Want to change plans now?

March 18, 2015 Blog Article

You don’t have to wait!

Medicare has a new way for you to get the coverage you want instead of having to wait for this year’s Open Enrollment in October!

At any time during this year you can switch to a Medicare Advantage Plan or Medicare Prescription Drug Plan that has a 5-star rating and your new insurance will take effect on the first of the following month.

This means that if you are unhappy with your current insurance you can change right now to a 5 star rated plan and you don’t have to wait. Change today and start using a top rated Medicare plan NEXT MONTH!

Plan ratings are based on member surveys, information from doctors and health care providers, and other sources. The plan ratings are scores that show the quality and performance of the plan, on a scale of 1 to 5 stars, with 5 being the highest rated plans.

If you or a family member would like to learn more call me today. There is no cost or obligation to talk with me. I would be glad to talk to you and answer Medicare-related questions in Maine & New Hampshire. You can use the Contact Me page to send me a confidential email or call me toll free (866) 976-9038 or call me direct at (207) 370-0143.

Will Medicare Pay for Protective Underwear?

February 2, 2015 Blog Article

Urinary incontinence is problematic for many seniors and unfortunately the answer is no, Medicare will not pay for disposable absorbent products (adult diapers) except while you are in the hospital or in a skilled nursing facility or if you have a home health nurse. There are other incontinence supplies which are covered such as catheters, but disposable absorbent products are largely, if not entirely, the financial responsibility of the individual.

Medicare may not cover your supplies

but the right insurance plan could…

If you are like most and dealing with urinary incontinence yourself, there are some Medicare Advantage plans that could help with these costs. Some Medicare Advantage plans offer over-the-counter benefits for non=prescription drugs and supplies. These plans offer you a monthly allowance of supplies to help manage your incontinence or other over-the-counter needs such as vitamins, cough syrup, bandages, heating pads, and other items that are not covered by Medicare or your prescription drug plan. You should talk with a plan representative to determine how the plan covers incontinence supplies.

Click here to have a representative contact you to explain which plans are available in your area.

Check other sources of assistance.

If Medicare is not a possible payer for incontinence supplies and you are left wondering, “How will I pay them?” Fortunately there are some third parties who might be able to offer you some assistance.

Veterans Administration

The Veterans Administration is one third party that provides help. While the VA does pay for adult diapers, many veterans advise caution with regards to the quality. Specifically, the standard issued brand of adult diapers is not considered to be of high quality. However if a veteran has a preferred brand such as Attends, Depend, Prevail, Tena or Tranquility it is possible to have those paid for by obtaining a prescription or statement of medical justification that explains the medical reasons for which a particular brand of adult diaper is necessary.

Medicaid

Medicaid for individuals in nursing homes will supply adult diapers and other disposable, absorbent products. Most Medicaid Waivers, which provide assistance to individuals living at home or in the community, also provides assistance typically under the category of home healthcare supplies. However, Medicaid Waivers and rules change from state to state and in some states the program may limit the brands or quantities of product available to an individual for a set period of time. Individuals on Medicaid should check with their local Medicaid office. MaineCare covers disposable incontinence products for those who are twenty-one (21) years and older are as follows:

Disposable briefs or “pull ons” are limited to 8 units per day for adults; Disposable personal pads, liners, shields, guards and undergarments are limited to 1 case (of 150) per 36 day period for adults; Large sized disposable underpads are limited to 1 case (of 150) per 36 day period for adults. Disposable non-sterile gloves are limited to 5 boxes (at 100 per box) or 500 gloves per member per 36 day period for adults.

When all opportunities for financial assistance have been exhausted and you must pay out-of-pocket for your supplies, the following may be of help.

Look for adult diaper coupons.

You can search by brand for coupons online at the following site: http://www.needymeds.org/Coupon_keyword.taf?_function=list&id_cat=29

Try using a discount prescription drug card.

Often times medical supplies as well as prescriptions are discounted. Discount cards can be ordered here absolutely free: http://goo.gl/forms/yZmOvyxPmk

Shop online.

Purchasing in bulk online can reduce the cost by as much as 50%, or even 80% over purchasing in a local pharmacy or grocery store. Furthermore products can be shipped free of charge and in discreet packaging. The lowest prices we found at the time of this writing for adult diapers and other incontinence supplies is from TotalHomeCareSupplies.com. Amazon.com also had some competitive pricing but there are shipping costs unless you are a prime member.

IMPORTANT NOTE: Keep all receipts because the total cost for adult diapers are tax deductible.

Click here if you would like to have a representative contact you to explain which Medicare Advantage plans offer Over-The-Counter benefits.

