Did you enroll in the wrong plan?

Did you enroll in a Medicare Advantage Plan or Part D drug plan by mistake or were you misled?

 

One of today’s options is to use The Medicare Advantage Disenrollment Period.

You can switch from your Medicare Advantage Plan to Original Medicare during this period. You can only make this coverage change if you have a Medicare Advantage Plan. The Disenrollment Period occurs each year from January 1 to February 14.

If you have a Medicare Advantage Plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Any changes made during this period will become effective the first of the following month.

For example, if you switched from a Medicare Advantage Plan to Original Medicare and a stand-alone prescription drug plan in February, your new coverage would begin March 1st.

Note: If you are enrolled in a PFFS plan with a stand-alone drug plan, you must keep your stand-alone prescription drug plan if you switch to Original Medicare during the Annual Disenrollment Period.

What if you miss the annual disenrollment period?

 

You ALSO have the right to disenroll and change plans if you…

  • …joined unintentionally. For example, you may have enrolled believing you were joining a Traditional Medicare Supplement (Medigap plan) or a stand-alone Part D plan that would supplement Original Medicare. You did not realize you were joining a Medicare Advantage plan with a limited doctor network through which you must get all of your Medicare health benefits.
  • …joined based on incorrect or misleading information. You may have been misled, for example, if a plan representative told you that your doctors are in the plan’s network but they are not, or if you were promised benefits that the plan does not really cover.
  • Through no fault of your own, ended up or were kept in a plan you do not want. For example, if you tried to switch plans but were kept in your old plan, you have the right to disenroll and change plans. You can also make a change if you were enrolled in plan through an administrative or computer mistake.

How you should request disenrollment depends on whether or not you have use services.

  • If you have used health services since you joined your plan (for example, you saw a doctor or filled a prescription), and your plan has denied coverage for services, you may want to request retroactive disenrollment or disenrollment back to the date you enrolled in the health plan. Retroactive disenrollment allows you to be disenrolled from a Medicare Advantage or Part D plan as if you had never joined it. Depending upon your situation, you may then wish to select Original Medicare (with or without a Part D plan) or a Medicare Advantage Plan with or without drug coverage. If you are granted retroactive disenrollment, once the request has officially gone through, you should ask any doctor who gave you care during the time when you were enrolled in the plan to refile the claims with Original Medicare and/or, your new Medicare Plan(s).
  • If you have not used any health services since you’ve had your Medicare Advantage Plan, you may want to request a special enrollment period to disenroll from your plan and make a new choice going forward. If your request is granted, you will be disenrolled from your plan at the end of the month in which you made the request. Such requests are generally processed faster than retroactive disenrollment requests. To prevent gaps in coverage, you should sign up for new coverage right away so that it starts as soon as you are disenrolled from the plan you did not want.

To request a retroactive disenrollment or a special enrollment period, call 1-800 MEDICARE and explain to the customer service representative exactly what happened to cause you to join the plan by mistake.

Would you like my help?

If you would like to talk to me or schedule a meeting to discuss your options, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send me an email message.

You will not pay anything for my help.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You do not pay any more than anyone else for your insurance and you are under no obligation whatsoever to enroll or change plans if you meet with me.  

Book an appointment with Maine Medicare Options using SetMore

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

 

 

 

 

Want Some Advice? Shop Around!

Like the song says, “You better shop around!”

This is very good advice!

Whether it is groceries, heating oil, or anything else, everybody wants to get the best value for their money. And today’s options for health insurance can be pretty darn costly. That’s why it’s a good idea to shop around for the right Medicare supplement.

Cost is not the only thing to consider.

There are dozens of Medicare plans available in Maine and New Hampshire this year, all with different costs. 

Keeping the following things in mind will help you make a smart choice and get a plan that meets your specific health care needs.

  • How much are each plan’s premiums and deductibles?
  • How much will you pay for the benefits and services you’re likely to use?
  • Is there a limit on what you will have to pay out-of-pocket for the year? 
  • If you’re currently enrolled in a plan, how does that plan stack up to the other plans that are available this year?

