Another reason to start that business you’ve been dreaming about!

(Yes David this blog is for you!)

Sole proprietors are the largest group of individuals expected to buy health insurance through the new Federal marketplace created by the Affordable Care Act (Obamacare). Under the law, self-employed people with no employees are considered individuals even if they hire independent contractors, and will be required to purchase insurance for themselves or face a penalty when they file their taxes at the end of 2014.
Health reform advocates believe the law will free workers of "job lock" caused by the need to hold on to employer-sponsored group health coverage. A report this year co-authored by the Urban Institute and the Georgetown University Health Policy Institute's Center on Health Insurance Reforms estimated that 1.5 million more Americans will be self-employed in 2014 because of reforms under the ACA.

Depending on family size and income, solo entrepreneurs and other individuals may qualify for federal subsidies if they purchase plans through the marketplace. 

Through the marketplace, you can compare plan premiums, deductibles and out-of-pocket costs. All marketplace plans offer an array of "essential health benefits," including emergency services, hospitalization, maternity and newborn care, lab services, chronic disease management, pediatric care, rehabilitative care, mental health and substance abuse services, and prescription drug coverage.  If you need a more in depth comparison I can certainly help you with that.
Basically the plans that are available to Maine residents fit into one of three coverage levels, based on the percentages of costs, such as deductibles, co-payments and coinsurance, shared by consumers. Bronze plans must cover 60 percent of an average person's expected costs, silver plans 70 percent, gold plans 80 percent.

The Kaiser Family Foundation has a tool to help people estimate their costs and potential savings here.

If you have a question or would like assistance comparing the plans available on the exchange you can call me at (207) 370-0143.  I am happy to talk to you about the plans on the phone or meet with you in person, whichever is most convenient for you.  You can also email me using the Contact button on my menu or by clicking here.

Retirees are the real winners with Obamacare!

I received a call from a friend of someone I helped earlier this year enroll in a Medicare plan.  Her friend is 63 and had retired from her job in 2011.  She was able to continue her health insurance coverage from her employer for a short time, but when it stopped earlier this year she tried to find an individual policy on her own. None of the insurers she called would cover her because she is diabetic.
“I didn’t even get to tell them about my heart condition,” she told me.  Because of this she has been without health insurance since July. She is a little over a year away from qualifying for Medicare and she was worried that an upcoming surgery will leave her with several thousand dollars in hospital bills so her friend suggested she call me.
She and I talked about her options under the new plans created by The Affordable Care Act, or Obamacare.  I explained to her how insurers must now offer coverage to people with pre-existing conditions and they will no longer be able to charge larger premiums on the basis of someone’s health. We also talked at length about how those with lower incomes (Under $45,000) can use tax credits to help lower their monthly premiums.
I wanted to share this story because I think it is important to remember why The Affordable Care Act was created.  The Media reports on all the problems, both real and imagined and many people (myself included) are very frustrated with the roll out of the website.   But that does not change the need for the health law.  And while older people may pay more than younger people the tax credit allows them to buy a policy for much less than they would pay today, particularly those people with expensive medical conditions.

And this is why I think retirees are the real winners in all this.

I talk to people every day who are turning 65 and considering their options.  Many times these people are forced to postpone retirement because they need health insurance for a younger spouse. These plans are going to enable people to retire at 65 or 67 and their spouses can bridge the gap to Medicare using one of the new health plans.  It may also assist some early retirees who do not yet qualify for Medicare obtain affordable health insurance in the same way.
I should mention that the lady who called me has not yet been able to access the online website to enroll in a plan because of all the technical issues that have plagued since October 1st.  But I am an optimist and I am hopeful that she and thousands of people like her will be able to enroll before the December 15th deadline and begin their coverage on January 1st.
If you live in Maine or New Hampshire and need help with your health insurance decision then give me a call and we’ll talk.   My phone number is (207) 370-0143 or you can contact me through my Contact page.  I specialize in Medicare Health Insurance Plans but I am also certified to help people find and compare plans on the new Federal Health Insurance Marketplace.


No Increase for Medicare Part B Premiums. It will stay at $104.90 for 2014.