You might have to pay back some of those Obamacare Tax Credits.

January 29, 2015 Blog Article

Folks who received tax credits for a health plan through healthcare.gov in 2014 should be receiving a Form 1095-A in the mail within the next few weeks. This form will indicate the amount of tax credits you have received in 2014 and you will need to report this amount on your taxes. Make sure that the information on the form is accurate. If it is incorrect you can call the Healthcare Marketplace at 1-800-318-2596 to request a corrected form.

If you underestimated your income and received too much in premium tax credits, you'll have to pay some or all of it back.

Health policy experts say there is currently no provision in the health law that would excuse someone from repayment if an error was made by the online marketplace. This does not mean a new rule may be in place by April 15th. If you encounter a situation where you are going to have to pay back some of the tax credits you received I would suggest you wait and do not file your taxes until closer to the deadline in April in case a rule is created allowing some reduction in what you need to pay back or offering some sort of payment plan.

But there is a limit on the amount that you must pay back.

The amount you'll have to repay is capped based on your income. A couple with an income between 200 and 300 percent of the federal poverty level ($31,460 to $47,190 for a family of two in 2014) would only have to repay up to $1,500. (People with incomes above 400% of poverty — $62,920 for a couple — would have to repay the entire amount.)

There has been a lot of confusion on how to determine your income when applying for insurance on healthcare.gov. For example, Social Security Disability Income (SSDI) counts as income when figuring your eligibility for premium tax credits, but disability insurance payments received from an employer policy may or may not count as income depending on who paid the premium. You should consult a tax accountant for clarification on how much of your income is taxable.

If you discover there was an error in your premium tax credit last year call the Healthcare Marketplace at 1-800-318-2596 to change your tax credit for 2015 so the same thing does not happen to you next year.

If you need any help determining which health insurance plan is best for you please contact Todd toll free at (866) 976-9038 or by using the contact form on this site.

Get Help With Your Healthcare Costs

January 24, 2015 Blog Article

You may qualify for help with your premiums, deductibles, copayments, or prescription costs with Extra Help or with a Medicare Savings Program.

Medicare has 4 savings programs that can help with your healthcare costs:

Qualified Medicare Beneficiary (QMB) Program (also known as the Medicare Buy-in)

Individual monthly income limit* – $1,001

Married couple monthly income limit* – $1,348

Program helps pay for: Part A premiums, Part B premiums, Deductibles, coinsurance, and copayments

Specified Low-Income Medicare Beneficiary (SLMB)

Individual monthly income limit* – $1,197

Married couple monthly income limit* – $1,613

Program helps pay for: Part B premiums only

Qualified Individual (QI) Program

Individual monthly income limit* – $1,345

Married couple monthly income limit* – $1,813

Program helps pay for: Part B premiums only

Qualified Disabled and Working Individuals (QDWI)

Individual monthly income limit* – $1,962

Married couple monthly income limit* – $2,655

Program helps pay for: Part A premiums only

Save on Drug Costs

If you have limited income and resources, you may also qualify for “Extra Help” to help pay your Medicare prescription drug costs, like premiums, deductibles, and co-payments.

In 2015, drug costs for most people who qualify are no more than $2.65 for each generic/$6.60 for each brand-name covered drug. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.

In 2015, you may qualify if you have up to $17,505 in yearly income ($23,595 for a married couple) and up to $13,440 in resources ($26,860 for a married couple).

If you don’t qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your State Medical Assistance (Medicaid) office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change. (To apply online follow the link at the end of this article.)

Countable resources include:

Money in a checking or savings account
Stocks
Bonds

Countable resources don’t include:

Your home
One car
Burial plot
Up to $1,500 for burial expenses if you have put that money aside
Furniture
Other household and personal items

Apply for Extra Help – Contact Social Security.

Find out if you qualify for a Medicare Savings Program. You can apply online or visit your local State Health Insurance Program. Call Social Security toll-free at: 1-800-772-1213 or TTY 1-800-325-0778, Monday-Friday 7am-7pm

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME 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 meet with me to discuss your options or to review the plans that are available. I am paid by the insurance companies in the form of a commission if you enroll in a plan. You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

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

*Medicare Savings Program Income Limits are for 2015 (2016 amounts are released in March).

QMB Quimby

Turning 65 and still working?

January 14, 2015 Blog Article, Medicare, Part D Prescription Drug Coverage, Top Posts

Should I apply for Medicare even though I have insurance at work?

