Medicare May Be Raising Costs to Beneficiaries in 2016

It is projected (not finalized until later in 2015) that both Medicare Part B deductibles and Medicare Part B premiums will have a significant increase for 2016. According to the 2015 Medicare Trustees Report, it predicts that Part B premiums will increase from $104.90/mo. to $159.  However, since current Medicare beneficiaries will not be getting a Social Security cost of living raise in 2016, their premiums will remain stable.  It is new Medicare recipients that will be paying the $54 per month increase.  However, everyone should expect that the Part B – $147 deductible that has stayed the same for a number of years, will jump to $223 per year.  This may not immediately impact those who have other insurance that covers the Part B deductible this year.  But, ultimately, it will justify premium increases in the future.

We are also seeing increased costs in the Part D prescription plans for 2016.  Many plans are raising the deductibles and cost of the premiums and co-pays.

Important things to know about Annual Enrollment

Annual Enrollment Period, (AEP) also know as Open Enrollment Period (OEP) is from October 15, 2015 until December 7, 2015.

  • All Medicare Advantage Plans and all Prescription Drug plans will change for 2016.  Medicare supplements (Medigap) benefits will stay the same and automatically renew.
  • It is important to “shop” for a plan for 2016.  This can be done at 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 2016.
  • If you are satisfied with your existing coverage, it will automatically renew for 2016.
  • If you want to change plans, this OEP is the time to make the change.
  • Part B premiums will be going up for new Medicare beneficiaries.  This will not affect existing Medicare recipients.


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, 2014 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 33 different plans available in 2014.  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 2015.  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.



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












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.

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.


A Plan F is a Plan F, is a Plan F

A Plan F is a Plan F is a Plan F.  I say this often to my potential clients. It is true, but not the whole truth.  Because the Centers for Medicare and Medicaid (CMS) have standardized all Medicare Supplement Plans (also known as Medigap Plans), it is true that the level of benefits are the same. All Plan F plans must cover Medicare deductibles and co-insurance, no matter which company you purchase from.

However, a Plan F from one company to another company can and does vary significantly.  I am an independent insurance agent who specializes in this. The following are ways that they can vary and you need to consider when choosing a Medicare Supplement Plan:

  1.    Rates can vary significantly.  In Virginia, as of this writing,( September 17, 2012) a Plan F rate for a 65 year old female can range from a low of $92.13 per month to over $300 per month.  (We are talking identical coverage!) These rates vary due to many factors such as the area in which you live.  For example, a person who lives in one zip code can pay $20/per month less than their neighbor who lives down the road but in a slightly different zip code.  A smoker may pay more with some companies.  Males may have a higher rate with some companies.  Some plans have rates which are guaranteed to increase every year as you get older.  Some plans level off their rates after age 75.  (Unfortunately, all of them can – and do- raise their rates on an across the board basis.)
  2. There are extra “Perks” and extra Costs.  For example, you must be a member of AARP to buy their Plan F from United Health Care.  Currently, this is an additional cost of $16 per year.  But on the Perk side, the AARP/UHC plan includes a Silver Sneakers benefit.  That alone, could save you over $50 per month if you are already paying for a fitness center membership.  Mutual of Omaha has a 7% couples’ discount.  And companies are adding more perks (benefits that are not required by law) every day trying to get your business.
  3. Ratings and Customer Service.  Have you ever had a question and had to talk to someone in India, or be put on hold for what seems like a lifetime?  This is a consideration when purchasing a plan you will probably keep for many years.  Though in my experience, this is usually not a big consideration because these plans (as long as they are from a reputable company) work like a dream.  It is rare to be dissatisfied with a Plan F as long as you can afford to pay the premiums.

So the bottom line is – Shop plans with a knowledgeable agent who can enroll  you into best plan for you.



Original Medicare Benefit Coverage

What is the difference between a Medicare Supplement policy and a Medicare Advantage policy?

They both are meant to enhance Original Medicare (Part A and Part B) benefit coverage. However, they are distinctly different and can not be interchanged.

A Medicare Supplement (also known as a Medigap policy) is purchased for a premium from a private insurance company. The plans are standardized and a good plan (such as Plan F) will basically cover all medical expenses that are not covered by Original Medicare.

Medicare Advantage Plans (also known as Medicare Part C), are plans that are contracted with the Center for Medicare and Medicaid (CMS). You enroll in a specific plan managed by an insurance company. That plans then is responsible for paying for your medical expenses. You are responsible for co-pays and co-insurance.

These plans have to be ,by law, be as good as or better than Original Medicare. They may include extra benefits such as a built in prescription drug plan and discounts on medical related services