Comparing costs of today’s options for prescription drug coverage is another part of the cost puzzle

  • Do you know how much your prescriptions will cost under each plan? 
  • Does the plan cover the drugs you take? 
  • Will the Part D coverage gap (or “donut hole”) effect you?

Only you can determine what mix of benefits and costs will work best with your needs and budget, but I can help. 

Meeting with me will make it easy to compare plans so you can pick one that best meets your needs. 
I will explain everything you need to know and after we’ve narrowed your options to a few really good plans, together we will review those plans to get more details about their benefits and services. 

And you pay nothing for my help!

That’s right. I will help you review your plan options.  I can answer any questions you have about these plans because I am trained by each insurance companies on how the plans work plus I have clients who use these plans and I have real experience helping them year after year.  And I am available throughout the year if you have any questions or need help! 

This means you get to benefit from other people’s experiences!

I will show you which medicare supplements will cost you less and I will also share with you which medicare plans my customers prefer based on their experiences with customer service and working with the insurance company so you’re not stuck fighting to get them to pay for something.
No one plan is perfect for everyone.  Each plan is different, just like each person is different.  I will help you understand the differences so you can make a choice with confidence!

Would you like my help?

If you would like to talk to me 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.”

Book an appointment with Maine Medicare Options using SetMore

CMS Lifts Sanctions on Cigna

UPDATED on July 12, 2017.

Cigna, whose Medicare Advantage business has been under sanctions for 18 months, is once again free to enroll customers in MA plans beginning July 1, according to a filing from the Securities and Exchange Commission.

The Centers for Medicare and Medicaid Services lifted a suspension placed in January 2016 after “widespread and systemic” failures that prevented members from accessing medical services. According to Reuters New Reporting Service, the governments imposed sanctions when it learned Cigna failed to “handle complaints and grievances properly from patients who had been denied coverage for health benefits or drugs.” The audit also found issue with its list of covered drugs.

According to Modern Healthcare, the sanctions have had a big effect on Medicare enrollment figures. As of March 31, Cigna enrolled 441,000 Medicare members, down 20 percent from the same period in 2016, just after the sanctions took effect. According to the 2017 Q1 report, revenue was also down 18 percent over the last year.

The Original story (published in 2016) …

Cigna Corp. announced on September 6, 2016 that it will not be able to offer new insurance plans during Medicare’s upcoming Annual Open Enrollment period.

Cigna said, in a notice filed with the U.S. Securities and Exchange Commission, that it’s still working with the Center for Medicare & Medicaid Services (CMS) to address audit findings that led to a Medicare plan sales ban in January of 2016.

“Cigna expects that these matters will not be resolved in time to participate in the 2017 Medicare Advantage and Part D annual enrollment period.”

In January of this year, CMS accused Cigna of running its Medicare plans in a way that threatened enrollees’ access to care. CMS prohibited Cigna from selling new Medicare plans in 2016, but allowed Cigna to continue to cover the people in the Medicare plans it had already sold.

CMS also has opened up the rules for anyone currently on a Cigna Medicare plan so they can change plans at any time. Cigna Plan Members in 2016 do not have to wait until the 2017 Medicare plan annual enrollment period which is set to run from Oct. 15 through Dec. 7th.

If you have a Cigna plan and want to review your options you can do that today and your new plan can start the 1st of next month! You do not have to wait until the end of the year!

If you have a Cigna Part D prescription Medicare drug plan and would like to find a plan that gives you better coverage or lower costs you can call 207-370-0143 and a licensed agent will review your plan choices with you.  There is no obligation to change plans and there is no cost for this help.  You can also call toll free: 866-976-9038 or fill out the online request HERE.

How to get the Generic EpiPen & pay less.

The drug company Mylan recently announced that it would roll out a new, generic version of its branded drug for just $300 per two-pack for commercially-insured patients.

Mylan has expanded it’s patient assistance program, which provides coupons and discounts to patients whose household incomes are four times the federal poverty limit.

