Saturday, January 21, 2017

Medigap Vs Medicare Advantage in 2017

The Complete Guide

Welcome to 2017! It’s a new year and there will thousands more eligible for Medicare and a thousand more questions when it comes to choosing Medicare health coverage. A lot of seniors we meet with really are confused about what Medigap and Advantage plans cover and how they differ in benefits and what is covered or not covered in each plan.

Seniors choosing a Medicare Advantage plan must realize they are giving up Medicare as their primary insurance.

 

The Advantage plan takes over for Medicare and makes all the rules regarding your health care and sets forth cost sharing, such as copays for doctor and specialist visits, impatient hospital care which can usually cost a couple of hundred dollars each day you are hospitalized, X-rays, lab services, outpatient procedures, ER visits, radiology etc.

When choosing an Advantage plan you would obviously want to sit down with a BGA Insurance agent because there are an abundance of plans to choose from and they vary widely regarding monthly premiums, deductibles, cost sharing and network providers. When I say network providers, you want to make sure whatever Advantage plan you settle on, all your doctors accept the plan you choose.

Each Annual Enrollment Period from October 15th to December 7th these plans change as far as costs so you want to make sure you contact your BGA agent to make sure you are prepared for the upcoming new year.

Let’s outline what is covered in these plans and how they can change from year to year.

Each company that sells Advantage plans have a few plan selections to choose from varying in pricing and covered providers.

For example:
Usually you pay a monthly premium to keep the plan you choose in force throughout the year. Sometimes when a new plan hits the market they have no monthly premium for a year or two. In a few cases as we have seen this year some plans may have a deductible.

That means you reach a certain limit out of pocket before the plan even starts paying benefits.

older couple considering a medigap plan

For example, if you purchase a plan that has a $1000 yearly deductible that would be the amount you would have to pay out of pocket before the plan starts paying benefits. Sometimes routine doctor or specialist visits are exempt from that deductible.

The other thing that is usually standard on Advantage plans are an Out of Pocket Maximums. That is the sum of money you could pay out of pocket for cost sharing. Usually on HMO plans that number is $6700 yearly and if you reach that number the rest of the year the plan would pay 100% of the remaining cost share for that year until your anniversary date.

Most HMOs require referrals for specialist visits. That means you would need a referral from your primary care physician before you can see a specialist for a specific condition. If you purchase a PPO Advantage plan they do not require referrals needed to see a specialist.

 

Another condition that you and your doctor need to take into consideration concerning Advantage plans is that if your doctor suggests you need an MRI or any other specialized test to further treatment, your doctor needs to get it approved with your Advantage plan so the benefit is paid for.

The one problem I find with Advantage plans is that they only cover 80% of the cost for cancer treatments such as chemotherapy and radiation therapy, the other 20% is the responsibility of the insured.

If you purchase an Advantage plan, contact your BGA agent regarding a cancer, heart attack and stroke supplement plan to pay for that 20% gap.

 

Call (855) 494-0097 for help with your plan if you live in New Jersey, PA, or Delaware.

The plans are great and very affordable.

The usual cost sharing benefits that may require a copay are doctor visits, specialist visits, emergency room visits, routine chiropractic services and outpatient surgery. Although hospital inpatient care is a copay most plans charge you the specific copay each day up to a certain amount of days. For example if you are hospitalized as an inpatient you could be charged a copay days 1-6 which could be a couple of hundred a day, but the copays do vary from company to company and plan to plan.

Some Advantage plans offer different kinds of preventative dental, vision, and hearing care for a small monthly added cost.

There is cost sharing involved with regards to cleanings, x-rays, eye exams, eyewear and hearing aids etc.

Another nice benefit you may offered with purchasing an Advantage plan is a fitness program for example Silver Sneakers. If you join a participating health club and use it for a certain amount of days throughout the year, the plan will pay your membership. This is another example of Advantage plans being about preventative care.

Most Advantage plans have drug plans built into the plan, meaning you don’t need to purchase any additional prescription coverage.

 

Of course, they have tiers and you pay a certain copay for a prescription depending on which tier that script falls in.

