Health Care Challenges for Retirees (2016)

Every day for the next two decades, roughly 10,000 individuals will turn 65.  The biggest wakeup call for many of these individuals will be that when they retire, the company they thought would take care of them in retirement, doesn’t do that anymore. They will now be fully responsible for their healthcare choices.

That’s right: fully responsible.

Aside from small business owners and private contractors, most workers have enjoyed the privilege of being partially subsidized by their employers—usually to the tune of about 50%-75% of the total premium—regardless of age or health conditions.  These large group policies have provided employees with a sense of comfort, stability, and consistency throughout their working lives, and many believe that this will continue after age 65, when Medicare steps in.

This is simply not the case.

Everyone approaching age 65 has a seven-month window to register for all benefits that Medicare has to offer. This period begins 3 months prior to the 65th birthday, the month of the 65th birthday and then 3 months after.  It is basically free for most, but some may expect to pay premiums based on income. Medicare A is not an all-inclusive insurance.  It covers most hospital care, including impatient care, skilled nursing facilities, and hospice care, but not all services.

Medicare Part B is supplementary, but everyone enrolled must pay (based on income).  It covers most other necessary medical services, such as doctor visits, physical therapy, medical equipment, etc.  Most people pay a monthly premium of a little more than $ 100 per month.

So far, we have two pieces of the pie that the retiree needs to be responsible for; neither and are free and only cover a portion of services.  Confused?

We’re just getting started.

Let’s skip Medicare Part C for now and jump to D—for Drugs and Donut Hole. Part D covers prescription drugs. Sound simple? Have a calculator? In 2016, enrollees are responsible for 100% of their first $ 360 if the plan has a Deductible. After the Deductible, the enrollee pays the coypayments or coinsurance as dictated by the plan benefits. Once the total money spent by you and the insurance company reaches $3310, you enter the “donut hole” where you pay 58% of the plans negotiated cost of the medication for Generic drugs and 45% for Brand drugs. Once you reach $4850 in TrOOP  money (True Out of Pocket) you enter catastrophic coverage and you will pay $2.95 for Generics and $7.40 or 5% for Brand drugs, whichever is greater . Got that? Lets go back to C.

Medicare Part C or Medicare Advantage health plans offer all of the benefits covered under Original Medicare and more. Many plans have NO additional premium beyond your Medicare Part “B” premium which you must pay. For plans with a monthly premium, rates are not based on age, gender or health condition. Also, most plans include Medicare Part D prescription drug coverage. Depending on where you live, you may have several Medicare Advantage plans to choose from. To enroll in a plan, you must be eligible for Medicare Part A and continue to pay your Medicare Part B premium, unless otherwise paid for under Medicaid or by another third party.

Another plan option is the Medicare Supplement. Medicare Supplement Insurance (also called a “Medigap Policy”) is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (or “gaps”) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.
Every Medicare Supplement policy must follow Federal and State laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance.” Medicare Supplement policies are identified by letters “A” through “N” and are “standardized”. Each standardized Medicare Supplement policy must offer the same benefits, no matter which insurance company sells it. Plan “F” is Plan “F”. The plan premium is usually the only difference between policies with the same letter sold by different insurance companies.

When purchasing Medicare Insurance, you must live in the plans service area and there are some other rules you must follow.

You may enroll in:

Medicare Only

Medicare + Part D

Medicare + Supplement + Part D

Medicare Advantage that includes part D

Medicare Advantage (MA Only PFFS) + Part D

You May NOT enroll in:

Medicare Advantage + Medicare Supplement

Medicare Advantage (MA Only HMO-PPO) + Part D

Sound overwhelming? It is.

Most American workers have enjoyed the luxury of participating in employer-subsidized healthcare plans that minimize the decision-making process. Unfortunately, there is an alarming misconception shared by the vast majority of the 10,000 Boomers celebrating their birthday today: that Medicare will pick up where their old plans left off.

Nothing could be further from the truth.

In fact, it can be argued that most people do not understand Health Insurance. Most people do not realize how many choices there are. This can be a daunting situation, as elderly citizens who do not understand Medicare can be  vulnerable to purchasing coverage that they may not want or need.

Best advice: Find a knowledgeable Broker. If you prefer to do things without Professional help, check the Medicare website, become knowledgeable about the different coverage options, and make sure that you have enough savings to cover any unexpected out-of-pocket expenses.

Oh…and Happy Birthday.

Brad Surrett is the Principal Broker at The Surrett Group LLC and founder of CompareGeorgiaMedicare.com. They are a Medicare Insurance Practice dedicated to helping individuals plan properly for their health care and its costs throughout retirement.

