Question from Greg: My wife has Multiple Sclerosis. She’s having mobility issues and is likely going to require some in-home care in the future. One of her primary needs is somebody to assist with bathing. I didn’t know if Medicare helps pay for a home care worker coming in once or twice a week to assist with personal hygiene. Can you advise please?
Question from Patricia: I think I get the differences between Supplements and Advantage Plans. However, I’m not clear how you add on Prescription coverage. Most people who are complaining are doing so about the cost of medicines. I would like to avoid this if possible.
I wanted a Supplement but wasn’t sure I could afford one, so I took a $0 premium Advantage Plan HMO. Now I’m scared I made the wrong decision. I’m a type 1 Diabetic with complications. Can you help advise me please?
When should those of us turning 65 start to plan for Medicare? What steps do we need to take? Contact The Health Insurance Store for more information.
Question from Sylvia: I just found out that I need to get the updated Shingles (Shingrix) shot, and in an online chat with the provider to inquire if it’s covered, I found out that my deductible for Tier 3 – 5 drugs is $435. The Shingrix shot is considered a Tier 3 drug and therefore subject to the deductible at a cost to me of $175. That deductible seems a little high and isn’t something I anticipated.
I and thousands of other US Steel Retirees are confused. We are provided an Advantage Plan. Calls to US Steel, Aetna, and the United Steelworkers Union all end up with the same response. “If you drop, change, or enhance the plan, you can never get it back”. We have no dental or eye protection that retired seniors drastically need. Is there any plan or supplement available that won’t break the bank?
My husband and I are investigating making a switch from an Advantage plan to a Supplement, if we qualify, and have several questions which we’ve not yet seen addressed in your columns:
Should I move from an Advantage plan that has a premium in the $70 per month range, to a true Medicare Supplement and Part D prescription plan at a cost of $150? Taking into consideration what someone may pay for medical services, in addition to Advantage Plan HMO or PPO premiums, a Supplement could be a much better value. Let’s take a look. #thehealthinsurancestore, #getyourbestplan
Question:
In last week’s column you recommended that people who have Medicare Supplements G or F change to N. I’m afraid to do that because N has Excess Charges. Is my fear founded? Can you fully explain what Excess Charges are and how they work?
Answer:
You don’t need to be afraid to switch to N due to Excess Charges for several reasons.
1) It’s illegal to bill Excess Charges in Pennsylvania as well as seven other states.
2) Only Doctors who don’t accept “Medicare Assignment” can bill Excess Charges. It’s estimated that only 7% of doctors do not and they generally fall into two categories: Primary or family doctors who’ve decided they just don’t want to deal with taking insurance. They work for cash only and aren’t interested in making claims to Medicare or private insurers. The others are doctors who treat the Uber rich such as movie stars, Wall Street CEO’s, foreign dignitaries, etc. They work out of places like Manhattan, Miami Beach, Los Angeles, and Palm Springs. Even after charging the maximum Excess Charges, 15%, these doctors would be working for pennies on the dollar compared to what their clients pay. They aren’t interested in giving that kind of discount to people like you or me.
3) There isn’t a full-service medical hospital in the country that doesn’t accept Medicare Assignment. As the population continues to age and people live longer, they don’t have a choice. It wouldn’t take long for a hospital to become wildly unpopular if they decided to bill people more than their competitors, which would lead to treating fewer patients. I imagine it also would cause billing nightmares. By the time they had to hire more people to work in billing and pay agencies to collect unpaid bills, the Excess Charges probably wouldn’t generate any extra profit. You might now ask “Even if the hospital accepts Medicare Assignment, what if the surgeon or anesthesiologist doesn’t?” That would be extremely, extremely rare. First, the majority of physicians are employees of a hospital system in today’s healthcare environment.
There are very few independent doctors left, especially surgeons who need to perform procedures in hospitals and outside of their own facilities. Secondly, doctors must meet certain criteria to get hospital privileges. I assume taking Medicare Assignment would be one.
