvenient times, Medicare understands. As of 2019, Advantage plan enrollees may make policy changes until the end of March.

New policies or any adjustments begin the 1st of the following month. Let’s say Katherine has a Medicare Advantage policy. She realizes her benefits don’t cover the care she needs in the upcoming months.

It’s February 1, so Katherine decides to find a more accommodating plan. She must wait until March 1 for her plan to start.

When to use the Medicare Advantage Open Enrollment Period

One big question is why beneficiaries would make another change? The reasons vary, but a common issue is that most people don’t understand how Advantage plans work.

Often Medicare enrollees attempt to make changes on their own without the help of an agent. There are many factors to consider when choosing an Advantage plan or a drug plan.

When deciding what option is best for you, it’s easy to overlook essential elements. That’s why working with an expert is beneficial; they make sure you don’t miss anything.

Unfortunately, beneficiaries forget to check the plan’s provider network before switching. Using an out-of-network doctor means paying out-of-pocket for services.

Recipients see the low premium cost and miss all the other costs associated with the plan. Yet, most programs have copayments and other expenses.

Medicare Enrollment Periods – The Breakdown

Learning the ins and outs of Medicare can be confusing, to say the least. One thing that seems to confuse many is the different Medicare enrollment periods.

The various election periods happen during certain times of the year. Election periods allow beneficiaries to make changes to their current coverage. Understanding each election period is essential for all.

The Annual Election Period

From October 15 through December 7 each year is the Medicare Annual Election Period. The AEP is the most common time for beneficiaries to change their Medicare Advantage or Part D plans.

Changes made during this time take effect on January 1. The Annual Election Period is for making changes to Medicare Advantage or Part D plans.

Each year, beneficiaries receive a Notice of Change letter in September. After reviewing this letter, you may decide you don’t like the upcoming changes. Use the AEP to switch to more comprehensive coverage.

The Special Election Period

Trying a Medicare Advantage plan for the first time can be nerve-wracking. You have twelve months to change back to Medicare if you try an Advantage plan for the first time.

During your first 12 months on the plan, you can switch without underwriting using the SEP. Advantage plans aren’t for everyone. The coverage may not meet your expectations or healthcare needs.

In such cases, the Special Election Period exists as a chance to go back to Medicare coverage. Beneficiaries may only use the Special Enrollment Period once in their lifetime.

Many circumstances qualify a person for a SEP. Moving out of state is a good reason, which means finding coverage in a new area. Beneficiaries may use a Special Enrollment Period to find a plan in the new service area.

Any major change can open the door for a SEP. If you get married, divorced, or are planning to move, expect eligibility for a plan change.

The Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is different than the fall AEP. Often the Annual Election Period is mistaken for the Open Enrollment Period.

The Advantage OEP is from January 1 – March 31 for Medicare Advantage or Part D enrollees. During this time, you have options for policy changes.

Although, this period doesn’t guarantee a pass into a Supplement. Choosing to enroll in a Supplement to go with your Medicare may save on costs of care.

First, you must apply and answer any health questions. Following your request, Medigap companies underwrite your application to determine your health risk.

Companies may deny coverage based on your health. When this happens, you may have Medicare coverage without Supplement insurance.

Changes in plan benefits or coverage take effect on the 1st day of the month following the request. So, if you have any changes to make, be sure to get the ball rolling.

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Housing Tips

Benefits of Living in an Active Adult Community

by Jagger Esch
written by Jagger Esch

Today’s seniors could discover an active adult community is exactly what they’ve been missing. Offering an ideal environment for retirees seeking a low-maintenance, but still active lifestyle. Many senior communities have resort-like advantages for residents.

As retirement nears closer, many people wonder what benefits come from leaving their pre-retirement home. Exploring an active adult community is a great start.

The number of seniors looking for an adult community across the country is on the rise. This could be the cause for the more recent increase in such communities.

Sometimes a retiree prefers to live in a more comfortable climate or needs to downsize for financial reasons. Other times it’s a matter of wanting to live closer to their loved ones.

Benefit from Living in an Active Adult Community

Neighborhoods specific to a 55 and older community are retirement homes or active adult communities. These neighborhoods aim to accommodate the lifestyle of a retiree.

