Important things to know about Annual Enrollment

Annual Enrollment Period, (AEP) also know as Open Enrollment Period (OEP) is from October 15th through December 7th each year.

All Medicare Advantage Plans and all Prescription Drug plans will change annually.  Medicare supplements (Medigap) benefits will stay the same and automatically renew.

  • It is important to “shop” for a plan every year..  This can be done at www.Medicare.gov or by contacting a reputable insurance agent that represents numerous plans.
  • Your existing insurance plan is required to let you know by letter what changes will be made for the upcoming calendar year.
  • If you are satisfied with your existing coverage, it will automatically renew for the next year.
  • If you want to change plans, this OEP is the time to make the change.
  • Be an educated consumer.  Changing plans could save you thousands of dollars per year.

Medicare Costs to Beneficiaries for 2018

Every year the Centers for Medicare and Medicaid (CMS) may change the out of pocket costs to Medicare recipients (known as beneficiaries).  In 2018, the Part A premium will continue to be $0 for most beneficiaries.  The Part B Premium will be $134 per month depending on your household income.  Those with higher incomes will pay more.  This is called IRMAA  and it based on a sliding scale. Feel free to contact me for more detailed information.

The Part A Hospital Deductible is $1340 per benefit period.

The Part B Medical Deductible remains stable at $183 per calendar year.

A Rehab/Nursing home stay will cost an additional $167.50 per day for days 21-100.

Please know that a supplemental Medicare policy (Medigap) may help pay for these increased costs.  Those who have Medicare Advantage Plans need to read their Summary of Benefits document since each plan has different premiums, deductibles and copays.

Dental Insurance Info

I recently met with Shirley, a prospective client for Medicare Supplement Insurance. She was shocked to find out that Medicare did not cover any dental costs. She said, “I don’t understand, good dental health and overall health go hand in hand”. I agreed, research shows oral health is linked to diabetes, heart disease, cancer and more. Unfortunately, that was not widely known at that time Medicare was implemented in 1965. Now, Medicare can not afford to pay out more benefits. Medicare beneficiaries need to purchase a separate policy if they want that coverage.

As it turns out, I can help. If you think insurance is hard to understand, dental Insurance is even more complicated and there are lots of choices. I begin by asking questions such as do you presently have a dentist and if so, are you willing to change? I ask that because a lot of available plans offer benefits only if you use their network providers. How often do you get your teeth cleaned? Do you routinely use services other that just preventative ones?

Consumers usually see the most savings when using a network type plan. This is because the insurance company has negotiated a significant discount. These savings get passed on to you. But, a lot of dentists do not work with any dental insurance plans or limit the ones they participate with. In that case, I recommend an “indemnity” type plan. With this type of plan, you can go to any dentist and get reimbursed for a portion of the expenses. Usually, the longer you keep your plan, the better the benefits.

I explain that either type of dental insurance can save significant money but it is not going to cover all the expenses. There are waiting periods, deductibles, co-insurance costs and usually a limited amount of coverage to consider. Occasionally, self-insuring may be the best choice.

Personally, I have a combination dental, vision and hearing plan that lets me go to whatever dentist I want. I get my prescription glasses at the warehouse-type stores where I really save. I love it because it really helps me budget my expenses and encourages me to take care of myself on a regular basis.

In case you are wondering, Shirley chose a dental plan that also included a membership to her local YMCA. The cost of the plan was lower than a regular membership fee. The dental coverage was like a free added benefit.

 

Don’t Miss Medicare Annual Enrollment Period

Beginning October 1, 2018 Medicare eligible beneficiaries can start “shopping” for new Medicare Advantage and Medicare Part D Prescription Drug Plans (PDP).   Those who are in Medicare Supplement plans should be okay unless you have seen major rate increases and want to see if you can get a better premium price.

I highly recommend at least looking at the options available to you.  I have seen clients save up to $2000 per year by just changing to the best prescription plan for them.  The Part D plans are annual contracts and can change significantly from year to year.  In this area, there were 24 different plans available in 2017.  All of them vary in premium, deductible, formulary, tier levels and prices, and pharmacies that they prefer you use.