The model for it usually looks like this:

Deductible/no deductible

Preferred retail cost sharing (preferred generic/generic/preferred brand/non-preferred brand/coinsurance specialty drug)

Standard retail cost sharing (preferred generic/generic/preferred brand/non-preferred brand/coinsurance specialty drug)

Initial coverage limit – A maximum of $3700 in total drug cost.

Coverage gap – The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2017, once you and your plan have spent $3,700 on covered drugs, you’re in the coverage gap. This amount may change each year.

Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Catastrophic – Once you’ve spent $4,950 out-of-pocket in 2017, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Most Advantage plans will offer a mail order benefit so you can purchase a 90 day supply.

Other benefits that usually require cost sharing that you should know about are:

Urgent care – Ambulance – Rehabilitation services – Mental health – Podiatry – Skilled nursing facility – Durable medical equipment – Prosthetic devices – Wellness programs – Part B specialty drugs – Radiology services – Cat scans – MRI’s – Surgery


Medigap Plans

Also known as Medicare supplement plans is where Medicare A & Medicare B is your primary health insurance and you then purchase a Medigap plan to cover the gap Medicare doesn’t pay for. Basically your A & B covers about 80% of hospitalizations, ER visits, doctors and everything else “medically necessary”.

For example, if you suffer a stroke and you’re hospitalized for 10 days, your Medicare A&B will cover about 80% of the cost and depending on which Medigap plan you purchase it should cover all or mostly all the 20% gap.

Something else to think about when purchasing your Medicare insurance. Unlike Advantage plans where your doctor has to get approval to treat you for certain tests outlined earlier, under Medicare if your doctor says you need the treatment, it’s usually covered as long as your doctor codes your treatment correctly when submitting billing to Medicare.

Medicare usually abides by what your doctor says you need, which means you are in control of your own health care. In short what it usually comes down to regarding Medicare and your Medigap plan is if your medical doctor feels you need it, it is usually covered.

If you purchase a Medigap plan you have an open network throughout the United States, meaning if the doctor, specialist, or hospital accepts Medicare your Medigap plan is automatically accepted.

Medicare or your Medigap plan do not require referrals when needing to see a specialist. If you have an issue that you can only see a specialist for you just book the appointment and go, you do not need special permission or approval from your primary doctor or Medicare.

Benefits covered under Medicare and Medigap plans for example are:

Doctor visits – Specialist visits – Inpatient hospital care – ER visits – Outpatient procedures – Urgent care – Ambulance – Rehabilitation services – Mental health – Podiatry – Skilled nursing facility – Durable medical equipment – Part B specialty drugs – Radiology services – Cat scans – MRI’s – Cataracts – Glaucoma – Surgery – Blood – Hospice care

Earlier I talked about cancer treatments such as chemotherapy and radiation therapy and that Advantage plans only cover 80%. With Medicare as your primary, chemo and radiation therapy is covered and your supplement plan will pick up the other 20%.

Medicare or your Medigap plan does not have built in drug coverage like an Advantage plan has. If you decide on Medicare as your primary insurance you need to purchase a stand-alone prescription plan at an additional monthly premium.

A lot of folks we meet with are confused when trying to figure out which Part D plan is right for them so we take away that burden. As their BGA broker we will sift through all the various drug plans and find the one that will save them the most money each year.

Not only will we do it the first time but every year after that. It’s a free service BGA agents provide their clients because we really do enjoy when we can save them money each year.

The model for the Part D program is the same as I outlined earlier when talking about Advantage plans. In this case, you have a choice which plan to choose from which best fits your needs.

Monthly premium
Deductible/no deductible

Preferred retail cost sharing (preferred generic/generic/preferred brand/non-preferred brand/coinsurance specialty drug)
Standard retail cost sharing (preferred generic/generic/preferred brand/non-preferred brand/coinsurance specialty drug)

Initial coverage limit – A maximum of $3700 in total drug cost.

Coverage gap – The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2017, once you and your plan have spent $3,700 on covered drugs, you’re in the coverage gap. This amount may change each year.

Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Catastrophic – Once you’ve spent $4,950 out-of-pocket in 2017, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Medicare or your Medigap plan does not cover routine dental or routine eye exams. However if you have a medical condition such as cataracts or glaucoma it is covered under Medicare and your Medigap plan. BGA Insurance does offer additional coverage for dental, vision and hearing that is inexpensive and would be separate from your Medicare.

Joseph-Bachmeier

Do you have questions about Medicare Advantage or Medigap in 2017?

Contact us! Philadelphia, New Jersey, and Delaware agents can help.

Joe Bachmeier

(855) 494-0097

info@bgainsurance.net

 


The post Medigap Vs Medicare Advantage in 2017 originally appeared on the BGA Insurance Group Blog

Thursday, October 20, 2016

What Is Final Expense Insurance?

American journalist Frank McKinney said over a hundred years ago, “Fun is like Life Insurance, the older you get the more it costs.” While a funny limerick at the time, insurance companies have adapted from this concept.

What is one to do if they have gone their whole life without purchasing any type of life insurance and have loved ones they need to protect? Years ago there were not many options for seniors who found themselves in this situation, Life Insurance late in life was typically very costly and thus not an option for seniors. This is why many insurance companies today now offer Final Expense or Burial Insurance.

seniors thinking about final expense

What is Final Expense Insurance?

Traditional life insurance, whether it be term life, whole life or universal life policies have been around forever and are designed to offset the earning power and life value of its policyholder.  They are in place to cover loss of income, mortgage costs, college tuitions, etc. and can have death benefits in excess of a $1,000,000.

Unlike traditional life insurance, Final Expense policies are designed to offset potential medical bills, small debts and most importantly the cost of a funeral, burial or cremation. These types of policies have a much smaller face value ranging anywhere from as low as $2,000, going as high as typically $30,000 depending on the insurer.

Prior to the popularization of Final Expense products being offered by insurance companies, a lot of folks went directly to a funeral home and purchased what is called a Pre-paid funeral plan. These types of plans are typically paid in full upfront and the funeral home becomes the beneficiary of that plan to use for the cost of your service.

There are some pitfalls to this option. As was already mentioned, the beneficiary of your policy is the funeral home. What happens to that money if it is mishandled or misappropriated, if the funeral home goes out of business or if you, the policyholder, were to move?

Also, most of these plans only cover the agreed upon price at the time of purchase and may not account for inflation. So a desired funeral service may have one cost at the time of purchase and may cost something considerably different years down the road when it is time to put that plan in motion. 

Lastly, when buying a pre-paid funeral plan, the death benefit of that plan can only go towards the cost of the funeral services.  There is nothing to be passed on to family members to offset other costs associated with your passing.

This is where insurance companies saw a gap in what was available to seniors and began offering Final Expense policies. Final Expense insurance differs drastically from how pre-paid funeral plans work at almost every turn. First, insurance companies are monitored and regulated by the state. If a company were to go bankrupt, it is up to the state to step in and use it’s guarantee fund to protect policyholders so your policy is always protected.

Next, with a Final Expense policy, you as the policyholder get to dictate who your beneficiary is. You can name one person as the beneficiary of your policy or you can spread the death benefit out to many members of your family. You can even name contingent beneficiaries just in case something were to happen to your primary beneficiaries and you are able to change these distinctions at any time as life changes occur.

Unlike a Pre-paid funeral plan, Final Expense policies can cover costs beyond that of a funeral or cremation service.  Maybe you have a small credit card debt, existing medical bills or even would like to leave your family some financial assistance. These are all options you have as the owner of a Final Expense policy.

Another convenience to Final Expense is the surprisingly low premiums associated with these plans. Never has life insurance been more affordable and this applies to Final Expense policies as well. Unlike a pre-paid funeral plan, you aren’t required to make an initial large investment; instead you can pay a much lower monthly premium.

Now that you are comfortable with the differences between traditional life insurance, final expense insurance and pre-paid funeral plans the big question now is; “Do I need it?”

