MEDICARE PLANNING by Cal Burley
WHAT
YOU NEED TO KNOW ABOUT MEDICARE
6/19/2009
This document has general information,
intended to focus on important issues that impact most Medicare
recipients. The information for this article is available in the
last two annual publications called “Medicare and You” for 2008 &
2009. These publications
will be referred to throughout this paper and have authority over
this document.
1.
ARE YOU POURING MONEY DOWN THE DRAIN?
Every year, there are changes to the Medicare programs. In response
to Medicare changes, the insurance carriers make changes to their
Medicare products. The purpose of this document is to review
some of these changes and to alert you to what you should be doing
to ensure that your insurance coverage is up-to-date.
The Centers for Medicare & Medicaid Services (CMS) is the US federal
agency that administers Medicare. One of their roles is to be
a watch dog for Medicare members who are referred to as
“beneficiaries” by Medicare. Due to all the changes, CMS has
continually issued new information to Medicare beneficiaries
regarding changes to their options.
Many seniors feel they studied their options when they first signed
up for Medicare and they believe that no further activity is needed.
Considering the importance of an annual review of your Medicare
coverage CMS created a questionnaire in Medicare and You 2008.
This questionnaire alerts you to the importance of an annual review.
They titled the questionnaire, “Is Your Money Going Down the Drain?”
(see attachment A). There is a similar alert in the 2009
edition as well. If you do not have this booklet, see item 5
below.
2.
IMPORTANT MEDICARE FACTS
We all know that Medicare does not pay for all of your medical
expenses. Each year your potential out of pocket expenses
change. Medicare Part A (Hospital) Deductibles change annually
as well as what you pay monthly for Medicare Part B (Medical).
For 2009 the deductible for Medicare Part A has been raised to
$1068. Depending on ones health, some individuals may have to pay
this deductible multiple times per year.. The deductible for
Medical (Part B) will be $135 plus you are responsible for 20% of
Part B charges. At this point in time, the 2010 rates have not
been released.
3.
PRESCRIPTION DRUG FORMULARY CHANGES
Most prescription drug plans change annually and that is why it is
important that every Medicare recipient have a review performed for
them every year, early in the fourth quarter of the year so they may
adjust their coverage’s accordingly. Please remember that your
window for changing plans is from November 15th through December
31st each year. (see attachment “G”)
Part D, Prescription Drug plans offered by individual insurance
companies are reviewed annually and adjusted for the coming year as
deemed appropriate by the carriers and Medicare. These changes
often affect your pocket book. From plan to plan and
from year to year, you should review your options. Medicare’s
web site www.medicare.gov
has a special tool that is updated annually for your use during the
forth quarter to analyze your potential savings on prescriptions as
your needs and plans change.
By inputting your prescription drug information into the Medicare
program, a current analysis is run that will narrow down the
prescription plans in your area, based on your current prescription
needs. Many times Medicare recipients’ have found savings of
several thousand dollars per year by changing their Prescription
Drug plan.
What is analyzed as the best plan for a recipient one year, is
frequently more expensive or less effective the following year.
Senior citizens are often heard complaining about how expensive
their medications are, without taking advantage of the tools and
guidance that is available to them. One of the reasons Medicare has
enrollment or election periods every year is to allow you to make
changes to your plan.
If you feel overwhelmed, do not hesitate to seek assistance.
4.
PRESCRIPTION DRUG COVERAGE GAP
All Medicare drug plans have a coverage GAP. This GAP is
frequently called the “Donut Hole”. During the coverage GAP
you must pay all of your prescription drug costs as well as any
monthly premium if you have a standalone plan. Please note
that some prescription drug plans do provide assistance during the
GAP, however, these are usually limited to Generic Prescriptions.
We recommend that you review Medicare and You and also seek
additional help with your prescription costs. (see Attachment
D)
5.
MEDICARE AND YOU
Each year CMS issues an annual publication called “Medicare and You”
during the 4th quarter of the year. You will be receiving a
stack of mail about Medicare Supplements, Medicare Advantage plans,
plus Prescription Drug literature. Several of these mailings
can be important.
Please carefully read any mail that is from your insurance carrier
that addresses Change of Benefits. The insurance companies are
required to send an Annual Notice of Change to you each year.
Ignoring these notices can be a costly mistake. When you make
your first trip of the New Year to your pharmacy you may be
surprised by how much your share of the costs have gone up. By
then it may be too late.
By far the best document that you can read and refer back to is the
annual edition of Medicare and You. If you do not receive a
copy of the Medicare and You, you may request a copy on line at
www.medicare.gov.
Also you may call me and I will email a PDF copy as soon as it is
available.
6.
LONGEVITY IS INCREASING YOUR POTENIAL FOR MORE MEDICAL NEEDS
It is no secret that the life expectancy has nearly doubled in the
last century. As people age, the possibility of contracting
new diseases also increases. There are several ways to address
this possibility and the first choice should always be a healthy
life style.
A healthy life is a better life. Medicare is your partner in
staying healthy. Medicare is committed to providing you with
benefits that meet your needs and information that can help you make
informed health care decisions. To get the most from your
benefits, you need to know what Medicare covers. Likewise,
before you select an expensive procedure, you should find out what
is or is not covered. Again, the two best sources for Medicare
information is the current edition of “Medicare and You” booklet and
the Medicare website at
www.medicare.gov (See item 5 above).
7. AN
OUNCE OF PREVENTION CAN GO A LONG WAY
Many senior citizens do not realize that they are entitled to a
Welcome to Medicare physical. There is also a list in the
“Medicare and You” booklet that references the types of preventative
care that is recommended by Medicare. Medicare recipients are
encouraged to bring this list to their doctor to make sure they are
not neglecting their health care.