The company’s generic version of the EpiPen is set to launch “in several weeks” and will be listed at 50% of the price of the brand name version, which has a retail price of about $600 per two-pack.  Aside from the cost, the generic version will be “identical to the brand-name product, including device functionality and drug formulation.”

If you have insurance with a high deductible, you will want to apply for their $300 savings card to access the generic EpiPen.  The “My EpiPen Savings Card,” as it’s called on the company’s website, will then “act as cash” at the pharmacy, bringing down the cost of your co-pay or co-insurance for a two-pack of EpiPens to no more than $300.  You can use the savings cards to purchase up to 6 two-packs per year.

Click here to get your card:  www.epipen.com/savings

If you have any questions or need help with the cost of your medications or would like reviewing your health insurance plan or Medicare Part D prescription drug plan, please send me a message using the CONTACT page or call me at (207) 370-0143.

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

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.”

Book an appointment with Maine Medicare Options using SetMore

Phyllis Vance turns 65

Today I read that actress Phyllis Smith’s is turning 65. Like me, you probably remember her best from her role of Phyllis Lapin-Vance on the television show, The Office.

If her character were actually turning 65 and retiring and if Dunder Mifflin were in Stratton, Maine instead of Scranton, PA and if she called me to help her find a Medicare plan (I know, a lot of “ifs”).  I started to imagine what that meeting would have been like.

I arrive at Phyllis’ home on time and ring the bell. She answers and invites me in.

I introduce myself, “Hello, I’m Todd.”

We shake hands.

“I’m Phyllis Vance,” she replies. “My husband is Bob Vance, he owns Vance Refrigeration.”

“Oh, yes I’ve seen his television commercials,” I reply.

She smiles a satisfied smile.

As Stevie Wonder plays quietly in the background, we sit down and start talking about what her needs are, when she plans to retire and I tell her a little about myself and how I got into this business of helping people.

“Can I get you something to drink? Water? Coffee?  How about some cake?” She holds up what appears to be a cake in the shape of a woman’s butt wearing nothing but a thong.

“I made it myself. I’m thinking of going into the erotic cake business part time when I retire.”

I politely refuse the cake and I start my standard spiel, “Before I begin explaining Medicare and how it works, do you have any questions?”

She asks if “Viagra” is covered by Medicare and I explain how prescription medications are covered by private health insurance plans with an approved Medicare contract under Part D of Medicare.” I explain, “Not all drugs available are covered by Part D plans. Drugs used for purely cosmetic purposes, as well as Erectile Disfunction remedies such as Viagra and Cialis, are also excluded from most plans. However, starting January 1, 2016 some Medicare Advantage plans and Part D drug plans have included Viagra on their lists of covered drugs.

“That’s good,” she grins, “because when Bob turns 65 he’ll need that.”

I explain how Medicare has four parts, A and B – managed by the federal government, referred to as Original Medicare and C and D – offered by private health insurance companies with contracts approved by Medicare. As I tell her the details on the differences of Part A and Part B, the costs and what they cover, she asks if Medicare would cover her in Rome.

“Friends of ours that I used to work with, Jim and Pam went to Rome a few years ago so Bob is taking me there this summer.”

“That sounds wonderful. I’ve always wanted to see Italy,”

She continues, “Jim and Pam had one of those office romances. I knew about it before anyone else.”

After hearing some stories about this young couple we talk about her insurance options. I explain the differences between Medigap plans and Medicare Advantage plans and how both work with Medicare. I go into detail about the Emergency coverage both types of plans offer outside the U.S., while she is in Rome.  After she asks a few more questions and determines which type of plans seem best for her we talk about the prescriptions she takes and I look them up to see which plans offer the lowest overall costs for her.

After reviewing these plans she tells me which one she likes best and we fill out the application together. While I’m filling out the application I ask if her co-workers threw her a retirement party and she tells me that since she is head of the party planning committee she actually had to plan her own party. She tells me some stories about this horrible woman named Angela that she worked with but in the end she’s really going to miss everyone there, even Angela.