Use Medigap Plans To Cover Medicare’s Part A Charges

Medicare can be confusing because different types of out-of-pocket charges lie beneath the actual benefits. What’s likely to be your biggest expense when it comes to health care? That’s going to be hospitalization whether you experience an accident or your health takes a turn for the worst. In either case, hospital charges fall under Medicare’s Part A coverage, which has a large deductible. Medicare pays for up to 60 days in the hospital after you have met a Part A deductible.

What Is The Part A Deductible?

In 2015, your Medicare Part A benefits don’t begin until you have met a deductible of $ 1,260 per benefit period. Here’s how that works. You can think of a benefit period as a spell of illness that continues until 60 days after you are released from the hospital. If you need to enter a skilled nursing facility immediately after you leave the hospital for temporary rehabilitation, your benefit period may last until 60 days after you leave the nursing facility.

What if you leave the hospital or nursing facility too soon and have to be readmitted? As long as you’re readmitted within those 60 days, that’s considered to be part of the same benefit period. In that case, you will not be charged a second deductible. That means you do not have to spend $ 1,260 again to meet the Part A deductible before Medicare pays your hospital bill.

Medicare only provides complete coverage for the first 60 days you are in the hospital. The number of days you were hospitalized after your first admission will be added to the number of days you’re there after you have been readmitted. If those two stays add up to 60 days and you’re not ready to be released, you’ll have to come up with a portion of the daily hospital charges going forward.

From the 61st day though the 90th day of hospital care, you will be charged $ 304.00 per day. If you still require hospital care after that, you’ll be charged $ 608.00 a day from the 91st through the 150th day.

How Can You Get Protection From Benefit Period Deductibles?

Medicare does not limit the benefit periods it will cover during your lifetime. However, with each benefit period carrying another $ 1,260 deductible, we’re talking major medical costs if you need to be hospitalized within several different benefit periods.

With Medicare Supplement Insurance, the plan covers the Part A deductible, regardless of where you fall in the benefit period structure. Medigap Insurance Plans will cover  you for 100%, 75% or 50%  of the deductible depending on which plan you have. Of course, the Medigap Plans that offer partial reimbursement typically have lower monthly premiums.

Going with a low-priced Medigap Plan may sound appealing, but remember that you may not be able to change plans after your health deteriorates. During your open enrollment period, insurers cannot refuse your application for Medigap Insurance, or charge you higher than standard rates, or limit coverage for pre-existing health problems.

Your medical history is completely irrelevant during open enrollment, which typically begins on the first day of the month in which you are at least 65 and enrolled in Medicare Part B. This golden opportunity only lasts for six months, though. Outside of open enrollment, you may not be able to find an insurer that will allow you to enroll in a different plan with a pre-existing condition. That’s why you may save in the long run by enrolling in the Medigap Plan with the best protection when you have the chance.

By Brad Surrett of The Surrett Group LLC and CompareGeorgiaMedicare.com – One of Georgia’s leading independent agencies specializing in Medicare Supplement Plans. We invite you to learn more about how our MediGap advisors can help you get the best Medicare Supplement plan for all of your needs.

Critical Illness Insurance

Critical Illness Insurance: In this plan, the insured receives a lump sum amount within a few days of diagnosing a critical illness, Once this lump sum is paid, the plan ceases to exist. Some plans have an elimination period (typically 30 days) post-diagnosis before they honor the claim.

Some insurers offer critical illness plans with the alternative option of receiving claims payment in installments over a period of 5 years (the choice needs to be made at the time of making the claim). Such policies provide long term cover of 10 years to 30 years.

Typically, once a claim has been made no more premiums have to be paid and the plan ceases. However, some insurers provide the insured with a choice of continuing the plan for the remaining critical illnesses for a lower sum assured and revised premium rates.

Many critical illness plans provide coverage for:

Aorta graft surgery
Cancer
Coronary artery bypass surgery
First heart attack
Kidney failure
Major organ transplant
Multiple sclerosis
Paralysis
Primary pulmonary arterial hypertension
Stroke

What are some of the limitations to a Critical Illness plan?

The critical illness plan will not offer coverage if the insured person has been suffering from the specified illnesses at the time of purchasing the insurance policy or if care, treatment, or advice was recommended. Further, coverage is not offered if she/he is diagnosed with a specified critical illness within a period of 90 days to 120 days from the commencement of the policy.

