If you’re having trouble reaching your insurance company to get an answer to a question or resolve a problem, try contacting your insurance agent (the person who helped you choose a plan and enroll).  Licensed agents can help you with claim issues, resolve billing issues, and explain plan designs, benefits, and options.  We work closely with each health insurance company and have dedicated customer service representatives to handle our requests.

Best of all, there is no cost to you when working with an agent like myself.  Your insurance rates are the same with or without a licensed agent on your side and there are no hidden fees.  As a licensed health insurance agent, I can assist you with any questions or issues you may have during the year or during Open Enrollment when plans change their rates and benefits.

Licensed agents act as a single point of contact between you and the insurance company.  We are paid in the form of a commission based on your enrollment in a health plan by the insurance company.  These commissions are paid by the insurance company, not you!  

“It really is a win-win situation for all my clients!”

If you don’t have an agent and would like one on your side then send me a message or give me a call.  I would love to be your hero!

You can reach me at (207) 370-0143 or by email using the form on my CONTACT page here.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Has this ever happened to you?

You sign up for new insurance online and you pick a plan that you think is great because the price is right and all the copays are low, then you get a huge bill from your doctor’s office saying that the insurance did not pay.  What gives?

I recently talked to someone who was told by a customer service agent on the “Obamacare” Healthcare.gov helpline to call her doctor’s office to find out if they accept the insurance.

“This is a big mistake.”

Often times the staff at your doctor’s office sees many different insurance cards.  They may see a card from the company who has the plan that you chose and it will sound familiar to them so they may say, “Yes, we accept that insurance.”

The problem is that your new plan may be an HMO (Health Maintenance Organization) and if that’s the case, this plan has a network of doctors that will accept the insurance.  Any doctor not participating in this network will not accept the plan.

What’s the problem if they say they accept it?

The problem is that they may not know it’s an HMO plan.   See, there are many different types of plans and some are PPO (Preferred Provider Organization) plans.  These PPO plans have coverage for out-of-network doctors (usually at higher rates.)

Read more about the differences between HMO, PPO and other plans here.

So, if someone has a PPO plan with the same insurance company then they could see any doctor because it covers doctors visits whether they are IN or OUT of the network.  The staff at your doctor’s office may have seen people with cards from this insurance company so the staff at your doctor’s office might have the impression that they accept ALL plans from this company which may not be the case.   If your doctor is not in your new plan’s network then your new HMO plan will not pay the bill and you will either have to find a new doctor or pay the bill on your own.

How can you be sure your doctor accepts your new insurance plan?

Work with an agent or call the insurance companies directly before you sign up for any plan and make sure all your doctors, hospitals and Medications are covered by the insurance.   This is why I believe everyone should work with an insurance agent when shopping for health insurance.  I look at the overall costs associated with the plan when I meet with a new client.  We check to make sure any doctors or services you need are covered by the new plan before we enroll.  And we make sure to check to see if all prescription medications are covered because each of the plans covers medications differently.

Are you only working for the Health Insurance Benefit?  If so, then don’t wait until you’re 65 to retire!

“Take the time now to enjoy your hobbies and spend more time with your family.”

The Affordable Care Act could be the answer!

The new healthcare plans created as part of The Affordable Care Act (Also known as “Obamacare”) are perfect for folks who want to bridge the gap until they are eligible for Medicare at age 65. If you are single with a retirement income under $35,000 or less or married with double that, you may qualify for credits that would lower your monthly premium to between $100 and $250 per month!  If your income is lower then your premium would also be lower and you may also qualify for a reduced deductible!

If you are only working because you NEED health insurance then now is the perfect time to look at these plans to see if you can reduce your hours to part time or retire early and have the life you’ve been dreaming of!

 If you would like to see if you can afford insurance on your own and what your plan will look like then give me a call (207) 370-0143 or send me an email and I can help you!  My services are free and I will help you find the right plan and enroll so you don’t have to mess with the online healthcare marketplace system.  I’ll make it easy!

Read more …

Have you planned for Long-Term Care expenses?

Most people know that Medicare only covers 90 days each year in a hospital or nursing home. But what they usually don’t know is that once the hospital or nursing care facility changes your care status from “skilled care” to “custodial care”, Medicare no longer pays.   This also means that any Medicare supplement plan you have will stop paying as well.