Today, more individuals are moving into adult communities before retirement. State and federal rules regulate these communities. Each neighborhood has its own rules and regulations. Some require ALL residents be at least 55 or older; however, others may only require 80% of residents to be 55 or older.

Congress initiated an 80% rule to allow younger adults to stay in their home should their 55+ spouse pass. However, children under the age of 18 may not live in an active adult community full-time. Most associations allow 30-60 days each year for minors to visit.

Although, rules and regulations may vary depending on the community guidelines. Additional regulations may include the retiree’s income, financial situation or criminal background.

There are many reasons a person may decide to move into an active adult community.

Older Adults Benefit from a More Active Lifestyle

One of the most beneficial aspects of moving to an adult community is the active lifestyle that comes with it. Many communities have various activities to choose from; all of which are fun and easy enough for everyone.

From fitness centers, recreation rooms, and different exercises to keep you healthy. No matter what pace you need to go, activities accommodate all residents.

Some of these fun lifestyle activities range from cooking, painting, shuffleboard, picnics, barbecues and much more!

A Social Community is Important with Age

The quality of life can change drastically with or without a sense of community, especially as we age. Living in an active adult community can provide residents with that community-like environment.

The goal of creating long-lasting memories and knowing their neighbor is a common benefit among residents. For those that don’t live close to their relatives, this can be a great way to stay social.

Getting older doesn’t have to mean loneliness. Many individuals find great friendships and a sense of belonging within the social community of an active adult organization.

Maintenance-Free Living

We’re not talking about just snow plowing, leaf blowing, and basic lawn services. Maintenance-free means all exterior building services including streets, roofs, driveways, and sidewalks.

Adult community staff generally handles even interior repairs, replaces hard-to-reach lightbulbs and other things. Sometimes, having loved ones living close by makes these tasks less difficult.

However, not all people have the help of their family members. For some, the idea of a maintenance-free life is exactly what they need.

Support Services Available

Living independently is something we all strive for, especially as we get older. Although, many of us will experience illness or accidents that prevent us from living without any help.

Fortunately, communities for 55 and older, have multiple services available for residents. Some places require additional costs for using certain support services.

Typical services such as housekeeping, meal prepping, light errands, and pet care. Personal support services like physical rehab, daily living assistance for those in need, and medication reminders.

Convenient Locations

When looking for an active adult community, location is one of the biggest things to consider. Some individuals prefer walking or taking public transportation over driving. For these adults, the location should be near certain places.

Completing tasks like shopping at the mall or attending church events may be difficult if living in certain areas. Moving to a community near hospitals, churches or shopping malls may be ideal for those unable to drive themselves.

Living near grocery stores, theaters, restaurants, and other community facilities make life convenient. Many adult communities are located close to these venues to provide residents with a better quality of life.

Feel Safe & Secure

Many active adult communities have strict security policies in place, allowing only approved residents and guests on the property. Additional security staff is on-site to ensure the safety of all residents. Perks include well-lit parking lots, common walkways, sidewalks, and streets.

Other safety features include working fire alarms and smoke detectors. Also, emergency maps displayed for evacuation purposes and exit doors clearly visible.

As we age, it can become easier to get confused or lost. Having well-lit and clearly marked can help a senior greatly in emergency situations.

Don’t Wait Until Retirement

Active adult communities are “retirement communities”. However, there’s no need to leave your employer to live here.

Although, restrictions for the residents usually include age and income. A common misconception is that members must be retirees to live in a 55+ park. However, that’s not always true.

Members of the community can travel freely or enjoy an active lifestyle without the responsibilities of owning a home. Living in one of these communities can free up more time for retirement activities or just a more relaxed lifestyle.

Be Happy in an Active Adult Community

The baby boomers are moving into retirement. The right residency may offer an active social life, recreation, and activities, privacy, and security, but most of all relaxation.

Most community designs keep the resident’s needs in mind. Offering a socially, physically and mentally active lifestyle for all within the community.

Also, members may meet new people and make new friends. Doing so is easy while taking part in some of the different activities the community offers.