Get the Medicare covered preventive service you need, like cancer
screening (Mammogram, colorectal, prostate), cardiovascular
screening, and a yearly flu shot. These tests and services are
critical to your overall health and can help you prevent diseases or
detect them early on, when treatment works best.
(See attachment B).
8. NEW
OPTIONS CREATE THE NEED FOR MORE INFORMATION
Originally when going on Medicare, your options were to self insure
what Medicare did not cover or to purchase a Medicare Supplement (Medigap)
policy. Changes in Medicare that came out in 2005 have opened
up a new option called Medicare Advantage. Medicare Advantage
plans that do not have Prescription Drugs (Part D) integrated into
the plan are often referred to as an MA plan. The Medicare
Advantage plans that do incorporate Part D are refereed to as a MAPD
plan.
In the Medicare Advantage field there are additional options like:
-
Preferred Provider Organization (PPO)
-
Health Maintenance Organization (HMO)
-
Private Fee For Service (PFFS)
-
Special Needs Programs (SNP)
-
Medicare Savings Accounts (MSA)
It should be noted that Medicare Advantage Plans may appear to be like a Medicare Supplement since they cover Part A and Part B. However, there are significant differences between Medicare Supplements and Medicare Advantage Plans.
Medicare Advantage (MA & MAPD) plans are health plan options that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” When you join a MA plan, you are still in Medicare. Some of these plans require referrals to see specialists. In many cases, the premiums or the costs of services (co-pays) can be lower in a MA plan than they are with a Medigap Policy.
MA plans provide your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. They generally offer extra benefits, and many include Part D prescription drug coverage. These plans often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan. Some of these plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
Medicare pays an amount of money for your care every month to these private health plans, whether or not you use services. Medicare Advantage Plans also include options that provide specialized care for people who need a lot of health care services. Even if you are temporarily out of the service area of the plan, you are still covered for emergency, or urgently needed care.
While these new options are not for everyone,
they should be explored. For many, they are the best choice.
For others, they are not. Considering the potential for
savings, learning how they work could be time well spent. Some
MA plans have maximum out of pocket caps while others do not.
Contact me if you would like my assistance.
9.
EMPLOYER SPONSORED HEALTH PLANS
If you are currently covered by an Employer sponsored plan, please
check with the Human Resources or Benefits Group before you enroll
in Medicare Part B. Signing up for Medicare Part B may affect
your ability to continue coverage for you or your dependents.
Medicare will usually become your Primary coverage. Also, make
sure your dependents do not lose their coverage because you didn’t
ask the right questions.
Whenever you have a question, you can call Medicare at
1-800-633-4227.
10. LONG TERM CARE INSURANCE
Medicare does not pay for Long Term Care. Who should have Long
Term Care Insurance? How much does it cost and what are the
advantages for you? How do you find out about the available
plans and how do you compare plans?
Long Term Care insurance covers a variety of services that help
people with health or personal needs and activities of daily living
(ADL) over a period of time. Long-term care can be provided at
home, in the community or in various types of facilities, including
nursing homes and assisted living facilities. Most long-term
care is custodial. Medicare doesn’t pay for this type of care
if this is the only kind of care you need. Long-term Care
insurance also does not replace Medicare.
It is important to think about how to get and pay for long-term care
before you need it. Also, since Colorado became a Partnership
state is 2009, you should investigate how this can save your estate
if you purchase one of these plans.
Your health status, risk factors, finances, preferences and family
situation affect your costs and coverage. For more information
about long-term care, visit
www.medicare.gov . Before you choose a policy, you, your
family, lawyer, financial advisor, and/or insurance agent should
consider all of these factors.
11. HOW DOES ONE STAY CURRENT ON ALL
THESE ISSUES?
There are many senior citizens who are willing and able to keep up
on these changes. Others have too much going on and other
issues to deal with. That doesn’t mean that help is not
available. You can get a host of information from the
medicare.gov website.
Medicare has very helpful associates at their call centers who can
assist you. Community organizations will assist you.
Also, you may get information from friends and family.
As a Senior Markets Specialists I am available to work with you on
an individual or group basis. As a broker I work with many
different insurance companies so I am not locked into one product
and I can explain the differences in many plans. I take the
time to understand what your unique needs are so that I can
recommend the best insurance solution for your particular needs at
the time of issue.
My goal as a Senior Markets Specialists is to stay current on
industry trends and changes. Throughout the year I stay
abreast of regulation and market changes so that I can maintain my
knowledge and certifications in the industry. I take every
opportunity to hone my knowledge by attending conferences and
conference calls. I also spend months maintaining my
certifications so that I am always informed and ready to assist you,
anywhere in Colorado.
Constant training provides me with insight into how changes impact
my clients from the standpoint of coverage and premium. I stay
in touch with my clients and I perform annual reviews every fourth
quarter for every client so you receive the benefit of my subject
matter expertise.
Thank you for reviewing this information package. Do you need
help with comparing your prescription drug coverage between plans?
If you have more questions or would like to talk directly with a
Medicare Specialist who understands these subjects, please feel free
to contact me. I would be more than delighted to work with
you.
Sincerely,
Cal Burley
Senior Markets Specialist
303-954-8807
Attachment A “Is Your Money going
Down the Drain?”
Attachment B “What Preventive Services Do You Need”
Attachment C “Personal Work Sheet’
Attachment D “Beware of the GAP 2009”
Attachment E “Medicare Supplement Standard Plans”
Attachment F “Your Options, Med Sup vs Medicare
Advantage”
Attachment G “Medicare Enrollment Information
”Information for this paper came from “Medicare and You”, 2008 & 2009 plus the www.medicare.gov webpage.
Presented for your convenience and education by
Jerold R. Gilbert, Esq.
-
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