Recognition from AARP Medicare Plans from United Health

It is an honor indeed, to have AARP Medicare Plans from United Healthcare recognize me as a level 2, “Authorized to Offer” agent.  Every “A2O” agent is required to meet rigorous criteria to become “Authorized to Offer” status.  Even though I pride myself on being a professional to all my clients and the insurance companies that I represent, it is this particular company who recognizes that professionalism.  In order to qualify for this I had to meet certain standards and ethics.  Some of these include:

  • Demonstrated competency and experience requirements
  • Commitment to community service
  • Required agent training on product, ethics and needs analysis, as well as regulatory training requirements
  • State licensure
  • Annual disciplinary history and background check review, including third-party credit and criminal checks

I must:

  • Requalify every year
  • Sign a code of Ethics
  • Protect consumers through required Errors and Omissions insurance
  • Not engage in door-to-door marketing or cold calling
  • Meet with you in the place of your choice
  • Place you with the best product for you.  I am commission “neutral” meaning I don’t push you to a product that pays me the most.
  • Give you a clear explanation of who you are doing business with
  • Clarify all consumer disclosures and provide you with the limitations and exclusions of product

It is important to you because an “Authorized to Offer” agent:

  1. Can provide you with personalized service and can assist in finding solutions to fit your needs.
  2. Can address the complexity of many of the insurance and financial products AARP members may need in order to have protection and a sense of security.
  3. Can meet with you in-person to address your specific questions and concerns and can lead to a more thorough understanding of how the solution addresses your unique needs.

You can expect me to be a trusted professional and practice four core principles:

  1. Approach every interaction with integrity
  2. Put client needs first, even if it means recommending a product not branded by AARP
  3. Be an expert and stay informed
  4. Display a commitment to the community.

For further information, please refer to the official Introducing “Authorized to Offer” Local Agents brochure (You will need Adobe Reader installed on your computer to view this document. Adobe Reader is available for free here.)

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 segment video (click on the word segment to see it.)

 

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.

Changes – Good & Bad for PDP’s in 2014

I have been spending enormous amounts of time certifying so that I can enroll you the Medicare plans you may want in 2014.  I always tell my Medicare clients that they “need” to shop for Prescription Drug Plans each year, in order to save money and hassle.  Really, if you do not want to do this, please let me help!  If you do nothing, you will receive an ANOC letter (annual notification of change letter) from your current plan.  If you are okay with the changes (usually a jump in premium amount), you do not need to do anything and your plan will automatically re-enroll you for 2014.  Experience has taught me that you could possibly save hundreds – even thousands of $$$$ just by making a phone call to me.

The new 2014 plans will be available to shop on Oct. 1, 2013 though I can not accept an application until Oct. 15, 2013.  This enrollment period will end Dec. 7th, 2013.  The good news is that some of the dollar limits have actually gone down!  For example, the maximum deductible will be $310 instead of the $325 that was in place for 2013.  The bad news is that the amount to reach the donut hole is lower for 2014: $2,850 versus $2,930 in 2013.  The good news is that you will pay less while in the donut hole and get out of it a bit sooner.  The maximum yearly “out of pocket” drug costs will be $4,550 for this coming year as opposed to $4,750 this year.  While in the donut hole, you will get a 28 percent discount on your generic drugs versus the 21% discount in 2013.  This is SLOW but sure progress for the total elimination of the donut hole by 2020.

I am getting excited about helping my existing clients and always welcome new clients!  Please remember to refer your friends, neighbors, and family to me. I appreciate your business!

Confused about Medicare?…. This may help!

Almost every day, I talk with people aging into Medicare. Almost everyone is confused. One reason is that there at least two names for exactly the same Medicare feature.  For example:

A Medicare supplement is the same thing as a Medigap policy

Medicare Part A is inpatient hospital and nursing home insurance

Medicare Part B is medical insurance (doctor, lab, x-ray, ER, etc.)

Medicare Part C is also known as a Medicare Advantage Plan or MA or MAPD (includes a PDP)

Medicare Part D is a prescription plan also known as a PDP

A Gap in prescription coverage is also known as the “Donut Hole”

A low income subsidy (LIS) to help pay for prescriptions is also known as “Extra help”

There are 4 parts to Medicare: Parts A.B,C, and D but confusingly enough when shopping for a Medicare Supplement policy,  you have eleven plans to choose from: Medigap Plans A, B, C, D, F, high deductible F, G, K, L, M, and N.