 

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Medigap

Comparing Medicare Carriers for Supplement Plans

by Jagger Esch
written by Jagger Esch

There are many things for a Medicare Beneficiary to consider before choosing the right Medicare Supplement (Medigap) carrier for themselves. For most, they tend to look at carriers that they are familiar with to start.

While it is true that all companies that offer Medigap plans must offer the exact same 10 standardized plans, the differences from company to company can vary greatly.

Cost

Cost is the biggest factor that most Medicare Beneficiaries investigate first, and rightfully so. The reason goes back to the plans. They are regulated by law to cover the same benefits no matter the company. Therefore, cost plays such a large factor, however, it is far from the only thing to consider.

Rate Increases

Rate increases happen all the time in life, not just in insurance. Some companies such as AARP United Health Care give on average a rate increase every 6 months, while most other carriers see yearly increases.

Unlike the plans, the rate increases are not standardized, and some companies will have higher percentage increases than others. Deciding factors are the market strength of the given carrier and plan in the area, inflation, as well as other factors such as claims.

At times companies will have a rate reduction, such as United American’s reduction in Florida in 2018. This is not common but goes to show how prices can fluctuate, but on average the expectation is that the increase will happen yearly.

Customer Service

How well a company treats their customers is another important thing to consider. When calling some companies, you will end up speaking to representatives in other countries or have long wait times to get the assistance you need.

Today we are going to be discussing 3 of the larger household names that offer Medigap Plans: Aetna, Humana, and Cigna.

Aetna

Aetna is one of the largest Medigap carriers in the United States. They offer a 12-month rate lock. That means when someone elects to go with an Aetna Medigap Plan, they will not have a rate increase for at least the first 12 months of their new policy.

Since Aetna has one of the strongest market shares of Medigap offerings throughout the country, they also have on average some of the most conservative rate increases compared to many of their competitors. They are an AM Best A rated company. They also have very good customer service for their Medicare Supplement clients.

Aetna does offer other types of coverages for seniors as well such as Part D Prescription Plans, Dental Vision and Hearing Plans, Critical Illness Plans, Hospital Indemnity Plans, and even Medicare Advantage Plans.

For more information on how Aetna Medicare Supplement Plans work and to see if they are the right fit for you, click here.

Humana

Humana is another large health insurance company, and while they do offer Medigap plans, their larger focus is on the Medicare Advantage market. They are a great company but for most of the United States, their prices for Medigap Plans are not competitive.

Likewise, since their primary focus in not Medigap, they do not have a large market share of the Medigap market which generally means their rate increases will be more liberal, or higher.

Like Aetna, Humana offers other coverages that seniors can take advantage of, as mentioned earlier. One of their biggest offerings is their Medicare Advantage Plans. They do also have Dental, and Part D Prescription Plans

Click Here to find out more information on Humana Medicare Supplement offerings and how they work.

Cigna

Cigna has really established themselves as one of the most competitive Medigap carriers in the industry. Like Aetna, they offer a 12-month rate lock, as well as conservative rate increases.

Cigna is also one of the nation’s largest insurance companies, giving them some of the strongest abilities to handle the claims of their clients. This is one of the main reasons for their competitive pricing and conservative rate increases.

Cigna also offers coverages that seniors can take advantage of such as Final Expense Life Insurance, and Critical Illness Plans. Like both Aetna and Humana, they offer Part D Prescription Plans as well as Medicare Advantage, but they really shine in the Medicare Supplement field. They have great customer service as well as, an AM Best rating of A as well. Here is a great article about Cigna regarding fee-forgiving.

Medicare.gov is a great resource for seniors looking to transition into Medicare. On Medicare.gov you can find resources that will assist in figuring out which Part D Prescription Plans provides the most advantageous coverage for a Medicare Beneficiary. You can find out if your doctor accepts Medicare, as well as resources on preventive services, and much more.

Another great site to help seniors with the transition is CMS.gov. CMS or The Centers of Medicare and Medicaid Services, is the regulating body for Medicare, and Medicare plans. Here you can find the latest details about Medicare and any changes or updates to the Medicare system.

 

 

 

 

 

 

 

 

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