Long-term care is a range of services and support for your personal care needs. Most long-term care isn’t medical care, but rather help with basic personal tasks of everyday life, sometimes called activities of daily living. Medicare doesn’t cover long-term care (also called custodial care), if that’s the only care you need. Most nursing home care is custodial care.

The annual cost of long-term care expenses range from $17,680 for adult day care to more than $92,000 for a private room in a nursing home, according to Genworth Financial.

So why don’t people start saving for this expense or at least buy long-term care insurance?

A new poll conducted by Associated Press-NORC Center for Public Affairs Research says about 4 people out of 10 don’t think they will ever need long-term care.

“I’m very healthy at 68 and I really don’t have any impending and current problems.” said one man surveyed.

The survey found that nearly 4 in 10 respondents mistakenly expect to turn to Medicare, which doesn’t pay for long-term care. Respondents with incomes below $50,000 were more likely to expect to rely on government programs such as medicaid (MaineCare) to take care of them.  What a lot of people forget is that to allow MaineCare to take over the bill you have to pay for the costs until your assets are gone, meaning you have used up all your savings and in some cases sold your home and used that money as well.

I think it is in everyone’s best interest to know how much long-term care insurance will cost you before you make the decision to go without.   Most people I talk to think that Long-Term Care insurance is “too expensive”.  And yes, the “free” quotes you get online from various websites are very generalized and do not give you an accurate price which makes most people think it’s not affordable.  Often times there are alternative insurance strategies you can use to make long-term care insurance affordable at any age.

If you would like to know how much a Long-Term care insurance policy would cost then fill out the form below and I will have a licenced agent contact you.

June is Men’s Health Month, a perfect time for you (and the men in your life) to take the steps to live a safer, healthier life.

Did you ever put off doing a task or getting a test and later wished you’d just gotten it over with? If you’re a man with Medicare, now’s the time to talk with your doctor about whether you should get screened for prostate cancer, for colorectal cancer, or for both.

Screening tests can find cancer early, when treatment works best.

Don’t let cost be the reason you put off screenings. Medicare covers a digital rectal exam once every 12 months. Medicare also covers a variety of colorectal cancer screenings – like the fecal occult blood test, flexible sigmoidoscopy, or colonoscopy – and you pay nothing for most tests depending on the type of plan you have.

FACT: Prostate cancer is the most common cancer in men, second only to lung cancer in the number of cancer deaths.

Men who are over 50 are at a higher risk for getting prostate cancer and your risks increase if you have a father, brother, or son who has had prostate cancer.

Colorectal cancer is also common among men. It’s the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. It is estimated that if everyone age 50 to 75 got screened regularly, as many as 60% of deaths from colorectal cancer could be avoided.

Most of the time, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum.  Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer.  If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened regularly for colorectal cancer.

Note:  While the screening is most often provided by your Medicare plan at no cost, if a polyp is removed then your procedure will be billed as outpatient surgery and depending on the type of insurance you have this may trigger a copay.

Watch this video on how Medicare has you covered on colorectal cancer screenings.

Click here if you’d like to learn more about the Men’s Health Month Campaign.

Would you like my help?

If you would like help reviewing your plan benefits and comparing those benefits with other plans that are available or if you just want to ask a few questions, you can call me directly at 207-370-0143 or send me a message.

The best part about working with me is that it will not cost you anything to talk with me and review your options.  I am paid by the insurance company once you choose the best plan for you.  I will not ask you to pay me or to make a donation.  And you will pay the same price for your insurance plan that everyone pays whether they had my help or did it all alone.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Medicare Supplement plans, often called Medigap plans by Medicare, are plans that work in combination with Medicare.  The most popular plans are Plan F and Plan N.

Before we compare these plans, it’s important that you understand how Medigap plans work and how they differ from Medicare Advantage plans.  Click here to read Medigap vs. Medicare Advantage.

Plan F vs. Plan N Benefits

Ok, now that you have the basics, its time to get more specific with these two plans.

Plan F

Referring to the chart below you can see that all the Medicare benefits boxes are checked for Plan F.  That means when Medicare approves a medical expense, Plan F covers 100% of your out-of-pocket expenses (copayments, coinsurance and deductibles).

Plan F also covers 80% of foreign travel emergency expenses with a $250 deductible and $50,000 lifetime maximum.

Plan N

The chart above shows that Plan N covers as much as Plan F covers except for:

• The Medicare Part B deductible
• Medicare Part B excess charges
• Doctor Visit and Emergency Room Copays
• Part B deductible

The Part B deductible for 2016 is $166. You are responsible for this yearly amount whenever you begin to receive any Part B services with Plan N.

