Preferred Provider Organizations (PPOs) – The
Similar to the HMO, the PPO has copyaments for medical services received from providers in the PPO’s network. However, the PPO usually has higher out-of-pocket expenses for medical services received outside the network of medical providers.
Private-fee-for-service (PFFS) –
With a PFFS plan you can go to any
Special Needs Plans –
While Health Savings Accounts might work for some people, they may not be the answer others need for health insurance needs. Contributions to a Health Savings Account might be an issue.
Since the advent of Health Savings Accounts in 2003 there’s been a lot of discussion on the viability of using them. Billed as a way to help millions of Americans save for qualified medical and retiree health expenses on a tax-free basis, the HSAs garnered a terrific amount of press coverage.
It seems out of sight out of mind is applicable in 2008. Many people don’t appear to have enough information about HSAs to make an informed decision. Many don’t understand quite how they work. The more important question though is really if they would even open an account in the first place.
That might seem to be an odd observation. People should be interested in opening a Health Savings Account because it benefits them and their families. Let’s revisit that assumption. It may benefit individuals and families.
Along with the question of whether or not an individual would actually open a Health Savings Account is the question of whether or not they would even contribute to it. It means setting money aside on a regular basis to make the account grow. If the account does not grow, it won’t do anyone any good, now or in the future. The point behind having a Health Savings Account is to save money for medical expenses. If no money is saved, no one has benefited.
Having a Health Savings Account is different than having a co-pay plan. So different, that many families who have tried using HSAs discover they don’t like paying the high costs of a doctor’s visit, and want to switch back to co-pay. Many people prefer the idea of a co-pay plan because it means their costs are lower when they make that trek to a physician.
In order to figure out what plan works for you or for you family, it makes sense to talk to a qualified insurance broker. They have the real scoop on the differences between a co-pay plan and a Health Savings Account, and can help you walk through the various options available. It’s the best way to get a plan that fits you to a T.
Congratulations, you turn 65 and are eligible for Medicare. Your monthly benefits from the Federal Government include social security as well as deductions for Part A and B of Medicare. Below we will give you a brief synopsis and guide you through the first steps of understanding the Medicare options available to you. Under no circumstances is this a thorough review. In order to completely understand the benefits you will receive under Medicare, read the comprehensive brochure for seniors “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare”.
Original Medicare parts A & B
As we know it, there are 3 parts to Medicare-Part A, B and D. Managed by the Federal Government, Part A (hospital insurance) covers inpatient hospital costs and helps cover skilled nursing facilities, hospice and some home health care costs. Medicare Part B covers physicians and services, outpatient care and some preventative services to help maintain your health when you are ill. The premium for Part A is $443.00 per month and unless you are disabled or have survivor benefits from a spouse who was covered by Social Security, these costs are the same for everyone and part of the benefit. Part B premium starts at $96.40 (may cost more depending on your annual income) and is withdrawn directly from your social security check. You can opt out of Part B coverage if you choose. Both A (hospital benefits) & B (Physician and medical benefits) have deductibles, co-insurance/co-payments, and maximum benefits with extra lifetime reserve days. There are gaps in the government plan and payments you will be directly responsible to pay. Selecting a supplemental plan from a private insurer can cover part of these gaps.
Medicare Prescription Drug Coverage (Part D)
Section D, added to law effective January 1, 2006, was enacted under the Bush administration and is funded with taxpayer dollars. If you had a Medicare plan before January 2006, you may have a Medicare Supplement policy that includes drug coverage. If you are new to Medicare, you may select a separate plan for drugs. There are two ways to buy a Drug plan-as part of a Medicare Advantage Plan or a separate Medicare Prescription Drug Plan. Since Part D provides basic coverages with large deductibles and co-payments, besides premium differences, these drug supplemental policies must offer Formulary or Generic Drugs in every category of treatment. Deciding which drug plan is best for you may be challenging. Knowing your drugs and dosages before selecting the plan is helpful. For approved drug plans check out the department of insurance site in your state.