I take the application and I tell her the next steps in the process.  She asks what she has to do next and I tell her, “Nothing.  I will take care of it from here.  If there are any problems with the application, I will call you and let you know.  I will also follow up with you in a couple weeks to make sure you have your insurance card and answer any remaining questions.

We say our goodbyes and I leave my business card so she can contact me if she thinks of any more questions or gets anything unusual in the mail. I get in my car and smile to myself as I drive back to the office, remembering why I love this job so much.  I love helping people and I get to meet so many truly wonderful people from all walks of life and they share some great stories!

The end.

If you want to know more about the differences between Medigap and Medicare Advantage plans I also wrote about that here: http://www.mainemedicareoptions.com/blog/medigap-vs-medicare-advantage

Part D Late Enrollment Penalty (LEP)

Last week I met with a gentleman who enrolled in Medicare a few years ago when he turned 65.  At the time he was healthy and took only one generic prescription that he was getting for $4.00 at Walmart so he did not see the need to spend $20 per month on a Part D Prescription Drug Plan that would only reduce the cost of the drug to $2.

Recently he had been prescribed a more expensive brand name drug so he called me to help him compare the costs on the different Part D plans in his area.  We found a plan that was perfect for his situation and he was very happy until I explained to him that he would have to pay a Late Enrollment Penalty (LEP) on top of his regular premium.  He did not understand why he should have to pay almost $10 per month extra because he did not have insurance.  Unfortunately this is how it works and the worst part is that he will pay this additional $10 for the rest of his life.

How can you avoid this penalty?

If he had just contacted me when he first turned 65 instead of doing it all alone I would have told him about the penalty and also could have helped him avoid the penalty altogether by telling him about a Medicare Advantage plan in his area that has a $0 monthly premium.   He would have had drug coverage with this plan.  He would have avoided the penalty AND his co-pay for his one generic prescription would have been $0!  By taking the time to meet with me he could have saved $48 per year AND avoided the penalty!

The Part D late enrollment penalty is important to understand if you are thinking of going without a drug plan.  Your penalty is calculated by adding 1% of the national base beneficiary premium ($34.10 in 2016) for every month you do not have a Part D insurance plan or certain other types of drug coverage while eligible for Part D.  This amount is added to your monthly Part D premium for life.  To avoid this penalty you must enroll in a plan that is at least as good as Medicare Part D coverage (this is known as “creditable” coverage).

NOTE:  COBRA does not offer “creditable” coverage so be careful if you are on a COBRA plan and turning 65.

Can you appeal the penalty?

Absolutely!  You always have the right to appeal any decisions like this that involve Medicare costs, but in this case your appeal is unlikely to be successful if your reason for not enrolling is that you “did not know that you were supposed to have prescription drug coverage.”

Your appeal is more likely to be successful if you believe there was a mistake, such as:

  • If you were covered by creditable drug coverage while eligible for Medicare. (Such as a group health plan through your employer)
  • Or if you received inadequate information or were not informed about whether your drug coverage was creditable.

To appeal the LEP you will need to complete the appeal form you receive from your Part D Prescription drug plan after you enroll in a plan.  Then attach any evidence you have. Evidence can be a letter from your employer or former employer stating that you had creditable coverage during the time that you were eligible for Medicare but not enrolled in a Part D plan. Then mail everything to the address on the appeal form. This address should be for MAXIMUS Federal Services, which is the company contracted by Medicare to handle these appeals.

The appeal deadline is 60 days from the date you received the letter informing you of the penalty. You can expect a decision from MAXIMUS within about 90 days. If your appeal is successful, your plan has to pay you back for the LEP payments you made while your appeal was pending.

Don’t be afraid to ask for help!

Working with someone like myself who has the knowledge and experience with these Medicare plans can help ensure you do not miss any of these important details and can also simplify the entire process of comparing Medicare supplement plans.

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.”

Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

Medicare Diabetes Coverage

Diabetes is a common medical condition in which the body either doesn’t make enough insulin or doesn’t respond properly to the insulin it makes.  A healthy body uses insulin to process sugars, but when there isn’t enough insulin in the body, too much sugar stays in your blood.  If your blood sugar remains consistently high, your doctor may diagnose you with diabetes.

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.

Medicare Part B and Medicare Part D generally cover the services and supplies needed to control diabetes. Here’s a breakdown of how Medicare covers diabetes.

How Medicare Part B covers diabetes

Medicare Part B covers the fasting blood glucose test, which is a diabetes screening. Medicare covers 2 diabetes screenings each year for beneficiaries who are at high risk for diabetes.  High risk factors for diabetes include: high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar.  If diabetes runs in your family, you may also need regular diabetes testing. Your doctor may also recommend services that Medicare doesn’t cover.

You generally pay nothing for these diabetes tests if your doctor accepts the amount approved by Medicare for the diabetes screening. However, you may have to pay 20% of the amount approved by Medicare for the doctor’s visit.

If your doctor diagnoses you with diabetes, Medicare covers the supplies you need to control your diabetes, including blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, and blood sugar control solutions.

Medicare Part B may cover an external insulin pump and insulin as durable medical equipment(DME).  You pay 20% of the amount approved by Medicare, after the yearly Medicare Part B deductible.

Diabetes may result in blood-circulation problems that can become serious over time. For example, poor blood circulation increases the risk of problematic foot disease issues.  Medicare Part B covers foot exams every six months, as long as you haven’t seen a foot care professional for another reason between visits. Therapeutic shoes are also covered for people with diabetes who need special footwear.

Medicare may also cover medical nutrition therapy for diabetes, if referred by a doctor. You pay 20% of the amount approved by Medicare after the yearly Medicare deductible for services related to diabetes.

If diagnosed with diabetes, Medicare Part B may cover up to 10 hours of initial diabetes self-management training. You may also qualify for Medicare coverage for up to two hours of follow-up diabetes training each year. Training is only for those at risk or recently diagnosed with diabetes, and you must have a doctor’s or health-care professional’s written order for the diabetes training.

How Medicare Part D covers diabetes

Medicare Part D is Medicare prescription drug coverage, which is available through either a stand-alone Medicare prescription drug plan or a Medicare Advantage Prescription Drug plan.  Because insulin is a prescription drug used to control diabetes, Medicare Part D covers insulin.  However, Medicare Part D does not cover insulin for diabetes when it is administered with an insulin pump.  In that case, insulin for diabetes may be covered under Medicare Part B as durable medical equipment, as indicated above.  Medicare Part D also covers other drugs that can help control diabetes.

If you’re diagnosed with diabetes, you will need certain medical supplies to administer the insulin.  Supplies may include syringes, needles, alcohol swabs, gauze, and inhaled insulin devices.  Medicare Part D covers these medical supplies for diabetes.

Under Medicare Part D, you may pay a coinsurance or co-payment as well as a deductible, depending on your Medicare prescription drug plan or Medicare Advantage Prescription Drug plan.

Would you like help finding the plan that best covers what you need?

I would love to help you find the right Medicare plan or just answer 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.”

Book an appointment with Maine Medicare Options using SetMore

Retiree Plans & Medicare

If you have retiree insurance, it is a good idea to sign up for Medicare when you first become eligible at age 65.

According to Medicare rules, retiree insurance plans pay secondary to Medicare.  This means that Medicare pays first for your health care, and then your retiree coverage pays for some or all of the remaining costs.  If you do not sign up for Medicare, you may have problems accessing coverage.

Here are a few important things to know.

First, if you become eligible for Medicare and don’t sign up, your retiree policy may not cover you.  Many retiree policies require you to sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) and may not make payment until Medicare does.  If your retiree policy does cover your health care costs, it may later recoup payments it made when Medicare was supposed to pay primary.