Part B Excess Charges

When you compare Medicare supplement plans, it is essential that you understand Part B excess charges.

Many people, and many insurance agents for that matter, struggle to understand what a Medicare Part B Excess charge is.

Simply put , it is an additional amount that a physician or other healthcare provider can charge you over and above the Medicare approved amount.

There are many doctors and facilities who accept the Medicare allowed charge. However, there are also doctors and other healthcare providers who DO NOT accept the allowed charge and have excess or additional charges.

“ I was really confused about my Medicare options before Todd helped me understand the Medicare plan that best fit my needs. ”

>>> read another customer review

Still unclear about the differences?

Here is an example that should make it clearer:

Let’s say you are visiting your doctor for an office visit and you have Original Medicare Part A and Part B, but no other insurance or plan. Medicare’s allowed charge for your visit is $100.  Your doctor has the option and a right to charge up to 15% over the Medicare approved amount.

If your doctor doesn’t accept the Medicare maximum allowed payment (called “assignment”) and charges the additional 15 percent or, in this case, $15.00. The allowed charge is $100 and Medicare will pay 80%, which means Medicare will pay your doctor $80.00.  You are responsible for the 20% ($20 in this case) and the 15% ($15 in this case) excess charges or making your out-of- pocket cost $35.

Remember, if a doctor or other healthcare provider does not accept Medicare assignment, they can charge you, the patient, for the co-insurance plus an additional 15% of the total allowed charge.

Doctor Visit and Emergency Room Copays

Under a Plan N, you may also have to pay up to $20 copay per office visit, and a $50 copay per emergency room visit. The $50 is waived if you are admitted to any hospital, and the emergency room visit is covered as a Medicare Part A expense.

The main point for you to understand is that if your doctor or other healthcare providers accept Medicare assignment, you will not be paying for Part B excess charges. And if you were enrolled in plan N, your out-of-pocket costs would be the same as Plan F, except for having to pay the annual Part B deductible, and doctor visit and emergency room copays.

If the cost of a Plan N is substantially lower than the cost of a Plan F, perhaps a plan N would make a lot of sense for you.

Let’s take a look at those costs by showing a Medicare supplement Plan F rate comparison with that of Plan N.

Plan F vs. Plan N Cost

Below you will see costs with Plan F and Plan N rates. The first one shows the monthly premium for 5 of the top insurance companies that offer a Plan N in Maine, and the second shows those rates for Plan F. These rates are for any residents of Maine:

Plan F and N Premiums

Among these 5 companies, the average cost savings between plan F and Plan N for someone age 65 is $68.58 per month or $822.91 per year.

So, if your doctors and other healthcare providers accept Medicare assignment, and you choose Plan N, your cost savings per year would be about $822.91, minus $166 (your Part B deductible which you must still pay), office visit copays and perhaps emergency room copays.

Keep in mind that these savings will occur if all health care providers accept Medicare assignment.

But also keep in mind, that even if some of those health care providers do not accept assignment and charge the allowed 15% extra, your savings could still be significant.

• Both Plan F and Plan N are popular, comprehensive plans.
• Plan N benefits are almost the same as Plan F benefits.
• Plan N can be significantly less expensive than Plan F, without giving up, in many cases, a lot of benefits.
• You will need to do some homework to determine which plan is better for you, or if you should buy a supplement plan at all.

A professional, experienced agent like myself can help make your homework and the entire process to compare Medicare supplement plans so much simpler and easier.

If you would like help comparing your needs against the many Medicare plans out there or if you just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Are you turning 65 and still working?  Read this.

Cataracts are the leading cause of blindness in the world, according to the World Health Organization.  Even though they can occur at any age, cataracts are most common later in life – so common that they’re considered part of the aging process.  If you have Medicare, it’s a good idea to understand what cataracts are, as well as their symptoms and treatments.

The information contained in this article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition.

What are cataracts?

Cataracts are a clouding in your eyes’ natural lenses. Once cataracts form, the lens becomes increasingly opaque as cataracts interfere with light getting through to your retina. You can have cataracts in one eye or both.  The actual cause of cataracts is still unknown. However, the breakdown of lens proteins and other chemical changes associated with aging appear to be contributing factors.