Medicare Advantage Part C Plans
Included in the description of Medicare is Part C, which you might assume is an additional benefit you receive –it’s not. Part C is coverage you can select instead of traditional Medicare. Offered by private insurance companies, Medicare Advantage Plans (MA) are private plans that are approved by the federal government. Choosing a MA plan means you will decline coverage through traditional Medicare. The insurance company has rigorous rules and regulations to follow and can be suspended for misleading material or infractions. An independent agent must be certified separately to sell Medicare Advantage Plans because they are perceived to be an extension of the Federal Government. These plans can be HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), PFFS (Private Fee for Service), MSA (Medical Savings Accounts, or SNP (Special Needs Plans). With MA plans, you will not purchase a Medicare Supplement plan since the supplemental benefits will be included in the Part C, MA plan.
Which plan is best for you? Listed below are some of the differences between Medicare Advantage (MA) and Medicare Supplement (a.k.a. Medigap) plans.
The Physician you choose
Your real choice with a MA versus a traditional Medicare Supplemental plan is to make sure you get the doctors and hospitals you want. Most MA plans are regional and the insurance company may not offer a MA plan in your zip code but may offer a Medicare Supplement plan in your area. MA plans designate the hospital and the doctor you must see. If you like HMO plans, you would probably be satisfied with a MA plan. If you prefer to select your own doctor and hospital, you would best be served with a PPO/Medicare Supplement plan. Many doctors will take Medicare patients but are not on the list to take Medicare Advantage patients. Do your homework first and find out what type of plan your doctor will honor.
Guaranteed Issued Rules
A law strictly regulated with Medicare is Guaranteed Issue. You are eligible for Medicare, Medicare Supplement or a Medicare Advantage plan even if you have health problems (preexisting conditions) the first month that you are eligible to be covered under Medicare Part B age 65 or older. However, this guaranteed issue right is good for only 6 months after you are eligible. After that the insurance company can underwrite your medical history and you can be turned down, excluded for preexisting conditions or surcharged. If you are covered under a group medical insurance program at your work after you are eligible for Part B, you can wait until your group plan is over before you select a supplement or MA plan, guaranteed issued. You are required to provide proof of enrollment of Medicare Part A and B in order to purchase a supplement. (There are a few other exceptions for guaranteed issue.) In any case, if you plan on choosing a supplemental plan to fill in the gaps of Medicare or you wish to take an Advantage plan, you are best to choose the coverage when you are first eligible or when group benefits end with your employer.
Medicare Supplement Plans (Medigap Policies)
Medicare Supplement policies are available to fill in the gaps of traditional Parts A & B. These plans are standardized and called Plans A through L and must offer the same benefits, no matter which company sells the plan. Not all companies sell A – L. Premiums and contracted doctors and hospitals are usually the major differences in these plans. Plans F & J offer the riches coverages for Medigap plans and also cover foreign travel emergencies which may be important if you travel outside the US. The Department of Insurance in your state can provide a list of companies that provide Medicare Supplemental plans. These supplemental plans are usually less than $180 per month depending on the company you select and most doctors that accept Medicare will accept the supplemental plan benefits you choose as long as the plan is not an HMO or MA plan. Again, consult with your physicians billing department to make sure your plan will be accepted before your final selection.
There are benefits not covered by Medicare. These include: Long Term Care, Vision, Dental, hearing aids, eyeglasses, and private duty nurses during recovery from illnesses. As you approach age 65, your mailbox will explode with offers for Medicare Advantage and Medicare Supplement plans. Marketing material from A.A.R.P. and other senior organization can be confusing. Understanding the differences can save you time and money. Choosing an independent agent who is contracted to sell both Medicare Supplement and Medicare Advantage Plans is to your advantage. Call or contact our agency for more details and for your free guide to “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare”.
Medicare is the national health insurance plan for the elderly and disabled in the United States. It first became law when in the Great Society of Lyndon B. Johnson in 1965 the Social Security legislation was amended to include this social insurance program. Unlike the single payer plans of most first world countries Medicare only covers 80% of the costs of most health care, and is limited to Americans age 65 and older, and others with certain disabling conditions.