You may remember that last year I wrote about some very scary rumors that Obamacare was going to cause Medicare premiums to double or triple by 2014.   It started with an email circulating that stated as part of Obamacare (known more formally as the Patient Protection and Affordable Care Act, or PPACA) the Medicare premium will increase to $247 by 2014.

The Good News…

That's right.  The good news is that yesterday the Department of Health and Human Services announced that the premiums for Medicare Part B will not increase in 2014 and remain at $104.90 per month.  The deductible will also remain at $147. I agree with CMS Administrator Marilyn Tavenner when she said, "This is good news for Medicare beneficiaries and for American taxpayers."
In addition to the Medicare Part B premium remaining the same, they also said the Medicare Part A premium will drop $15 in 2014 to $426.  Part A pays for inpatient hospital care, skilled nursing facilities and some home health care services, but 99% of Medicare users do not pay premiums for Part A.  (To learn more about Part A click here.)
New Medicare premium rates come out each fall and take effect in January.  Medicare laws dictate that beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue.  In other words, Medicare beneficiaries receive a 75% subsidy for Part B, so every $1 in Part B premiums for enrollees is matched by $3 in general revenues.

The Not-so-Good News…

Even though the Part B premium that is taken from your Social Security Check each month is not going to increase, this does not mean that your insurance supplement premiums will not go up.  Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. 
You need to be aware of how your plan may change, and prepare accordingly.   Medicare Open Enrollment is October 15 to December 7 and it is your only opportunity to review your plan and change to the better plan of your choice.  Right now there are several plans that have made some changes to their plans that will take effect on January 1, 2014.  You should have received an Annual Notice of Changes at the end of September listing any changes to your current plan.  You can find out about all of the plans in your area by using the Plan Finder tool at
If you would like a personalized, in-depth review of the changes to your current plan or the new plans available this year I am here to work as your guide.   I can help you review any changes and answer any and all questions you may have about your plan or another.  And if you find a better one I will help you through the process of changing. The best part is there is no cost to meet with me to review your choices.  The decision whether or not to change is entirely up to you.  If your health plan gives you the coverage you need and the costs to you are low I will encourage you to stay with it.
If you live in Maine or New Hampshire and would like someone with my knowledge and experience to help you review your health insurance then give me a call and we can talk.  My phone number is (207) 370-0143 or you can contact me via email through my Contact page.  I specialize in Medicare Supplements but I also help people under 65 find and compare plans on the new Federal Health Insurance Marketplace.
Take care,

How the Government Shutdown effects your Medicare Enrollment

Social Security field offices will be open but only with limited services. And with fewer Social Security employees expect a long wait in line or on the phone.

Your alternative is to do everything online.

Social Security processes all of Medicare’s enrollment paperwork and a few months ago (almost as in preparation of the shutdown) they put new changes in place to streamline the system to focus more on enrolling people online. Many of the Social Security workers are on furlough because of the shutdown but field offices will be open but only with limited services. And with fewer Social Security employees expect a long wait in line or on the phone. Your alternative is to do everything online.

You can enroll online for Medicare through Social Security at

About 90 days prior to turning 65 you should go online and apply for Medicare Parts A and B, which will be on your Medicare red, white & blue card.  Enrolling in Part B is optional so if you plan to continue working after age 65 and will have health coverage through an employer group plan then you should decided if you want to postpone Part B. Click here to read more about turning 65 and plan work few more years.  Start the process of enrolling in Medicare at least 90 days before the month of your birthday. For example if your birthday is Dec. 28, go online to at least 90 days prior to December 1st and you will have your Medicare card arrive in plenty of time to have a Dec. 1 effective date.  Medicare coverage always starts on the first of the month.  Once you have your Medicare card you can enroll in the Medical health plan of your choice.

Good luck and feel free to contact me using the contact form on the Contact Me page if you have additional questions or you can call me directly at (207) 370-0143.

What do I do when I get my Medicare card in the Mail?

When you get your Medicare card contact me for help comparing the new plans available.  I am a licensed insurance agent in Maine and New Hampshire and I am happy to answer your questions or meet with you to explain things and help you enroll in a plan.  I do not charge anything to meet with you.  If you enroll in one of the plans I represent then I will be paid a commission by that plan.  There is no obligation to enroll in any plans when we meet.