Some typical exclusions applicable to critical illness plans:

Death within 30 days following the diagnosis of a critical illness.
Absence of submission of a doctor’s medical certificate confirming the diagnosis of illness/injury or underwent medical/surgical procedure.
Any congenital illness or condition.
Any medical procedure or treatment not medically necessary, not performed by a doctor, treated by family member.
Self-medication or any treatment that is not scientifically recognized.
Treatment relating to birth defects and external congenital Illnesses.
Birth control procedures and hormone replacement therapy.
Any treatment/surgery for change of sex or any cosmetic surgery or treatment
Presence of HIV/AIDS infection.
Naval or military operations of the armed forces or air force requiring the use of arms
Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc.

Critical Illness policies vary by carrier and state of residence. In Georgia, contact Brad Surrett, Principal Broker at The Surrett Group LLC or visit www.thesurrettgroup.com for more information.

 

Medicare What Is under Observation?

By definition Medicare Part A covers a portion of the inpatient care in a hospital or in a skilled nursing facility if the patient needs this care after at least a three-day stay in a hospital. The Medicare web site devotes a section describing Part A coverage, specifically differentiating between an inpatient and an outpatient stay in a hospital. Patients pay a larger percent of an outpatient hospital stay.

Quoting directly from this government source (bold print theirs): Staying overnight in a hospital doesnt always mean youre an inpatient. Always ask if youre an inpatient or an outpatient.

Hospitals have now added a new outpatient category called Under Observation.

Case Study

On September 10, 2010, The Washington Post reported that an 85 year-old lady fell, broke four ribs and entered a hospital in Silver Spring, Maryland. She spent six days there and was transferred to a skilled nursing facility. Most of us would agree that she had met the criteria for Medicare Part A to cover its promised portion of her hospital and nursing home stay.

However, her claim for nursing home care was denied because she did not have the required three days of inpatient hospital care. Since she did not require any treatment while hospitalized, the hospital claimed that she was under observation during her stay.

Under observation means short-term treatment and tests to decide if the patient should be admitted for inpatient treatment. Under observation hospitalization typically involves a stay of 24 to 48 hours and is technically considered to be outpatient status. In this case, the patient spent six days as an outpatient; she had never been admitted.

The bottom line is this 85 year-old lady was responsible for the full amount of her nursing home stay, over $ 10,000, and shes not alone in this predicament. Medicare processed over 1.1 million claims for observation care in 2009. In over 83,000 cases the duration of observation care exceeded forty eight hours.

When Is Inpatient Care Warranted?

The classification of a patients status as inpatient or outpatient is often determined simply by the numbers either through a computerized tool or possibly by a physician who has not even treated the patient. In some cases a patients status can change from day to day during the hospital stay.

If you are on Medicare or caring for someone who is covered by Medicare, be sure to understand their hospital status as in inpatient or outpatient.

To learn more about medicare and protect you from the cost of long term care, please visit our website www.thesurrettgroup.com.

Enrolling in Medicare

Enrolling in Medicare is an easy and simple process. If a person regularly makes Social Security or Medicare payments or contributions, he or she is automatically qualified for Medicare coverage for hospitalization when he or she reaches the age of 65. Because of his or her previous contributions, this hospitalization benefit gained from enrolling in Medicare is of no cost to him or her. However, if not, a person will need to apply for a Medicare membership, and may need to pay a certain fee, depending on any previous records of contributions made.

There is also another benefit under Medicare which people may apply for. This is the one that covers doctor and outpatient services. This coverage though, requires a monthly or yearly premium. For those who are employed and are enrolled under the company’s health insurance provider, they do not need to apply for this Medicare coverage, since they are already covered by their company’s provider.

With regard to the doctor and outpatient coverage, it has to be clear to enrollees that not all doctors are covered by the insurance. Some doctors do not accept Medicare coverage. This means that if a person’s doctor is not under Medicare, it would be better if he or she switched to a Medicare-accredited doctor. Of course, he or she can still choose to stay with his or her doctor, but will need to shoulder the expenses that go with it.

Moreover, there are also limitations to the doctor and outpatient service coverage. Because of this, some people enroll in private health insurance providers who can take care of the expenses not covered by Medicare. They may pay an extra premium for these, but the benefits are significant in the long run. Basically, a person who is enrolling in Medicare should know these details, so that he or she will not be surprised in case he or she is billed for anything, despite the Medicare membership. Again, Medicare only covers up to a certain extent, and requires members to meet certain qualifications to determine their coverage.

Just like enrolling in anything – a course, class, or membership – it is the responsibility of a person or member to get to know the details of whatever it is he or she is getting into. This is even more important when there is payment involved. Sometimes, problems and complaints arise from people who fail or forget to look into the details, shell out their money, and then expect things based on their assumptions.