Insurance needs are different for everyone. The level of coverage one needs differs from family to family and person to person. Today a bare bones funeral, depending on where you live, typically runs about $6,000 but that can easily get upwards of $10,000 after you factor in flowers, a catered memorial, obituary notice and additional services. Unfortunately, Social Security is not properly funded to offset these costs and will typically only pay around $300 at the time of your death.

insurance broker meeting with elderly couple

There are 3 types of responses I hear when discussing Final Expense policies with my clients:

“I’ve had a life insurance policy for years and I don’t need anymore.”

“I have money set aside for those costs.”

“I want a minimal affair, my kids can bury me in the backyard.”

Knowing about Final Expense options can help address all three of these concerns. If you’ve had a policy for years that you’re still paying on, it may have built in cash value that you didn’t even realize. Maybe you’re over insured with a large whole life or universal life policy you bought early in life and no longer need to worry about the mortgage payments, your children’s tuition, your loss of income, etc.

If you’re in this situation, you can roll the cash value of your existing policy into a single premium Final Expense policy with it not even affecting your monthly expenses. And unlike a pre-paid funeral plan where a $10,000 initial investment will yield $10,000 worth of services, insurance companies will significantly pad your death benefit if you elect to purchase a single premium plan. For example, if a 65 year old male in Pennsylvania were to buy a $10,000 single premium Final Expense policy, the death benefit for that plan would be over $16,000!

“I have money set aside for my funeral services.” It’s great that you’re in a position to have adequately saved and planned for this event, however the money you put aside for your funeral may not go immediately to your heirs. It will have to pass through probate along with the rest of your estate, and while that happens who will pay the out of pocket expenses associated with your passing?

A Final Expense policy not only addresses this issue by being paid out immediately at the time of your passing, but as previously stated can also help maximize the finances you did put aside. What if, instead of putting $10,000 aside for your funeral, you took out a $10,000 policy at $40/month and passed away 5 years later? You would have spent $2,400 of the $10,000 set aside and now your heirs receive a $10,000 death benefit and there’s still $7.600 sitting aside in a separate account.

Lastly, a common joke I hear when talking with clients regarding Final Expense insurance is, “They can bury me in the backyard.” Much like weddings, people tend to overspend at funerals.  Our loved ones want the ceremony to reflect their feelings they have and provide a service to honor your life. While you may have a minimalist approach to your burial, chances are your loved ones will want to make a gesture commensurate to love they have for you.

These are all items to take into account when deciding if you need a Final Expense insurance plan and there are many companies out there who offer these types of plans. Please don’t be fooled by commercials you see on TV that advertise for plans that offer guaranteed acceptance. Despite sounding like an incentive to you as the consumer, that isn’t necessarily the case.

When purchasing any type of insurance plan, you want to be asked health questions because if you pass you will qualify for lower premiums. These are all items our team of Licensed Insurance Brokers at BGA Insurance Group can help go over with you. Call to book a free review and we will go over all of your options and find a plan that fits your needs and your budget.

Book your appointment:


The post What Is Final Expense Insurance? originally appeared on the BGA Insurance Group Blog

Thursday, October 6, 2016

Understanding Dual Eligible Medicare Plans

“In this world nothing can be said to be certain, except death and taxes.” Had Ben Franklin been alive to see the current healthcare situation in our country today, he may have added confusion regarding government healthcare policy as another certainty. It seems there are so many gray areas and variables to consider.seniors reviewing insurance

Trying to get a real person on the phone who can give you a straight yes or no answer sometimes seems like a quaint memory from years past. I would like to touch on the differences between Medicare and Medicaid to try to eliminate some of that confusion.

The simplest distinction between the two is that Medicare is generally for people turning 65 and that Medicaid is for folks who need assistance due to financial constraints. However there are areas where the two overlap. Let’s take a look at exactly who qualifies for assistance and what benefits they may be afforded.

When determining eligibility, the Social Security Administration (SSA) will take into account income and resources. There are different levels of assistance for different levels of income and resources.