The Government branch - U.S. Department of Health and Human Services, Centers for Medicare & Medicaid (known as CMS) tries to be helpful.  They have a wonderful publication Medicare & You that is only 140 pages long. It has been my experience that you only get this resource after you have Medicare and even then, very few people will read or understand it.  That is where I come in!  I know and understand this information! However, I do use a flow chart found on page 14, to show my prospective clients.  I find this visual to be very informative. You may find this  Medicare Chart on a separate page on my website.

As always, please feel free to contact me with any questions.  My knowledge is absolutely free to you with no obligation.

 

Free Preventative Health Screenings (Before you have to meet your health insurance deductible)

I have a wonderful family doctor and she just ordered a bunch of preventative tests for me.  I asked if they would be covered before my deductible (its high) and she said she  really did not know.  I called my insurance carrier and they said I should ask my doctor. Does anyone know what is on the list of services that went into effect with the Affordable Care Act?  I did some research, and here is a partial list. I am not including children and pregnant women because their list is a lot longer.  There are a lot of screening tests including:

Abdominal Aortic Aneurysmone-time screening for men of specified ages who have ever smoked

Alcohol Misuse: Screening and counseling

Aspirin: Talk with your doctor about taking aspirin every day (depends on age)

Blood Pressure: Get your blood pressure checked

Cholesterol:  Have a cholesterol check if you are an adult of a certain age or at higher risk

Colorectal Cancer:  Screening for adults over age 50.  Does include periodic colonoscopies

Depression:  Talk with your doctor about depression

Diabetes, Type 2: Screening for adults with high blood pressure, and counseling on how to prevent

Diet: Counseling for adults at higher risk for chronic diseases

HIV: Screening for adults at high risk

Immunizations: vaccines for adults (doses, recommended ages, and recommendation populations vary):

  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster (shingles)
  • Human Papillomavirus (HPV)
  • Influenza (flu)
  • Measles, Mumps, Rubella (MMR)
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella (chickenpox)

Obesity: screening and counseling for all adults

Sexually Transmitted Infections (STI): prevention counseling

Syphilis: screening for adults at high risk

Tobacco Use: screening for all adults and help quitting (cessation interventions) for tobacco users

Well Women Visits: you should not have to pay for your appointment to get the following ordered/done:

  • Breast Cancer Mammography: screening every 1 to 2 years for women over age 40
  • Cervical Cancer:  Exam and PAP smears for sexually active women
  • Chlamydia Infection: Screening for younger women and other women at higher risk
  • Contraception: FDA – Approved contraceptive methods, sterilization procedures, patient education and counseling
  • Gonorrhea: Screening for all women at high risk
  • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
  • Osteoporosis: Screening for women over age 60 depending on risk factors

A few notes and disclaimers:

  1. These are preventative screening tests.  Once you have been diagnosed with something, a follow-up test does not mean free.
  2. They are only screening tests.  If something is found, the test my no longer be “free.”
  3. Your insurance carrier will decide what you have to pay for.  If you disagree, you may always file an appeal.
  4. The above list is not comprehensive and there may be exceptions and fine print.

 

 

 

 

 

No Health insurance? – Deadline is Approaching

By January 1, 2014, every American who is not covered under a government plan, will have three options for health insurance.

  1. Get coverage through an employer, if available.  (More employers will have to offer coverage or may be fined. – It depends on their number of employees.)
  2. Buy a health plan through an “Exchange” (you may qualify for a subsidy) or buy directly from an insurance company “off exchange.”
  3. Go uninsured – but you will incur a tax penalty unless you qualify for an individual exemption. In 2014 that penalty will be the 1% the taxable household income.   So, if your family makes $25,000 per year, your penalty will be $250.00.  If your family makes less than $9500 per year it will still be $95.00.

The good news is: no one will be denied coverage even though they have pre-existing medical conditions.  The bad news is: Even with financial assistance for those making less than 400% of the Federal Poverty level (as of 2012, $44,680 for an individual and $ 92,200 for a family of four) it will still be a significant premium bill that most will not have the budget for.  In addition, even with a plan, there will be fairly large copayments and deductibles.  It will not be free as many people now falsely think it will be!