Medicare Open Enrollment starts tomorrow. Are you ready?

According to Medicare, each year, health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether.

If you have a Medicare Advantage or a Part D prescription drug plan then there may be important changes that will occur at the end of the year.  And if you don’t understand those changes you may be stuck with a plan that does not work the way you think.  Your opportunity to change plans ends December 7th of this year.

This is a short list of some of the things that may change at the end of this year with your plan.

  • The drug formulary (listing of medications the plan covers)
  • The network of providers and pharmacies
  • Your out-of-pocket costs (co-payments, coinsurance)
  • The annual out-of-pocket maximum spending limit
  • The annual deductible
  • The monthly premium

Each year these drug lists are reviewed and some drugs are removed from the plan and sometimes others are added.  Also they can be moved to a higher or lower tier meaning your co-payment could increase or decrease so it really is wise to check to make sure your medications are not effected.  Coverage rules for medications (quantity limits, step therapy, prior authorizations) can also change.

The other and more important answer is to be a wise shopper.  If you are currently on a Medigap plan or Medicare Supplement plan you most likely pay a larger monthly premium than you would with a typical Medicare Advantage plan so it would be wise to at least exam these plans and see what the cost savings might be.   Medicare Advantage plans also sometimes have additional benefits beyond what Medicare offers such as dental, vision and hearing coverage and also money to pay for your vitamins.

Prior to the Annual Open Enrollment Period, your Part C Medicare Advantage or your Part D drug plan must send information about changes in benefits and costs for the upcoming calendar year.  It is very important to take the time to study that information.  If you have concerns I suggest you call the Member Services number on the back of your insurance card and a representative there can answer your questions.  It may also behoove you to meet with a licensed health insurance agent if you have someone that you know and trust to see what other plans are available.  I suggest meeting with an agent because agents are trained and tested on these plans before they can talk about them so they may be able to offer you additional insight on some benefits you could overlook when shopping alone.

If you are the independent sort, as are most folks from New England, than you can find all the Medicare Advantage plans for the 2014 year listed in an easy to compare format at the back of your Medicare & You Handbook.  Medicare sends these out to beneficiaries every year so if you did not get your copy just call 1-800-MEDICARE and they will send it out to you.  You can also use the Planfinder Tool on the website to compare plans.

You can make a change anytime between October 15 and December 7 each year.

If you live in Maine or New Hampshire I would be more than happy to meet with you and help you find a plan that may cost less or offer you better coverage than your current plan.   And if you have any questions you can reach me by telephone at (207) 370-0143 or you may contact me through my website at

Medicare Releases 2014 Part D Costs

The Centers for Medicare and Medicaid Services (CMS) has released the 2014 costs for a standard Part D prescription drug plan.

  • The deductible will drop from $325 to $310.  
  • The average monthly premium remains stable and is projected to be $31. 
  • The discount in the donut hole for brand-name medications will remain at 52.5%. The discount for generic drugs will increase to 28% from 21%. 
  • Medicare has dropped the limit for entering the donut hole (Coverage Gap) from $2,970 to $2,850 and the threshold for getting out of the donut hole is $4,550, down from $4,750.  (The Coverage Gap limits are set by a formula established in the 2003 drug plan law involving the negotiated value of prescription drug costs.)
  • The beneficiary’s cost sharing in the Catastrophic Coverage phase drops from $2.65 to $2.55 for generic drugs and from $6.60 to $6.35 for brand-name medications, or 5% whichever is higher.

If you live in Maine or New Hampshire, and would like to learn more about the new plans available in your area you can use the Contact Me page or call me directly at (207) 370-0143. 

Most people need help picking an insurance plan.

People picked the least costly plan only 42 percent of the time according to a recent study.

I just finished reading a very interesting paper distributed by the University of Pennsylvania law school.  A marketing student from Columbia Business School gave ordinary people a basic health insurance literacy course;  told them they were buying health insurance for a family that would need a certain amount of health care per year; then offered a list of plans.

Decision graphic

When these “average consumers” chose from a four-plan menu, only 42 percent picked the plan with the lowest rate.  When they were shown eight plans the results dropped to 21 percent.  Only two people out of ten were able to choose the plan with the lowest rate when shown eight different plans.