Yes. If you’re not retiring and you are continuing to work then you may want to consider enrolling in Medicare Part A and delaying Part B until you retire and leave your employer sponsored health insurance plan. Even if you’re not receiving Social Security benefits at age 65, you’re still eligible for full Medicare benefits. This includes the Part A (hospitalization), as well as Part B (doctors’ visits and outpatient care) and Part D (prescription drugs); you pay a premium for each. But if you are not collecting social security benefits then it’s up to you to contact Social Security to sign up for Medicare only. You must do this within your “initial enrollment period.” This period starts three months BEFORE the month you turn 65, includes the month you turn 65 and continues three months AFTER that — a seven-month period.

Do you have an HSA?

If you enroll in Medicare Part A and/or B you can no longer contribute to your Health Savings Account (HSA). Whether you should delay enrollment in Medicare so you can continue contributing to your HSA depends on your circumstances. Carefully weigh the savings of enrolling in Medicare against the advantages of continuing to save money in a tax-free HSA.

You don’t have to enroll in all parts of Medicare.

Only the parts you need.

In a situation where you are still working at age 65 and have health insurance through your employer you don’t have to enroll in all parts of Medicare until you retire. If you have creditable insurance coverage through an employer plan, you can apply for Part A only. Part A might help pay for some of the costs not covered by your group plan such as your deductible if you go into the hospital for a surgery or if you need to stay in a skilled nursing facility. And as long as you have group coverage, you won’t be penalized for delaying Part B or Part D (Medicare Prescription Drug Coverage). When your employment or group coverage ends, you then have eight months in which to sign up for Part B and enroll in a Medicare Supplement or a Medicare Advantage plan. This is where I come in! There are a lot of different plans available and finding a plan that covers your doctors and your specific medications at the best price is what I do best. I’ve helped hundreds of people find the right plan and saved THOUSANDS in the process.

Your decision to enroll in Medicare Part B if you are still working is really a cost/value decision. The standard monthly premium for Part B is $121.80 in 2016. Where as Part A in most cases has no monthly premium. So your decision to enroll in Part B while you’re still working might depend on how much money you’re making and what your current costs are with your employer health insurance plan. You also need to consider what you’re getting. If you work for a company with 20 or more employees, your group health plan is still the primary payer of your medical bills, making your Medicare benefits of limited value. However, if your company has fewer than 20 employees, Medicare would be the primary payer and your company’s plan the secondary payer. In this case, it’s best to talk to your employee benefits administrator to see how Medicare would work with your insurance. The Part B coverage may well be worth the monthly premium.

What if I retire and then go back to work?

It’s not unheard of for insurance needs to change as people move in and out of the work force. So what happens if you retire, enroll in Part B and then find yourself back at work with employer coverage once again?

In this situation, you can drop Part B while working and re-enroll at any time while you have group coverage or during the eight months after your employer coverage ends, without risk of penalty or higher premiums.

For now, I suggest you mark the dates of your initial enrollment period on your calendar.

Then when the time comes, call the Social Security Administration at 800-772-1213 to sign up for Medicare Part A and/or Part B. You can also go to www.ssa.gov for more information.

No matter how long you choose to work, there’s no reason not to take advantage of the benefits you’ve earned. Keep in mind, this information is no substitute for an individualized consultation. You can Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me. I would be glad to talk to you and answer questions about your options. You can reach me toll free at (866) 976-9038 or CLICK HERE if you would prefer e-mail. I am looking forward to answering your questions and helping you get the coverage that you need.

-Todd 🙂

Missed the deadline? You have options!

December 29, 2014 Blog Article, Medicare, Part D Prescription Drug Coverage

Did you Miss the December 7th Medicare Annual Open Enrollment Deadline?

Don’t worry, you still have options!

Special Enrollment Periods (or SEPs) allow you to change to another Medicare Part D Prescription Drug or Medicare Part C Advantage plan outside of the annual Open Enrollment Period (from October 15th to December 7th). SEPs are only granted for specific reasons (such as when you move outside of your plan’s service area, qualify for low income assistance in your state or a plethora of other reasons)

One Special Enrollment Period that is available is the 5-star SEP.

If a plan is available in your area, you can use the 5-star Special Enrollment Period for a once-a-year opportunity to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating. The 5-star SEP is available to you at any time during the plan year. So, if you discover that your plan has changed significantly in January, you are not stuck with it until next year. You can change plans today.

Who is eligible for this SEP?

Beneficiaries currently enrolled any MA, MAPD or PDP plan (including those that already have a 5-star rating)
Beneficiaries who are enrolled in Original Medicare and meet the eligibility requirements for Medicare Advantage

Effective dates for enrollments made under the 5-star SEP will be the first of the month following the month the enrollment request is received. Once you enroll in a 5-star plan using this SEP, the individual’s SEP ends for that plan year and the individual will be limited to making changes only during other applicable election periods. To summarize, the 5-star rating SEP can only be used one time during the plan year.