Qualified Medicare Beneficiaries (QMB) 2016
Individual monthly income < $1,010 Married monthly income < $1,355
Individual resources < $7,280 Married resources < $10.930

People at this level will receive assistance with part A premiums, part B premiums, as well as deductibles, coinsurance and copayments.

Specified low-income Medicare beneficiary (SLMB)
Individual monthly income < $1,208 Married monthly income < $1,627
Individual resources < $7,280 Married resources < $10,930
People at this level receive assistance with part B premiums only.

Qualified Individual Program
Individual monthly income $1,357 Married monthly income < $1,823
Individual resources $7,280 Married resources < $10,930

Countable resources include money in checking or savings accounts, stocks and bonds.
Assets not counted are your home, one car, burial plot, up to $1,500 in burial expenses, furniture and other household and personal items.

Not that we see what level of income and resources allot what amount of benefit, let’s take a closer look at dual eligible plans.

Dual eligible plans are designed to coordinate Medicare and Medicaid benefits.

The advantages to having a dual eligible plan as compared to straight Medicare can be seen in in both benefits and patient care.

In a 2012 study by Avalere Health, it was found that enrollees also had a 31 percent lower discharge rate, 43 percent lower rate of days spent in the hospital, 19 percent lower average length of stay, 9 percent lower rate of emergency visits, and a 21 percent lower readmission rate than dual eligibles nationwide who are enrolled in traditional Medicare.

The bottom line: This coordinated, integrated care model kept enrollees out of the hospital and produced fewer readmissions than traditional Medicare coverage.

As if the benefits of coordinated care weren’t enough, the dual eligible plans, also known as special needs plans or SNiP’s, add a few incentives that do help folks out a lot. Many plans offer transportation to doctor visits and an over the counter monthly allowance to pick up non-prescription items such as bandages, ointments, etc.

There are approximately 9.3 million people who qualify for dual eligible plans. Of that only about 20% are taking advantage of the SNPs. That leaves roughly 7,200,000 people who could be receiving better care and more benefit than they are currently getting through Medicare alone. If you or someone you know thinks they may qualify for assistance contact your SSA for more details. If you find you do qualify, it would be in your best interest to contact a professional to learn more about these attractive and underutilized dual eligible plans.

Looking for answers in person? Attend an upcoming Medicare Seminar

seminar-button

BGA Insurance Group is based in the Philadelphia area and can assist seniors in New Jersey, Pennsylvania, Allentown, and Delaware.


The post Understanding Dual Eligible Medicare Plans originally appeared on the BGA Insurance Group Blog

Friday, September 30, 2016

Amerihealth 65 HMO to Exit New Jersey for 2017

Important Medicare Announcement

Amerihealth 65 HMO to Exit New Jersey for 2017

bga insurance group

AmeriHealth HMO, Inc. has announced it will not renew its Medicare contract for 2017.  All Medicare beneficiaries currently enrolled in the AmeriHealth 65 Preferred and AmeriHealth 65 Medical Only plans will receive, or may have already received, letters explaining their rights and eligibility for new plans.  

For all Medicare beneficiaries currently enrolled in one of these plans you must take action to ensure you have coverage for January 1st, 2017.  

If you take no action you will be placed back on Original Medicare.  You may join a plan between October 15th, 2016 and February 29th, 2017.  

If you do not choose a plan with prescription drug coverage by February 29th you will not have prescription drug coverage in 2017.  

If you choose a plan between October 15th and December 31st coverage will begin on January 1st of 2017.  If you choose a plan after January 1st it will begin February 1st, 2017.  Choosing a plan after February 1st will result in coverage beginning March 1st, 2017.

Medicare Beneficiaries have 3 options to choose from:  

  1. You can choose another Medicare Advantage plan that does or does not include prescription drug coverage.
  2. You can do nothing and go back to Original Medicare (Parts A and B only).  You will not have prescription coverage and will be subject to large hospital deductibles, a medical deductible, 20% of all medical costs and no maximum out of pocket.
  3. You can go back to Original Medicare and add a Medigap policy with Part D prescription drug coverage.  Due to your loss of coverage you have a special right to purchase a Medigap policy.  Save your letter to present to the Insurance Carrier you purchase your Medigap policy from.