Yes, unfortunately, the “donut hole”, (also known as the gap in coverage) will still be in place for 2018.  It will not be until 2020 that you should expect not to pay more than 25% of the retail price for any medicine.  If you have a difficult time paying for your medicines, there is “extra help” available. I can connect you to someone who will see if you are eligible income-wise and will help you complete the necessary paperwork.

As in past years, all Medicare Advantage Plans (also known as Medicare Part C) will change also.  There are insurance companies that are “exiting the market” and a few new ones coming in.  The premiums, co-pays and co-insurance will likely go up. Be sure to check if your doctors are “in Network”. It does not cost anything but a little time, to be certain that you are in the best plan.

If you qualify for Medicare but are still covered under a work health plan, you may very well want to look at your options.  You should be able to get better coverage for a lower cost by utilizing Medicare and dropping your work insurance.  That can be a scary thing to do, but as long as you have a competent advisor, it may well save you money!

I consult for free.  Only if I put you in a new plan, am I paid a commission by the insurance companies. You do not have to pay anything extra to get the benefit of my years of knowledge and experience. Please don’t wait. This election period ends December 7th.

 

 

How Do I Get Paid?

I recently had a  prospective client ask how much my services cost. She had checked out my website, yet that question was not clear. It is not a secret, and I want all my clients to feel comfortable using me and my knowledge. I am an independent insurance agent/broker. I do not work for just one insurance company. I do not get a paycheck or any benefits. I do however, contract to represent many reputable insurance companies. If and when I place a policy with them, they reward me with a commission. In all honesty, these commissions can vary significantly. However, it is my practice to place my clients in the best policy for them; not the one that will pay me the most. There is also a misconception that using an agent will cost more than dealing with a company directly. That is not true. The Virginia Department of Insurance approves all the insurance rates. They are published in black and white, no matter what course you take to obtain your policy, the rates are the same. Why not use your local, experienced agent instead of trying to talk to someone on the phone, or figure it all out on the internet? I am not a high pressure sales person. Also, not only do insurance companies pay me for explaining the policy and doing the paperwork, many continue to pay me a trail of commissions for a certain time. That means every year that you renew, I get a small payment again. This is a good deal for you and for me. The insurance company wants you to be happy with their product. They know an approachable agent is of value to them and their clients. I tell my clients that they may contact me at any time for any reason. They are not “bothering” me, I get paid to help them and it is an important part of my work. Even if you choose not to buy a policy for from me, that is okay. I trust that I will have done a good enough job for you that you might refer me to someone else who will buy. I trust God that if I do the right things for my clients, God will make sure that my needs are provided for. It has worked well.

Two Words Can Cause Medicare Patients Thousands of Dollars!

You could get caught owing many thousands of dollars even though I have sold you the best coverage available.  This is due to two little words in your hospital medical chart – “Under observation”.  Make sure that if you go to the hospital and stay there, that you are actually “admitted.”  NBC News explains it in this two words can cause medicare patients thousands of dollars video.

Here is another video created by Ronald Hirsch that explains the details of these rules. Ask to be admitted as an inpatient- The real rules.

Update 2018:  This is still a major problem today.  The laws now require hospitals to give formal notification of status change.  However, it is a form and it is seldom read or understood.  A nurse will just ask you to sign that you have received the paper. Your nurse may not even know the implications of moving you to observation status.

Unhappy with your Medicare Advantage Plan?

For those who enrolled or were re-enrolled in a Medicare Advantage plan for 2014 and are having “issues”, there is a way out;  But you need to act before February 14, 2014. Maybe your doctors are not in network, or a prescription you need is not covered. The government wants you to stay in your plan the whole year but will let you out in this special time called the Medicare Advantage Disenrollment Period (MADP).

It is important to know that this will return you to original Medicare.  You do have a guaranteed right to get into another prescription plan.  In addition, you may be able purchase a Medicare Supplement or other Medigap policy if you qualify. You may not enroll in another Medicare Advantage plan for this year.

If you are confused or want clarification, please feel free to contact PQ Wallace Insurance for a no obligation consultation. 757-232-4678 or pqwallace@pqwic.com.