The advantages with getting to know the details and the coverage of any membership is that people know what to expect, they know how to go about the processes, they know whom to talk to or what to do when there are problems or concerns, and they can easily find solutions to any issues. By the time they pay for or sign anything, they will be confident enough about their decision and are aware of what they are joining or getting into. This way, they can make the most out of their membership.

If you are looking for the best medicare coverage and medicaid medicare, visit our site for more tips and information. Contact us for free medicare advice.

Guide to Long Term Care Insurance

According to the U.S. Department of Health and Human Services about 9 million Americans, now 65 or older, will require long term care. HHS expects that number to rise by 25 percent to 12 million by 2020. With health care costs rising and longer life expectancies, funding long-term care needs is an increasing concern for millions of people, especially senior citizens.

The average annual cost of nursing home care is $ 74,806, according to Genworth Financial’s 2007 Cost of Care Survey, but that figure can fluctuate depending on the level of care required, and the state in which the care is provided.

However, it is important to remember that when planning for long –term care, the focus should not be on the cost of care currently, but what care will cost when it is most likely needed. That may be 10 years, 20 years, 30 years, or longer.

Now let’s consider five essentials regarding long term care insurance.

1. There are different types of provisions in long term care insurance

The type of long term care that is provided depends on the patient’s medical necessity, psychosocial needs, and financial situation. Types of long term care include: skilled nursing, intermediate, custodial home-based and hospice care.

2. Policyholders must meet certain conditions to receive benefits.

Long term care benefits begin when policyholders meet certain conditions. A licensed professional performs an assessment to determine if there is a medical necessity for long term care. Medical necessity is generally defined as an inability to perform daily activities, such as bathing, dressing, or eating, due to severe physical limitations or cognitive impairments.

3. The type of policy and the needs of the individual determine the cost of long term care insurance.

Annual premiums can vary significantly depending on your age, health, and the type of policy, but policies can run as high as $ 5,000 or more per year, However, you do not have to pay that much. Your premium could be reduced by choosing a shorter benefit period, buying at a younger age, sharing care, choosing a longer elimination period, reducing the daily benefits, and including inflation protection.

Related Individual Health Insurance Articles

House OKs Bipartisan Medicare Doctor Bill; Fate up to Senate

In uncommon bipartisan harmony, the House approved a $214 billion bill on Thursday permanently blocking physician Medicare cuts, moving Congress closer to resolving a problem that has plagued it for years.

The lopsided 392-37 vote shifted pressure onto the Senate, where its prospects have brightened as Democrats have muffled their criticism and President Barack Obama has embraced the bill. But with some conservatives also balking at the legislation, its fate there remained murky.

Thursday’s House vote came on a package that bore victories for Republicans and Democrats alike and was negotiated by the chamber’s two chief antagonists, Speaker John Boehner and Minority Leader Nancy Pelosi. That unity contrasted vividly with the usual partisan duels that hamper most congressional efforts on budget, health and other major policies…

Read the entire article at http://abcnews.go.com/Health/wireStory/house-ready-pass-medicare-doc-bill-senates-view-29917053

Your opinions welcome!

Bipartisan Love: Boehner, Pelosi strike deal to kick ‘doc fix’

According to CNN (3/19, Walsh), the House Energy and Commerce Committee “announced ‘nearly identical’ bills being introduced in both chambers that would replace the Medicare Sustainable Growth Rate.”

Read the full Article: http://www.cnn.com/2015/03/19/politics/boehner-pelosi-doc-fix-announcement/index.html

The Hill (3/20, Sullivan, Lillis) notes that the legislation released Thursday “does not include provisions offsetting the substantial costs.” Those details are still be negotiated, and a broader package is expected to be released in the coming days. Nonetheless, “congressional leaders are all but predicting the final product will win enough support from both parties to move this year.”

Read full article: http://thehill.com/policy/healthcare/236281-210b-medicare-deal-unveiled

Bipartisan agreement on Healthcare related issues are RARE! THis could be a big WIN for Seniors and all Meidcare beneficiaries.

HHS Explains Application of Annual Cost-Sharing Limit to Family HDHP Coverage

HHS has posted an FAQ explaining how the annual cost-sharing limit under health care reform will affect high-deductible health plan (HDHP) coverage. In the preamble to final 2016 parameters regulations issued last month (see our article), HHS established that the cost-sharing limit for self-only coverage should apply to all covered individuals, whether or not they are covered by a self-only plan. The new FAQ explains the agency’s position by applying it to a hypothetical HDHP with a $10,000 family deductible.