I was shocked by the results of this study but I also was somewhat encouraged.

I made a decision a few years ago to start this businesses helping people with the process of finding and enrolling in Medicare plans and it has been one of the best life decisions I’ve made.  It has brought me so much satisfaction and joy.  I love helping people and from what I read today people definitely need my help!

I made another decision a few months ago that I was going to take the courses for the new Health Insurance Marketplaces so that I could get certified to help people, who are not yet old enough to get Medicare insurance, with the new health plans that were created as a result of the Affordable Care Act.  I completed the courses and passed both my exams a few weeks ago.  And after reading this study I am very glad I did.  People need someone like me to help them pick the right plan.  Health insurance plans are complex and everyone has unique health concerns and priorities.  There are 21 plans being offered in October so just imagine what percentage of people will be choosing the right plan without some help.

Don’t worry.  Help is here!

If you are feeling overwhelmed with the choices of plans available this October, you are not alone.  I am here to work as your guide through this process and afterwards.   As my client, you can call me anytime with questions and each year these plans change so I will review your plan changes with you and if your needs have changed and there is a better plan available for you I will help you through the process of changing to the new plan.

If you live in Maine or New Hampshire and need help with your health insurance decision then give me a call and we’ll talk.  My phone number is (207) 370-0143 or you can contact me via email through my Contact page.  I specialize in Medicare Supplements but I also help people under 65 find and compare plans on the new Federal Health Insurance Marketplace.



Hospice Care & Medicare

I recently got a call from someone asking how Hospice care works when you’re on Medicare.  Here is what I discovered…

According to the website, if you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness. Your doctor and the hospice team will work with you and your family to set up a plan of care that meets your needs.

Your plan of care includes hospice services that Medicare covers. For more specific information on a hospice plan of care, call the Maine Hospice Council & Center for End of Life Care 1-800-438-5963 or visit for a list of programs in Maine.

The hospice program you choose must be Medicare-approved to get Medicare payment. To find out if a certain hospice program is Medicare-approved, ask your doctor, the hospice program, your state hospice organization, or your state health department.

Can I get hospice care in my own home?Elderly couple embracing

Yes!  Medicare also states that most hospice patients get hospice care in the comfort of their home and with their families.  Depending on your condition, you may also get hospice care in a Medicare-approved hospice facility, hospital, nursing home, or other long-term care facility.  The hospice benefit with Medicare allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay.

  • Hospice care is intended for people with 6 months or less to live if the disease runs its normal course.  
  • You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.  
  • A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends.  
  • You have the right to change providers only once during each benefit period
  • At the start of each period, the hospice medical director or other hospice doctor must re-certify that you’re terminally ill, so you can continue to get hospice care.
  • If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor re-certifies that you’re terminally ill.

Also all Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan. That includes any Medicare-covered services for conditions unrelated to your terminal illness or provided by your attending doctor.

What happens if I need other medical services?

Once you choose hospice care, Medicare will no longer cover treatment intended to cure your terminal illness so talk with your doctor if you’re thinking about getting treatment to cure your illness. Prescription drugs to cure your illness (rather than for symptom control or pain relief) also will no longer be covered by Medicare.  But remember, you always have the right to stop hospice care at any time for any reason. If you stop your hospice care, you’ll get the type of Medicare coverage you had before you chose a hospice program (like treatment to cure the terminal illness) If you’re eligible, you can go back to hospice care at any time as well.

All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.

Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

Care in an emergency room, inpatient facility care, or ambulance transportation is also not covered, unless it’s either arranged by your hospice team or is unrelated to your terminal illness.  This means you MUST contact your hospice team before you get any of these services or you might have to pay the entire cost.

What are the costs for Hospice Care under Original Medicare?Elderly woman kissing young girl

  • $0 for hospice care and there is no deductible.
  • Co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
  • 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest).
  • Your usual Part B deductible and coinsurance for your doctor’s services (if your attending doctor isn’t employed by the hospice).
  • Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • If you pay out-of-pocket for an item or service your doctor ordered, but the hospice refuses to give you, you can file a claim with Medicare. If your claim is denied, you may file an appeal.

Please Contact Me if you have any questions. 