4) Never. Not one single time, have we gotten a call from a client who has been billed Excess Charges. Plan N was introduced in 2010. I recognized the value immediately, and it has been the most popular plan among our clients since. We have sold over 3,000 Plan N policies. We make sure our clients understand the bills they are responsible for no matter what plan letter they choose. With N, it’s three bills and three bills only; the Medicare Part B deductible ($198 in 2020), a $20 co-pay at a primary care doctor or specialist, and $50 at the Emergency Room. They are well aware they pay $0 after their deductible has been met for services such as blood tests, X-Rays, MRI’s, CT Scans, hospitalizations, surgical procedures, durable medical equipment, diabetic supplies, Chemo, radiation, outpatient rehab, Skilled Nursing, etc. We instruct them to contact us right away if they get a bill for any of these services or one in excess of $20 for an office visit or $50 at the Emergency Room. We would know if billing Excess Charges were even a rare occurrence.
Today’s topic is regarding Supplements. However, I want everyone to understand that Advantage Plan HMO’s and PPO’s work very differently in regards to what bills one is responsible for, what doctors and hospitals one can access, how medical services are approved or authorized, how they are regulated, and what they cost. It’s vital to understand the pros and cons of both types of plans when making a choice. This is especially important for those going on Medicare Part B for
the first time, as this is generally the one and only chance people have to get a Supplement without their medical history being considered. That’s not the case with Advantage Plans. They must accept everyone who has both Medicare Parts A and B, regardless of past or present health issues, with only one exception.
If you are turning 65 soon or thinking about retiring, give us a call to set up a no cost consultation. Our agents are brokers, appointed with virtually every competitive Advantage Plan, Supplement, and Part D plan available on the market. Do not make the common mistake of simply calling the company you currently have your insurance with and buying a plan. Many companies won’t explain Supplements or even mention them as an option.
And if you already have Medicare, feel free to contact us to get a second opinion on what plan you may have enrolled or renewed in during the Annual Election Period which ended December7th. I’d also like to remind those readers who don’t live within a convenient drive to one of our three Western PA locations in Forest Hills, Connellsville, or Erie, we can consult over the phone or via virtual appointment, which is almost like sitting across the desk from an agent. You can also call with any questions or email me personally at aaron@hisc-80ff94.ingress-daribow.easywp.com. And don’t forget to follow us on Facebook for information on the latest news regarding Medicare and prescription drugs, which is going to be a hot topic as the House of Representatives debate and introduce bills that will supposedly attempt to reduce the costs of brand name medications.
No-cost, unbiased Medicare plan review and consultation with local, licensed agents.
Connellsville: 724-603-3403
Forest Hills: 412-349-8818
Save money, understand health insurance and get your best plan with the professionals at The Health Insurance Store.
Email: aaron@hisc-80ff94.ingress-daribow.easywp.com
Visit Online: https://getyourbestpla.wpenginepowered.com
#thehealthinsurancestore, #getyourbestplan
Ask the Medicare Specialist
Question: I’m going to be turning 65 in May. What do I need to do to enroll in Medicare?
Answer:
If you’re already collecting Social Security, you don’t need to do anything. You will be automatically enrolled and receive your Medicare card about 100 days prior to the month you turn 65. If you’re not yet collecting, you need to enroll in Medicare via Social Security. That can be done online at socialsecurity.gov or at your local office. You can apply for Medicare 90 days prior to the first day of the month you turn 65. I suggest starting that process as soon as possible to avoid delays in getting your card. Once it arrives, you can then choose a plan.