For more information you can visit the official Medicare website at Medicare.gov.

Please call today while your questions are fresh in your mind. There will never be any cost to you for my assistance or for a friendly, no-obligation chat.

You can reach me toll free at (866) 976-9038 or

CLICK HERE if you would prefer e-mail. I am looking forward to helping you move to a better plan to get the coverage that you need.

Will your Drugs cost more in 2015?

November 22, 2014 Blog Article, Medicare, Part D Prescription Drug Coverage

If you’re currently enrolled in Medicare, what you do or don’t do over the next few weeks could determine whether you can get the best, most affordable coverage next year. Hear’s why:

Medicare Part D prescription plans frequently change premiums, drug formularies, deductibles and co-payment amounts for specific drugs from year to year. Medicare Advantage plans often make similar changes; plus doctors, hospitals and pharmacies may drop out of their preferred provider networks.

Thus, by simply choosing the same options for 2015 without investigating alternatives, you could wind up paying hundreds or thousands of dollars more for similar healthcare services.

Medicare’s annual election period ends Dec. 7.

For most people, this is the best — and sometimes only — opportunity to make coverage changes. (Exceptions are made for people who qualify for special enrollment periods.)

If you already have traditional Medicare Parts A and B and a Medigap plan, you don’t need to make any changes; however, if you also have a Part D plan, you must either accept your current plan’s changes or choose another plan.

When choosing next year’s Part D plan:

Carefully review your plan’s “Annual Notice of Change” for any changes to premiums, deductibles, co-payments, covered drugs, participating pharmacies, etc.
Notice whether they’ve changed co-payments or co-insurance for your medications or possibly dropped some altogether. (Yes, this does happen!) Ask your doctor whether comparable, covered drugs will work; otherwise you could pay much more next year.
Even if your plan hasn’t changed substantially, it’s still wise to sit down with someone like myself who can help you compare all available plans. Each year I am trained and tested on the new plans by each of the insurance companies and I have the experience and knowledge to help you make the best choice.

IMPORTANT NOTE: The lowest monthly premium may not be your best bet — sometimes plans with higher monthly premiums have a lower overall cost due to their more favorable deductible, co-payment and coinsurance amounts. Also each company negotiates individual drug prices so a drug that costs $400 per month with one company may put you in the Coverage gap sooner than one that only costs $80 with another company. This is an important piece of your plan review.

Medicare Advantage plans are HMO or PPO type Managed care plans. They are alternatives to Traditional Medicare Parts A and B with a Medigap Supplement. Most cover drugs and some include extra benefits like vision and dental coverage or reimbursement for gym memberships. They usually have lower deductibles and co-payments but require you to use the plan’s provider network.

If your Part C, Medicare Advantage plan includes drug coverage you should also carefully review the “Annual Notice of Change” from your plan for any changes that could cost you more money in 2015.

Bottom line: Reviewing your Medicare options each year is complicated and time-consuming. But if you don’t and your plans change significantly, it could cost you a bundle next year.

Call Todd today for a no-cost plan review, toll free: (866) 976-9038

When do I enroll in Medicare?

November 16, 2014 Blog Article, Medicare, Part D Prescription Drug Coverage, Top Posts

When you're approaching age 65, it's important to thoroughly research the benefits and costs of each different Medicare insurance plan in your area. But it's even more important to make sure you enroll at the right time.

Missing an enrollment date could cost you higher premiums down the line or it could cost you coverage entirely.

If you are already receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare you won't have to worry about your enrollment date, since the government automatically enrolls you in both Part A and Part B at age 65. (Three months prior to your 65th birthday, your Medicare card will arrive in the mail.) Your only concern of timing would be if you declined Medicare Part B (and missed the initial enrollment window). If you do decline Part B, you will pay higher Part B premiums if you enroll later on. For each year that you don't enroll your premium will be 10 percent higher, unless you're insured by an employer-sponsored health insurance through either you or your spouse.

If you are not receiving Social Security or Railroad Retirement Benefits when you become eligible for Medicare you won't be automatically enrolled in Original Medicare. Instead, you'll be able to enroll during one of three enrollment periods.

Initial Enrollment Period – a seven-month window of time that begins three months prior to the month of your 65th birthday. The date your Part B coverage starts depends upon how early in the IEP you enroll. If you wait until the last four months of the IEP, the start date of your coverage will be later.
General Enrollment Period – January 1 to March 31 of each year. Your coverage will begin on July 1 of the year you enroll.
Special Enrollment Period – You can wait to enroll in Part B and not incur a premium hike if you had coverage through your job or your spouse's job at the time you became eligible for Medicare. While you're still covered, you can enroll in Medicare at any time – and for another eight months after you lose your group coverage or you (or your spouse) stop working.