 

 

 

 

 

 

 

 

 

 

 

2014 Medicare Deductibles

2014 Medicare Deductibles

Beginning in 2014:

  • The Part A deductible will be $1,216 (up from $1,184 in 2013)
  • The Part B deductible will be unchanged and remain at $104.90 per month
  • The Part B deductible will be unchanged and remain at $147 per year
  • The High Deductible Plan F will increase to $2,140 (up from $2,110 in 2013)

If you wish to change your Medicare Advantage Plan or Prescription Drug Plan, you must do so by December 7, 2014.  Please feel free to contact me for any questions or assistance.

Paula Q. Wallace –  757-232-4678 – pqwallace@pqwic.com – www.pqwic.com

 

Affordable Care Act will NOT be affordable!

It appears that Obama’s Affordable Care Act (ACA) is not going to be affordable for a great number of people.  Last week I attended agent meetings for both Optima and Anthem BCBS.  Though there are a great number of things to be finalized before Oct.1, 2013, the message I received was loud and clear.

My clients, and pretty much everyone else who now has an existing individual health insurance plan, will see significant rate increases for the “new and compliant plans” that will go into effect Jan. 1, 2014 and after. In fact, a lot of insurance companies are recommending that their clients renew their policies early.  This is a special consideration given to existing clients so that they may lock in their premiums until December of 2014.  This will postpone the sticker shock.  I highly encourage everyone affected to sign and return their early renewal paperwork as soon as possible.  If by some chance, a new plan is better because of coverage or premium, the insured still retains the right to buy the new policy.

The insurance companies desperately want their customers to know that they have to respond to the new laws and regulations. Thus in order to remain in business, they have to pass the costs onto the consumer and raise premiums.  For example, every person will pick up the cost of maternity coverage, whether you want it or not.  It is mandated that every qualified health plan (QHP) pay for maternity. In addition, infertility treatments and prosthesis’s are also covered in the mandated law.  No one can be turned down for insurance because of a pre-existing condition.  Therefore, the insurance companies are looking to have to pay claims for those who have cancer, diabetes, and serious heart disease for clients they never sold to before.

If you are my client, you will be receiving a call from me.  If you have another health agent, I suggest that you contact them soon. This is a troubling and confusing time for everyone.

 

 

Newport News Shipyard Retirees Losing Medicare Coverage

I am concerned about the amount of “unease” and lack of choices being expressed by retirees of Newport News Shipbuilding about the loss of their supplemental Medicare coverage.   There been several articles in the Daily Press about the letters that Huntington Ingalls Industries sent to their former retirees informing them that they need to use ExtendHealth to counsel them about their Medicare options.

I wish to share some important information that should have been explained to those affected.  I can offer this information because I have a reputation as a Medicare insurance “subject matter expert.” I am a licensed independent insurance agent who has specialized in helping Medicare eligible beneficiaries over the past 9 years, understand all the options available in the local market.

Because these Medicare eligible retirees are losing their supplemental insurance through no fault of their own, Medicare requires that insurance companies that offer Medicare Supplements, Medicare Advantage Plans and Prescription Drug Plans, offer plans that are guaranteed issue.  In other words, the retiree can purchase, an excellent plan, regardless of existing medical conditions, at a more competitive premium. Many of the plans use Medicare as the primary insurance and as long as a doctor or healthcare provider “accepts” Medicare, the Medigap plan will pay most, if not all the remaining charges. There is no need to worry about networks and the medical coverage will be as good as what they now have.

The prescription drug coverage, however, may or may not be as good. All reputable agents “shop” for the best prescription plan to meet each individual’s needs.  However, all of the available plans are subject to a gap in coverage, also known as the “donut hole.” The Centers for Medicare and Medicaid (CMS) will not allow any marketing of the approved 2014 plans until October 1, 2013.  This explains ExtendHealth’s reluctance to discuss specifics until then.

What remains unclear to me is whether the retirees must go through ExtendHealth in order to receive any funds from their retiree reimbursement accounts. If this is the case, then obviously HII is limiting the retirees’ choice of using a local, knowledgeable, reassuring and face to face agent.