Former President Harry S Truman and his wife Bess received the first and second Medicare cards after the bill was signed by President Johnson. Medicare is financed by payroll taxes on most working Americans, with equal contributions of 1.45% or pay up to a maximum by the employer and the employee. Medicare consists of several parts.
Part A Medicare covers hospitalization care. It is free to eligible Americans over age 65 if they or their spouse have paid Medicare payroll taxes for 10 years. Part A also covers skilled nursing home care if specific conditions are met.
Part B of Medicare covers some health care services not covered by Part A, and is deferred if the eligible patient is still working. Part B covers primarily outpatient services, and has both a deductible amount the patient pays, and then a 20% co-payment of costs above the deductible amount.
Part D of Medicare was effected Jan. 1, 2006 and covers prescription medications. It is optional, and there is a monthly cost to the patient. It is only available for Americans covered by Medicare Parts A and B, and the plans are provided by private insurance companies under Medicare regulations.
To find much more detail visit the Official Medicare Site.
I received a call the other day from my office saying a desperate and confused couple had come in needing some help with their
At the appointment I started asking questions as I usually do, trying to understand what the issues were, and how they had evolved. I found out that the wife was on
I found out that she was enrolled into a
As I begin to dig further I found that she had received a letter back in February from her plan saying that she did not have “creditable drug coverage” for the last six years and if she did not provide proof of “creditable coverage” within 60 days that she would be paying an additional $20/month which equates to $240/year. The not so funny thing about this was that the husband went to get a file at my request and right in the front of the file was the proof of creditable coverage from his previous employer. I called the plan immediately, and of course was told that since the time had expired it was out of their hands, and that I would have to go through an appeal with
Anyway, where there’s one termite there’s usually another or something line that. I started asking about their supplemental coverage, and of course they didn’t know what they had or what they had done. I uncovered a letter that was sent from an insurer saying that she had applied for a
I don’t have room here to go into the measures that I did to help them, but it was extensive, and it took several hours. The point? Well, sometimes you can do more damage than good when it comes to
P.S. If you receive something in the mail regarding your insurance, you might want to open it, and then take the appropriate action!
First, a quick explanation for those who are unfamiliar with how Part D works:
Every person who has elected to participate in traditional
There is no requirement that anyone enroll in
In addition to a monthly premium that varies according to the chosen insurance plan, some Part D participants will pay an annual deductible and a co-payment every time they purchase a prescription. Some plans do not require a deductible.
Participants will purchase their medications for only the cost of their co-payment amount until the total amount that has been spent by both the individual and the insurance company together equals $2,510 (in 2008).
After the individual and the Part D insurer have spent $2,510, the insured must then pay the next $3,216.25 (in 2008) from his or her own pocket. When the insured person has purchased medications costing $3,216.25 in a calendar year, catastrophic coverage begins and the Part D insurance company will pay the full cost of all medications for the balance of the year with the exception of a very small co-payment of 5% or less.
During the time the insured is “in the donut hole” and paying 100% for all prescriptions, he or she must continue to pay monthly Part D premiums.
1. Whenever possible, even before reaching the “gap,” ask if generic drugs will fit your needs. Some Part D insurers will cover generic drugs through the “gap.” If they don’t, generic medications are always less expensive than branded drugs.
2. Ask the doctor for free samples.
3. Ask if you can split your pills. There is often little or no cost difference for a pill that is twice the dose your doctor has ordered. If you can split these pills, you can purchase 60 days of medication for the cost of 30 days.
4. Shop around. There are often wide variances between pharmacies. Comparing costs between pharmacies can save as much as 25% or more. Costco and Sam’s Club pharmacies do not require that you be a club member to use their services.
5. Apply to Patient Assistance Programs. Some manufacturers offer free medications to individuals with financial needs. You can check with the Patient Assistance Program Clearinghouse at (800) 955-0989.