The FAQ notes that under the HSA rules, HDHP family coverage cannot provide any benefits until covered expenses (other than for preventive care) exceed the minimum annual deductible for family coverage. For 2015, that minimum family deductible is $2,600. (A plan could have an embedded individual deductible, but it would have to be higher than the family minimum.) But family HDHP coverage could impose a much higher deductible. (We note that the deductible could not, however, exceed the HDHP out-of-pocket maximum for family coverage, which is $12,900 for 2015.) For example, if the HDHP had a family deductible of $10,000—higher than the self-only annual limit on cost sharing ($6,600 for 2015)—the plan would have to begin covering the expenses of any family member whose expenses exceeded the self-only annual cost-sharing limit, notwithstanding the plan’s higher family deductible. The FAQ indicates that this policy applies starting in the 2016 plan year (when the self-only annual limit on cost-sharing will increase to $6,850).

EBIA Comment: This interpretation of health care reform’s annual cost-sharing limitation effectively embeds an individual out-of-pocket limit in all family group health plans with a higher family deductible—whether or not the high-deductible coverage is meant to make employees HSA-eligible. (The annual cost-sharing limit on spending for covered essential health benefits applies to all non-grandfathered, nonexcepted group health plans, as the PHSA provision is incorporated by reference into both the Code and ERISA.) That will likely affect plan costs, so it will probably require sponsors and insurers to reconsider and adjust benefits, premiums, or both. Given the significance of this policy, we wonder why it was articulated only in the preamble to the regulations (making it harder to find), and not in the regulatory language itself. Whatever the reason, any doubt about the agency’s commitment to this position left by the regulations should be eliminated by this FAQ reinforcing the point. Fortunately, the FAQ makes it clearer that plans will not have to apply this rule until their 2016 plan years, so sponsors and insurers will have time to respond. For more information, see EBIA’s Health Care Reform manual at Section IX.B (“Cost-Sharing Limits”); see also EBIA’s Consumer-Driven Health Care manual at Section X.C (“Family HDHP Coverage”) and EBIA’s Self-Insured Health Plans manual at Section XV.D.4 (“Out-of-Pocket Maximums and Health Care Reform’s Overall Cost-Sharing Limit”).

 

FAQ Available at: https://www.regtap.info/uploads/library/FamilyofoneMOOPPolicyFAQ_5CR_031015.pdf

Affordable Medicare Supplemental Insurance Plans-affordable Medigap Plans

Affordable Medicare Supplemental Insurance Plans

How to get the lowest possible rate on a Medicare Supplemental Insurance (Medigap) Plan, now and in the long run.

There are 3 keys to the getting the lowest rates:
1.Avoid “Attained Age” Rated Plans
2.Get Quotes from Several Carriers
3.Buy During “Open Enrollment”

“Attained-Age” Rated Plans are most affordable at age 65, but prices rise with age and could be more expensive in the long run.

With “Non-Age” Rated Plans prices don’t rise with age. They are also known as “Community-Rated” or “Issue-Age Rated”. Don’t be confused though, prices do go up.

You should get quotes from several carriers. The same plan has different prices with different carriers. All Plans, A – N are Standardized. You should not pay extra for a famous name. Insurers sell the exact same Medicare Supplement plans at different prices. Comparison shop to get affordable Medicare Supplement Insurance Plans.

Buy during your open enrollment period or if you qualify, during a Guaranteed Issue Period. During open and guaranteed issue enrollment periods pre-existing conditions are not held against you. The open enrollment periods start as early as age 64 years 9 months and ends 6 months after age 65 or your Medicare Part B effective date.

Medicare Supplement plans help whenever Medicare doesn’t completely cover your health care expenses. That includes doctor and hospital bills, but it also helps with skilled nursing facilities and with certain plans, even emergency care when you’re traveling out of the country.

To find the plan that’s just right for you, list your biggest health care costs and see which Medicare Supplement plans cover those charges for the lowest premiums. After you compare Medicare Supplement plans, compare the prices different insurers are offering on the plan you like most.

It is important to get professional help to compare Affordable Medicare Supplemental Insurance Plans from the Medicare planning team at The Surrett Group LLC and Comparegeorgiamedicare.Com. With years of experience in Medicare Supplemental insurance, our experts know Medicare Supplement plans and the insurers offering them.

Just call The Surrett Group LLC at 770-596-7355 or Comparegeorgiamedicare.Com at 855-733-7911 to get the answers you need and find the best Medicare Supplement plans. We can help you sort through all the Georgia Medicare Supplement plans now available by comparing your situation and needs to the benefits of each plan. We will take a look at your biggest health care expenses and show you the best Medicare Supplement plans to protect you from charges that Medicare doesn’t cover.

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