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?”

Do you need dental insurance?

I am asked all the time if Medicare covers dental?  The short answer is No, Medicare does not cover any routine dental care.

Medicare will only pay for dental services that are an integral part either of a covered procedure (reconstruction of the jaw following an accidental injury), or for extractions done in preparation for radiation treatment for diseases involving the jaw or if the tooth poses a health risk due to decay.  Medicare will not cover replacement of the tooth or a root canal or crown to save the tooth, nor will Medicare cover dentures.

According to a recent study by Boston-based discount dental service provider Universal Dental Plan, nearly half of Americans age 65 and older did not visit a dentist in the previous year, the number one reason being cost. The consequences of that decision can be dangerous. Poor oral health increases one’s risk of heart disease by 180 percent, risk of stroke by 300 percent and risk of respiratory infection by 500 percent – not to mention gum disease! Some folks opt to pay out of pocket for regular cleanings rather than pay for dental insurance, thinking that unless they were having major procedures done every year they would pay three or four times in premiums what they spend on the work needed.  But this not the best idea.

Medicare Advantage Plans May Include Dental

There are a few Medicare Advantage plans available in Maine and New Hampshire that cover routine cleanings and other work at the dentist.  When it comes time for you to enroll in a Medicare or during the Annual Open Enrollment Period (October 15th – December 7th in 2016) it is a good idea to review these plans if dental care is important to you.  Plans change every year and your plan may have added dental coverage and you don’t even know it.

Dental insurance is an alternative.

You can get a free quote from Delta Dental by clicking here.  The monthly premiums equal what most people pay out of pocket for their 2 cleanings each year so why now spend that money on the insurance so when you need a filling you will have coverage.   [Click here to see plans]

Dental Discount Plans are a popular option.

Discount plans are gaining in popularity. For a yearly membership fee, you can enter into a discount dental plan, which allows you to get significant discounts (between 15% and 60%) on dental costs, provided that you use dentists that accept these plans.  [Click here to see plans]

“Discount dental plans work like a BJ’s or a SAM’S Club membership,” says Edan Barshan, president of Universal Dental Plan. In return for the monthly fee, you can choose among a network of dentists who will give 10 to 60 percent rate reductions for certain services. That $1,000 crown might only cost $600 for a member of a plan.  And unlike dental insurance, which may not cover preexisting conditions or have waiting periods, you can shop for a discount dental plan knowing you need a root canal and select the plan that offers the cheapest price, says Buddy Johnson, chief executive officer of national discount dental provider DentalPlans.com. “You could sign up today and go to the dentist tomorrow,” he says.

Dental discount plans differ in several ways from dental insurance plans:

• Discount plans generally cost less than traditional dental insurance.
• You have to pay for the service in full, or negotiate a payment plan with the provider.

There are generally no restrictions on how many procedures you can get at a discounted price in a given year. Discount plans generally run for one year, so you can switch plans as your needs change. If you have a dentist already, you should ask whether he or she will accept the plan. Otherwise, you’ll need to find a provider who will. A number of discount dental plans include elective services, which are often not covered by insurance plans. Cosmetic dentistry, for example, is almost always excluded by insurance, but cosmetic procedures like tooth whitening are included in many discount plans’ list of services.

To search for discount plans in your area CLICK HERE and put in your zip code. As with any important financial decision, do your homework first. Find out what providers in your area are on the plan and what procedures are covered. Make sure that costs and benefits add up to a net plus for your particular situation.

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.”

Find out which insurance companies sell Medigap policies in your area.

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Medicare Supplements (Medigap) policies are standardized.

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can only sell you a “standardized” policy identified in New Hampshire and Maine by letters, A – N. (See Chart Below)

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.  Each insurance company decides which Medigap policies it wants to offer and the insurance companies don’t have to offer every Medigap plan.  So first choos the plan that’s right for you and then find out which companies offer that plan.

Note:  The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).

Medigap Plans

* Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything.
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015), the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Compare Medigap Plans and Rates

Shop Around for the Best Medigap Policy

Look for a Medigap policy that you can afford and that gives you the coverage you need most.  As you shop for a Medigap policy, keep in mind different insurance companies may charge different amounts for exactly the same Medigap policy, and not all insurance companies offer all of the Medigap policies.

Watch Out for Illegal Insurance Practices

You should know it is illegal for anyone to pressure you into buying a Medigap policy, lie or mislead you to switch to another company or sell you a second Medigap policy when they know that you already have one. It is also illegal to sell you a policy that cannot be sold in your state.  Work with someone local that has a good reputation and who you can trust.

Click here to learn about Medicare Advantage Plans under Part C of Medicare and how they differ from these Medigap plans.

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 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 any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“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.”