6. Apply for the Extra Help low income subsidy program. Individuals with low incomes and few financial assets can qualify for subsidized coverage that has no donut hole.
Be aware that if your drug costs are high and you expect that you will reach the catastrophic coverage portion of Part D, using these tactics to reduce your costs will stretch out the amount of time you may be stuck in the donut hole.
When a person first looks at the Medicare Supplement plans available they immediately zero in on plan F. This plan is the plan with all the boxes checked meaning it has the most complete coverage. Plan F is also the most popular plan available, but most popular does not always equate to the best deal.
If you take a look at the next plan down from F, plan G, you will see that it has almost the exact same coverage with the exception that G does not pay the
So let’s do some math. Once you have your Medigap quotes you will see that plan G’s monthly premium is less expensive than plan F’s. So subtract plan G’s monthly premium from plan F’s. Now multiply the answer that you get by twelve (the number of months you pay your premium per year). The answer that you get is how much more plan F costs to have than plan G per year. Now subtract the
For 2011, if the premium difference between plans F and G is greater than $13.50 per month, then Medigap plan G makes the most sense. Many people can save $100 – $300 per year even after having to pay out that $162 per year
Often insurance agents are reluctant to point out the possible savings available by purchasing a
Hospice services are available twenty-four hours a day, seven days a week. There is always a nurse on call at night and on weekends. The nurse will visit a patient as long and as often as necessary to ensure quality care. Because of this wonderful service, many people are under the impression that hospice care is expensive, and believe they cannot afford such treatment. However
In order to receive the
Electric wheelchairs are very expensive and therefore, it can be a difficult decision whether to buy one. However,
1. The person’s condition is such that, a wheelchair or scooter is a must for mobility.
2. The person cannot operate a manual wheelchair, hence an electric wheelchair or an electric scooter is required.
3. The person is capable of safely operating the controls of a wheelchair or scooter.
4. The person can safely transfer in and out of a wheelchair or scooter.
5. The person has adequate trunk stability to safely ride a wheelchair or scooter.
6. The person has not purchased a wheelchair or scooter and obtained reimbursement for that purchase within the last five 5 years.
If all of these criteria are met, then the person seeking support from
These five top tips for women’s health will help you look and feel your best and have the energy to work and play at the highest level. They’re here to guide you, whatever your challenge, whatever your goal. All you need to do is follow them.
Rule number one is eat a healthy diet. Why? It’s the best way to look and feel your best. Eating right will help you to control your weight. A good diet will also help lower your cholesterol and blood pressure and help prevent heart disease, stroke, arthritis, specific cancers and a host of other common health problems. Build your daily diet around skinless poultry, fish, lean meats, low fat or non-fat diary products, whole grain breads and cereals, and at least five daily servings of fresh fruits and vegetables.
Rule number two is establish a regular exercise program. Staying physically active is about as important as eating a good diet if you want to get healthy and stay that way. Know that exercise does not need to be overly stressful. To stay in shape, all that’s really needed is about half an hour of physical activity five days a week. Taking a brisk walk around the block is more than enough.
Rule number three is manage stress in your life. Women – as daughters, mothers and grandmothers – experience quite a bit of stress on a daily basis and stress is often the first symptom of many more serious health problems. That’s why it’s so vital for women to take a bit of time each day for themselves no matter how busy they are. Find a way to relax and just let go.
Rule number four is break all risky habits. And that includes smoking, recreational drugs, alcohol, unprotected sex and overindulging on sweets, salt and fats. These habits are dangerous and even deadly. So don’t smoke and stay away from people who do. Say no to drugs. And never drink more than one drink a day.
Rule number five is avoid the sun. Skin cancer is extremely common and, if it isn’t treated soon enough, can be a killer. So be sure to stay covered with long sleeves and a wide-brimmed hat and and/or an effective sunscreen of at least 15 SPF whenever you’re in the sun for more than just a couple of minutes.
If you trust and follow these five basic rules for women’s health, you can live a long, healthy and happy life. They’ve been tested over time and proven to work.