Another consequence of not signing up for Medicare is the possibility of a late enrollment penalty (LEP).  An individual can be subject to this costly penalty if they do not sign up for Medicare when they are first eligible to do so.  You can avoid a late enrollment penalty by signing up for Medicare three months before or up to three months after you turn age 65.

It’s also important to know that some retiree policies provide creditable prescription drug coverage.  Creditable coverage means that your coverage is as good as or better than Medicare Part D prescription drug coverage.  If you have creditable drug coverage through your retiree plan, you can choose not to sign up for a Part D plan and not face a late enrollment penalty later should you lose your retiree coverage and decide to enroll in a Part D plan.

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.”

Book an appointment with Maine Medicare Options using SetMore

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 but there is a lot you should be aware of before you make this decision… [READ MORE]

Medigap vs. Medicare Advantage

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

Questions like this are the reason I do what I do.  You need to know what your options are in Maine when you turn age 65 and enroll in Medicare – and there are a lot of options!

There are many differences between Medicare Supplement plans or Medigap as they are called in the Medicare literature.

One difference between Medigap and Medicare Advantage plans is that Medicare Advantage contracts operate on a calendar year basis and can have changes from year to year just like the health insurance plan you had prior to Medicare.  Medicare Supplement policies are standardized and are the same year after year.

Feeling overwhelmed?  Get local help.  Click here.

Another difference is the cost. Medicare Advantage Plans generally have much lower monthly premiums (sometimes $0, yes you read that right – zero!)  While Medigap plans can be much higher, often in the $200/month range.

With Medicare Advantage plans you are required to share in your medical costs by paying co-pays as you use the plans.  These plans operate very similar to the Medical insurance you may have had before you retired if you had an HMO or a PPO plan on the Healthcare marketplace (Obamacare) or with an employer.  Most Medigap plans have no or few out of pocket costs but they cost much more up front.

This is why most people turning 65 choose to meet with someone like myself who has the knowledge and experience with the different plans and can help you decide which plan is best for you. Choosing between these two types of Medicare insurance plans is just the first step.

Once you’d decided on Medigap or Medicare Advantage then you much choose which Medigap plan or which Medicare Advantage plan best fits your needs.  You may also need to pick a separate Part D prescription drug plan if the plan you choose does not include drug coverage.

Also, the best plan for you may not always be the best plan for your spouse so you with have to do the same research for both of you. For more information you can click here to compare the Medicare Advantage plans & drug plans in your area.  You can also schedule a meeting with an agent at the bottom of this page.

And if you have a question that needs to be answered right away, just give me a call.  My number is (207) 370-0143 or call toll free 866-976-9038.

Want to know more?

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.”

Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

Getting the most out of Medicare!

Medicare is a big topic with multiple complexities. Even though you have been paying into it for years, you may know very little about it or how it works.  Everyone agrees that it can be difficult to understand the many different insurance plans available and the nuances that go along with each one.

What I do everyday is help people get a better handle on exactly how Medicare works. I explain, in understandable terms, how Medicare works and the different options that you have to best fit your medical and financial situation.

Medicare Part A and Part B

As the song goes, let’s start at the very beginning.  Medicare is available to people age 65 or older who are U.S. citizens or who are legal permanent residents, and either you or your spouse have worked for 10 years (or 40 quarters of a year). It is also available to people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease and Lou Gehrig’s Disease (ALS). For details on Medicare eligibility, visit http://www.ssa.gov/medicare.

There are basically two parts to Medicare, Parts A and B. Together, these are also known as “Original Medicare.”  If you ever read anything about Medicare in the newspaper or hear about it on TV it is almost always to Parts A and B that they are referring.

Part A: Hospital Insurance

Part A helps cover inpatient care in hospitals, skilled nursing facility care, home health care and hospice care.

Most people do not have to pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working.  For this reason, most everyone who is eligible enrolls in Part A when they turn 65 even if they are still working and covered by an employer health plan.