For more information about signing up in Parts A and B you can contact your local Social Security office or call 1-800-772-1213. If you would like to know more or talk about your options and what plans are available for you, call me at (207) 370-0143. There is never any cost or obligation to discuss your options.

Once you have enrolled in Parts A & B you may need to enroll in a Medicare Part D prescription drug plan – even if you do not take any medications!

With Medicare's prescription drug coverage, your first opportunity to enroll is when you're first eligible for Medicare (during the seven-month period beginning three months before your 65th birthday). It's important to note that if you don't enroll during the seven-month period when you're first eligible, you may pay a late-enrollment penalty that will raise your Part D premium when you do decide to purchase coverage.

During the Open Enrollment Period mentioned above, you can also enroll in a Medicare Part D plan, switch to another Part D plan or leave Part D entirely. Again, pay close attention to the dates as they affect your options.

Between October 15 and December 7 – You can join a Part D plan, switch between Part D plans or drop your Part D coverage.
Between January 1 and February 14 – You can leave Original Medicare for an Advantage plan that offers prescription drug coverage. You can not switch from one Part D plan to another.

There is still much more you should know but these are some important dates to keep in mind. For more information about late enrollment penalties or to ask some specific questions you can call me anytime toll free at (866) 976-9038 or use my Contact Me form on this website to email me. 🙂

Why everyone needs professional help.

November 7, 2014 Blog Article

Cutting out the middle-man isn’t always a good thing.

Why You Need An Insurance Agent

It still shocks me when someone asks why they should use an agent instead of just calling the insurance company directly to enroll in a Health Insurance Plan. But I understand why you might ask this question. If you get something in the mail and it looks like a good deal then why not just cut out the middle man and buy direct?

The answer is simple. Because you need the advice and guidance of someone who is trained and experienced.

Who’s watching out for you?

When you call an insurance company they will only tell you why their plan is better than the others. They will not tell you what the competition may offer because their job is to sell their plan and only their plan. Also when they sell direct to you without an agent they increase their profits because they no longer have to pay a commission to an agent. This money does not get passed on to you. It stays in their pockets or gets paid out to their stockholders.

Your health insurance costs will not be any higher if you choose to work with an agent or if you choose to work directly with the insurance company. But it may cost you more in the long run if you choose not to talk with an agent. By going direct you might not learn about the plan that has a lower cost prescription copayment for an expensive brand name drug you take or the one that offers to pay for your vitamins or other health and wellness products.

There are many benefits to working with an agent.

In my opinion the most valuable benefit to working with an agent is your relationship with your agent. When you have a question or need to help making a change you have someone to call who is knowledgeable and has experience to offer you solid advice. Someone who cares about maintaining a relationship with you and wants to help you.

Additionally, Independent Agents like myself are trained and tested annually on ALL the health insurance plans we represent. We know what these plans cover and how they cover it. Agents also have first hand knowledge of customer experiences with each plan. Agents talk to their clients on a regular basis and know when their clients are unhappy with a plan and what shortcoming the plans have. The insurance company’s representative is not going to tell you about a bad customer experience but your agent will share their clients experiences with you both good and bad so you get a clear understanding of how the plan operates.

What about shopping online?

Some websites now offer a “comparison” so that you can see clearly how the different plans look “side-by-side.” These comparisons only show you the basic costs. They do not show you additional benefits offered such as dental, vision and hearing. Each plan is unique and has its strengths and weaknesses. Agents familiar with these plans know what those are and can assist you in making a better decision.

A typical meeting with an agent starts out with a conversation about your needs. I will ask basic questions to determine what your needs are and when we are through I will show you which plans cover your specific needs. Then you review these plans with your agent and you ask questions YOU will learn more about the plans so YOU can make the decision as to which plan is right for you. A good agent is a resource. Someone who has the knowledge and experience to help guide you in making a good decision and is there by your side every step of the way through the enrollment process and still available afterwards to answer any questions that come up.

Would you like my help?

If you would like help finding the right dental plan or 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.

Part B Premium stays at $104.90 for 2015

October 9, 2014 Blog Article

Good news! Medicare Part B Premium will NOT increase for 2015!

U.S. Department of Health & Human Services News Division announced today that the Part B premiums and deductibles for 2015 are to remain the same as the last two years! Also, premiums, copays and deductibles for other Medicare programs for 2015 were announced. CMS released a new bulletin today that can be read in its entirety be clicking on the link below.

http://goo.gl/RIjDdF

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