There are a couple of important scenarios people turning 65 need to be aware of. If you or your spouse are working and have the option of getting health insurance through an employer, you can opt out of Part B if that makes more sense financially. You’ll want to evaluate that, taking into consideration the cost of Medicare Part B, $144.60 per month in 2020, and the premiums for a Supplement or Advantage plan compared to what is being deducted from your paycheck for insurance. Many people don’t know what they’re paying for employer coverage. That’s a mistake. If you aren’t sure, ask your HR rep or whoever handles company benefits. It is also common for it to make sense for the employee to remain on the plan at work, but the spouse to come off. That’s because many employers are willing to cover more of the premium for the employee and less for the spouse.
There are more parts of the equation other than just cost. The size of your deductible and potential exposure to out of pocket medical bills also factor in. Medicare Supplements and Advantage Plans generally have little or no deductible. Another consideration when deciding to opt out of an employer plan and go with Medicare is what prescriptions you’re taking.
Those who take expensive brand name drugs are almost always best to stay on employer insurance due to the “Doughnut Hole.” One of our agents will be happy to help determine if remaining on your plan at work or going on Medicare is the better option. Please be advised that you absolutely should not drop Part B if you get health insurance from the company you retired from. Only those who are still working can do so and avoid what is known as the “Part B Late Enrollment Penalty.” We have met far too many retired teachers and Federal employees who made that mistake.
If you remain on an employer plan past 65 and opt out of Part B, when you do retire or decide that Medicare’s a better value, a document titled “Request for Employment Information,” will be required by Social Security. This form needs to be filled out by your employer in order to in enroll in Part B without penalty. We can provide a copy when needed.
I can’t stress this enough. When going on Medicare for the first time, it’s vital you get all options explained thoroughly. Not all Medicare plans are Supplements! I estimate 95% of people I meet for the first time have no idea Medicare Advantage Plan HMO’s and PPO’s aren’t secondary to Medicare. Advantage Plans are not designed to pick up the portion of the bill Medicare doesn’t pay (generally 20%). People on Advantage Plans have co pays for practically every medical service. If you have an Advantage Plan you will pay for doctor visits, blood tests, X-Rays, MRI’s, CT Scans, ambulance services, Emergency Room visits, etc. Other more expensive services like hospitalizations, Chemotherapy, Radiation, and Skilled Nursing stays can have out of pocket costs in the thousands of dollars.
Advantage Plans are quite popular and can make sense for those looking to save money on monthly premiums. However, they need to be chosen wisely. There are now approximately 50 HMO and PPO plans available in the Western PA market. It’s my professional opinion only a handful are worth considering. If you currently have Medicare and want to ensure you’re on what I consider to be one of the most competitive Advantage Plans for 2020, we can give you our thoughts in a matter of minutes with a simple phone call.
Advantage Plans have networks of doctors. And while most plans provide access to all Western Pennsylvania hospitals, there are plans that don’t. We have had many clients who got a rare disease or form of Cancer who needed to use out of State hospitals such as the Cleveland Clinic, UCLA, MD Anderson Cancer Center. That isn’t possible with most Advantage plans.
Supplement on the other hand, give you access to virtually all doctors and every hospital in the entire country, not just Western PA. There are no additional costs to use out of area medical providers.
Very few people realize when you initially go on Medicare that’s generally the only time in you life when Supplement companies accept you regardless of your current or previous health conditions. Federal regulations state they cannot deny your acceptance. However, seven months after you get Medicare Part B, those companies can deny your acceptance based on pre-existing conditions.
If you haven’t compared Advantage plans from multiple companies, or to Supplements the risk of receiving large medical bills and paying more premium than necessary are often the results.
No-cost, unbiased Medicare plan review and consultation with local, licensed agents.
Connellsville: 724-603-3403
Forest Hills: 412-349-8818
www.hisc-80ff94.ingress-daribow.easywp.com
Email your question to: aaron@getyourbestplan.om
Save money, understand health insurance and get your best plan with the professionals at The Health Insurance Store.
Visit Online: https://getyourbestpla.wpenginepowered.com
#thehealthinsurancestore, #getyourbestplan
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073
Serving These Areas
We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico
Not affiliated with the U. S. government or federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.