Beware of Scare Tactics about Obamacare

Regardless of your political sensibilities, intentionally scaring people with inaccurate and incomplete information is unethical.  The tactic of frightening senior citizens in order to advance a political agenda has become far too common.  When a new client asked me not about the security and peace of mind that Medicare would bring him but instead about how he would pay for his medical care once “Medicare premiums double or triple in the next two years” I decided things had gone too far.
Over the past few weeks I have been getting a lot of questions about rumors that Obamacare is going to cause Medicare premiums to double or triple by 2014.   It seems to have started with an email circulating that states as part of Obamacare (known more formally as the Patient Protection and Affordable Care Act, or PPACA) the Medicare premium will increase to $247 in 2014. The short answer to the question of the whether these figures for Medicare insurance premiums are accurate is no.
In the last few years, the standard monthly premiums for Medicare Part B have been set as follows:
2009 $96.40*
2010 $110.50*
2011 $115.40*
2012 $99.90*
(The actual premiums paid by some Medicare participants may be slightly higher or lower than these standard amounts.  For example, many beneficiaries paid less than the listed amounts in 2010 and 2011 because of the “hold-harmless” provision of Medicare which states that if the dollar increase in your Medicare Part B premium is bigger than the dollar increase in your Social Security check, you don’t have to pay the difference.)
As for future Medicare Part B premium rates, the information cited in the rumors that this email has generated is wrong on two counts: No provision of the health care legislation passed during the Obama administration sets Medicare premium rates, nor is a whopping jump of over 100% to a $247.00 monthly premium in 2014 a realistic figure.  New Medicare premium rates come out each fall and take effect in January.   Medicare beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue.  In other words, Medicare beneficiaries receive a 75% subsidy for Part B, with every $1 in Part B premiums for enrollees matched by $3 in general revenues.
Although the annual premium rates aren’t officially set until they are announced each fall, Medicare administrators track trends and anticipated changes and use them to formulate projections of Medicare premiums for the next several years.  According to the most recent report ( of the system’s trustees, issued in May 2011, those projected premiums (as listed on page 218) are:
2013: $110.50
2014: $115.80 
2015: $120.80
2016: $126.00
2017: $132.70
2018: $140.30
2019: $148.40 
2020: $158.60
I hope this helps put your mind at ease! Please share this with your friends who have also heard this terrible untruth!  

Medicare Supplemental Insurance & Medicare Advantage Plans

Someone on Facebook recently asked me,

“What’s the differences between Medicare Supplemental Insurance and Medicare Advantage Plans?”

Questions like these are the reason I love this business. People need to know that there are many options in Maine when you turn age 65.

There are many differences. One difference between Medicare Supplemental insurance (Medigap) and Medicare Advantage plans is that Medicare Advantage contracts operate on a calendar year basis (annually renewable) and Medicare Supplement policies are guaranteed renewable. Guaranteed renewable means that the insurance company cannot change what your Medigap policy covers once it is issued, or terminate your policy, unless you do not pay your premium within the grace period and/or you made a material misrepresentation on your application.

Faced with too many medicare options?

Another difference is the cost. Medicare Advantage Plans generally have lower monthly premiums than Medicare Supplements but you are required to share in your medical costs by paying co-pays as you use the plans.  Medicare Advantage Plans operate very similar to the Medical insurance you may have had before you retired if you had an HMO or a PPO plan.  Medicare Supplemental insurance (Medigap) plans generally have a higher monthly premium but you are usually not required to pay much else, if anything, out of pocket.

This is why many people turning 65 choose to meet with someone who can help them decide which plan is best for them. Choosing between these two types of Medicare insurance plans is an individual decision. What is the best plan for you may not be the best plan for your spouse.  For more information you can also visit the Medicare website at or call your local Area Agency on Aging to speak with a volunteer.

Need more help comparing the different health insurance plans?  I can help you.

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started.
Have a question that needs to be answered right away? Just give me a call at your convenience.  You can talk to a licensed insurance agent at (207) 370-0143 or call toll free 866-976-9038.
Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

If you would like me to come to your home and meet with you one-on-one please Contact Me.  My phone number is (207) 370-0143.

There is no obligation to you and no cost to meet with me.

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