For answers to all of your questions and for assistance in determining which available plans will best suit your medical needs please contact an agent at BGA Insurance Group, 855-494-0097.  

You might be wondering – does this affect my coverage?

Should I be worried?

At BGA Insurance Group, we will make everything 100% clear.

Request a free consultation to find out if this change affects your 2017 coverage.

 

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An additional take from Greg Gudis, co-owner of BGA Insurance Group

It comes every year for seniors; their chance to make changes to their Medicare plans.  Sometimes nothing changes and they stay right where they are, but not this year.  For seniors in New Jersey they are getting (or maybe already received) a letter from Amerihealth 65 explaining they have chosen not to renew their contract with Medicare.  The opening to the letter goes like this:

“AmeriHealth 65® HMO won’t offer your Medicare plan in 2017. This means your coverage through AmeriHealth 65 HMO will end December 31, 2016. You need to make some decisions about your Medicare coverage. It is important you take action before December 31, or you will only have Original Medicare starting January 1, 2017.”

Amerihealth has not given an official reason why they are leaving; just that they have carefully considered their decision to exit the Medicare market in New Jersey. One can only speculate why a large insurer like Amerihealth, with enrollment of over 20,000 people in their plans, would withdraw.  

Plans do this for many reasons but profitability is usually the culprit.  With a Medicare Advantage plan the insurer must design the plan based on the information they have from prior year’s claims, reimbursements and bonus payments from Medicare, and premium and copayments to be paid by the insured.   

Factor in star ratings that can affect their bonus payments from Medicare, which Amerihealth has been in steady decline since the Amerihealth 65 HMO plan inception in 2014, and the plan decides it is time to cut losses and move on.

What Are My Options?

Most importantly for a senior is “What do I do now”?  Well first and foremost don’t throw that letter away.  It is your golden ticket to a new plan.  You now have a few options.  First, you can do nothing.  You will go back to Original Medicare (A & B only), have no Part D prescription coverage, and have large copayments and deductibles when you need to go to a hospital or see a doctor.  

Your second option is to pick another Medicare Advantage plan.  There are several plans available in New Jersey including 2 new PPO options coming to many of the counties.  

Your third option (and the one you will need your letter for) is your special right to buy a Medigap policy.  In this case you will go back to Original Medicare for January 1st and purchase a Medigap plan to pick up some or all of the deductibles and coinsurances of Original Medicare.  

If you need prescription drug coverage you would also purchase a Part D plan.  While there are no health questions to purchase a Medicare Advantage plan, Medigap plans will underwrite you.  If you have your letter you are a Guarantee Issue for several plans regardless of your current health status.

You have from October 15th to December 7th to pick a plan during the Annual Enrollment Period which will take effect on January 1st 2017.  Because you are being dropped you can also continue searching and choose a plan after December 7th and up until February 28th.

If you pick a plan after December 7th but before January 1st the plan will begin January 1st.  If you choose a plan between January 1st and January 31st it will begin February 1st (which means you will have Original Medicare from January 1st until January 31st.  

If you choose a plan between February 1st and February 28th your plan will begin March 1st.  Failure to pick a plan by February 28th means you will have only Original Medicare until next year’s Annual Enrollment where you would be able to pick a plan to start the following January 1st.  To make things easier, ACT NOW!!!  

Remember over 20,000 people are about to lose coverage so there is going to be a mad scramble for seniors to meet with agents, attend seminars, or even just search the web for available plans.  The longer you wait the more daunting a task this becomes.  Get started now and just remember, you get to do this every year!!!


The post Amerihealth 65 HMO to Exit New Jersey for 2017 originally appeared on the BGA Insurance Group Blog

Tuesday, September 27, 2016

NJ Medicare Seminar Schedule for 2016

The following is the official schedule of Aetna Medicare Seminars during the 2016 Annual Enrollment Period

Click to add an event to your Google Calendar

 

Direct Link to New Jersey Medicare Seminar Calendar


The post NJ Medicare Seminar Schedule for 2016 originally appeared on the BGA Insurance Group Blog