Outpatient cataract surgery is typically covered under Medicare Part B benefits, while inpatient surgery is usually covered under Medicare Part A. You may have additional coverage and lower out-of-pocket costs if you have a Medicare Advantage or Medigap plan.
See Medicare Plans

Symptoms of cataracts

With cataracts, your perception of colors, headlights, and sunlight may change. Double vision can occur in people with cataracts, if the cataracts cause a difference in the degree of opacity in one part of the lens over another. While none of these symptoms automatically mean you have cataracts, they are commonly associated with cataracts.

Types of cataracts

• Multiple cataracts: affecting more than one part of the eye
• Nuclear cataracts: occurring in the central part of the eye
• Cortical cataracts: affecting the cortex, which surrounds the center of the eye
• Posterior subcapsular cataracts: occurring at the back of the lens

Treating cataracts with surgery

Doctors will often recommend surgery to treat cataracts. If you have cataracts in both eyes, the surgery is usually performed on one eye at a time. However, the correction of cataracts in one eye may be enough to improve your vision, and your doctor and you may decide to opt to cancel the surgery on your second eye.

Cataracts surgery is usually done on an outpatient basis, and it essentially involves replacing the natural lens in the affected eye with an artificial lens. The surgery has become fairly common: many people have cataracts removed every year, and most surgeries are successful and free of complications. But you should always discuss the risks of such surgeries with your medical provider.

Cataract surgery is extremely popular because it usually provides a lasting solution to a common problem. The surgery removes the entire lens and replaces it with an artificial lens that cannot develop a new cataract.

Your vision will likely continue to improve in the weeks following your cataracts surgery. In some cases, people still require reading glasses even after the cataracts are removed, which will be determined by your eye doctor.

In certain cases, even if you have cataracts, you may not need surgery at all. Ask your doctor about other options to treat cataracts. Medicare may cover non-surgical medical treatments for cataracts depending on necessity and type.

Medicare and cataract surgery

Surgery to correct cataracts is usually performed in people over age 65, and this includes Medicare beneficiaries. That’s why it’s important to know how Medicare covers the treatment of cataracts.

Surgery to remove cataracts is covered by Medicare, but Medicare only pays expenses directly related to the cataracts. If you had a non Medicare-covered condition before developing cataracts, you may be able to treat that condition during the same surgery, but Medicare only covers the costs associated with cataracts. Medicare will ask the surgeon to bill you separately for the parts not related to the cataracts.

Because an ophthalmologist (not an optometrist) performs surgery for cataracts, Medicare covers the surgery under Medicare Part B. Medicare covers fees from your ophthalmologist and the facility, but only the amounts approved by Medicare. You will pay a 20% Medicare Part B coinsurance for the surgery plus your Medicare deductible.

With cataract surgery, Original Medicare typically pays for standard intraocular lenses, but doesn’t usually cover upgraded lenses. If you want specialized lenses placed in your eyes, you’d probably be responsible for the additional cost.
See Medicare Plans

With cataracts, Medicare covers a pre-surgery exam to discuss your cataracts and anesthesia during the surgery. Medicare also covers any follow-up care. You’ll pay the 20% Medicare coinsurance, plus any Medicare deductible before Medicare pays its share.

Medicare and eyeglasses for cataracts

Normally, Medicare does not cover routine vision correction, but Medicare does cover eyeglasses, contact lenses, and intraocular lenses following surgery to treat cataracts.

If you require eyeglasses, Medicare Part B only provides coverage for standard frames. For more expensive frames, you’ll pay the difference over the amount approved by Medicare. Ask your doctor what frames are covered by Medicare.

Make sure your supplier is enrolled in Medicare and has a Medicare supplier number because Medicare won’t pay your claim if your supplier doesn’t have a Medicare supplier number.

You’ll pay 20% of the amount approved by Medicare (your Medicare Part B coinsurance), plus your Medicare deductible. Remember to tell your doctor to send the bill for your eyeglasses or contact lenses to Medicare.

Call Medicare at 1-800-MEDICARE for more information on Medicare coverage of cataracts surgery and treatment.

Tips from a licensed insurance agent

If you would like help reviewing your benefits and comparing those with other plans that are available or if you just want to ask a few questions, you can call me directly at 207-370-0143 or send me a message.

The best part about working with me is that it will not cost you anything to talk with me and review your options.  I am paid by the insurance company once you choose the best plan for you.  I will not ask you to pay me or to make a donation.  And you will pay the same price for your insurance plan that everyone pays whether they had my help or did it all alone.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Read more:  “What’s the differences between Medicare Supplements and Medicare Advantage?”