In 2016, there is a $1,288 deductible for the first 60 days that you are and inpatient in a hospital or skilled nursing facility.  Medicare calls this your initial “benefit period.” This benefit period resets after 60 days once you are out of hospital care.  If you are in the hospital longer than 60 days there is a co-pay of $322 per day up to your 90th day.  There is no coverage beyond 90 days each year except 60 days called “lifetime reserve days” that you can use at any time.  But understand that once these are used up they are gone for good.

Part B: Medical Insurance

Part B covers your doctor appointments, specialists, outpatient surgeries or care, durable medical equipment, and some preventive services.

Part B differs from Part A in that there is a premium that all beneficiaries must pay each month.  The premium starts at $121.80 per month, and can be higher if your annual income is over $85,000 for an individual or $170,000 for a married couple.

Part B also has a $166 deductible, and it will cover about 80% of all costs with no annual maximum out-of-pocket expenses.  You pay the remaining 20% as coinsurance.

Additional Medicare Options and Medicare Supplements

If you are enrolled in Medicare Parts A and B, you can choose to buy Medicare Supplement Insurance, known as “Medigap” from a private insurance carrier.   There are several plans to choose from and I think it’s best to sit down talk to a professional like myself who has the experience and knowledge to ask the right questions and identify which plans you should consider.

Depending on the supplemental plan that you elect, it will cover some or all of the costs that are not covered by Parts A and B. These programs can also help you cover the uncapped 20% of your medical expenses. There are several Medicare Supplement options that range from Plan A all the way to Plan N.

Typically if your doctor accepts Medicare, he/she will also accept your Medicare Supplement Plan (based on the terms and conditions of the plan). Take important note that neither Medicare nor Medicare Supplement plans cover medications, so you will have to enroll in separate prescription drug plan or Part D plan to cover the cost of your prescription drugs.

Part D- Medicare Prescription Drug Plan

These plans are provided by private insurance carriers. Each plan has their own list of approved drugs (also known as formularies).  I carefully review each plan’s list when I meet with new clients to ensure that your medications are covered and more importantly to compare the coverage on each plan to make sure you do not pay too much.  The cost for these plans can range from anywhere between $20 to over $100 per month and you can click here to view the plans available.

Part C: Medicare Advantage

Part C is also known as Medicare Advantage. I get asked the most questions about this program.  It combines Parts A and B and may add additional benefits (i.e. vision or dental), and typically includes prescription drug coverage (Part D). These plans can be as low as $0 per month in many areas. You can click here to view the plans available in your area.  Keep in mind that while using Medicare Advantage Part C, you remain enrolled in both Parts A and B and you are still responsible for those monthly premiums.

Medicare Advantage will generally take the shape of either a PPO or an HMO. A PPO gives you in and out of network choices, while an HMO will give you only one network of providers from which to choose. If you go to in-network providers, you will receive the negotiated rate. Be sure to research the chosen plan’s list of providers to ensure that your doctor is available in that network.

These programs typically have maximum out-of-pocket expenses that can be up to $6,700 per year, not including prescription drugs (in-network). Out-of-network provider expenses can cost even more. However, compared with the prospect of having to pay an “unlimited amount” due to the uncapped 20% we discussed earlier, $6,700 does not sound too terrible.

The Bottom Line

To get the most comprehensive and cost-effective coverage possible, most people end up electing some version of the following two combinations:

  1. Medicare Part A&B, with a Medicare Supplement Plan and Part D (to cover prescription drugs), OR
  2. Medicare Part A&B, with a Medicare Advantage Plan (Part C), most of which include Part D (to cover prescription drugs)
  3. Understand that you will have either a Medicare Supplement Plan or a Medicare Advantage Plan, but not both.

Premium-wise, a Medicare Advantage Plan will typically be less expensive per year than a Medicare Supplement Plan. For example, the cost range of the premium in Maine (my home state) is from $0 to over $110 per month. However, a Medicare Supplement Plan gives you more flexibility as there is no insurance company’s network of doctors that you are required to use. The cost range of the premium in Maine and New Hampshire is generally $100 – $200, depending on your age.

I would suggest that when you are planning for retirement you should also take time to think about your plan for medical insurance.

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

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