Keeping You in the Know

Health Tips and Information


Why You Should Review Your Medicare Coverage Each Year

When you turn 65 and enroll in Medicare, you might feel tempted to choose a plan and then forget about coverage decisions. But that would be a mistake, because the various options offered to you through Medicare can and will change over time! Additionally, your healthcare needs and possibly your budget will change as well. That’s why Medicare offers two different periods of time each year, during which you can make changes to Original Medicare or Medicare Advantage plans.

The first of those is the Annual Election Period, which runs from October 15 to December 7 each year. You can make changes to any Medicare plan at this time. The second, Medicare Open Enrollment, runs from January 1 to March 31 and only affects those enrolled in a Medicare Advantage plan.

So, why should you bother with these two enrollment periods? The answers are fairly straightforward.

First, Medicare Advantage plans operate on a network, and that network can change over time. Your preferred practitioners or facilities might drop out of the network, leaving you limited to whatever you are offered.

Second, your healthcare needs might change over time. You might develop certain health conditions that necessitate a Medicare Special Needs Plan (SNP), which can help you manage the costs associated with certain medical complications. Or you might simply wish you had features like dental care or vision services rolled into your plan (and some Medicare Advantage plans do offer those, whereas Original Medicare does not).

And finally, Plan D (prescription drug) plans can change from one year to the next. The plan’s “formulary” (list of covered drugs) might shift, and an essential presciption might not be covered at the same level anymore. This can become complicated if you rely on certain medications. And since most Medicare Advantage plans typically include Part D coverage, they might be affected by this type of change too.

Always read your Annual Notice of Change (ANOC) letter which arrives each fall before the Annual Election Period. This notice details any upcoming changes to your plan, so that you have time to identify your needs and switch to a new plan if necesssary.

And remember, we’re here to help. Call us with your questions about Medicare coverage, and we’ll be happy to help you sort through your options and choose a plan that works for you.

Stay Organized With These Medicare Enrollment Dates

When you reached age 65, you enrolled in Medicare for the very first time. But Medicare enrollment isn’t set for life. You have frequent opportunities to make changes to your plan(s), to ensure that your healthcare options arrangements to best serve your needs and budget.

But it can be a bit tricky to keep track of the different Medicare enrollment dates, and what you can or should do each time one of them comes up. This handy list will help you stay organized.

September and October of each year… Your Medicare plan administrator will send you an Annual Notice of Change (ANOC) letter. Read this notice carefully, because it will inform you of any changes coming to your plan for the following year. In particular, pay attention to your plan’s drug formulary (list of covered prescriptions) so that you can continue to maintain coverage for the ones you need. This is the time to compare your current plan to others that might be available to you.

October 15… This date marks the beginning of Medicare’s Annual Election Period. During this time you can drop your plan and enroll in a different one (either Original Medicare or a Medicare Advantage plan). You can also add a Part D plan to Original Medicare.

December 7… This is the deadline for the Annual Election Period. Make all changes by December 7, especially if you’ve chosen to enroll in Original Medicare.

January 1… This date marks the beginning of the new coverage year. Any changes you made during the Annual Election Period will take effect now.

January 1 through March 31… Each year, Medicare operates a Medicare Advantage Open Enrollment period. If you’ve enrolled in an Advantage plan, you can make changes at this time. You can drop your Advantage plan and go back to Original Medicare, add a Part D plan if you’ve returned to Original Medicare, or change from one Advantage plan to another. But you can’t switch from Original Medicare to Medicare Advantage at this time.

Of course, along the way even the most organized person can feel a bit overwhelmed at all of the Medicare options before them. If you have any questions or need assistance sorting through the different plans available to you, remember that free help is available to you. Just give us a call!


What to Do If You Receive a Notice of Creditable Coverage

If you’re over age 65 (or otherwise eligible for Medicare) and you have health insurance coverage through an employer, take note.  You should receive a Part D Notice of Creditable Coverage from your employer by October 15.

This notice must be sent to Medicare-eligible persons by the sponsor of their group healthcare plan, and it tells you whether your plan offers prescription drug coverage commensurate with that of a Medicare Part D plan. But just what does that mean? In 2022, “creditable coverage” means the plan provides the following:

  • A deductible of $480
  • An initial coverage limit of $4,430
  • An out-of-pocket threshold of $7,050
  • Coverage for brand name and generic prescriptions
  • Reasonable access to retail providers and mail order coverage
  • The plan pays on average at least 60% of prescription drug expenses

If your healthcare plan is “creditable”… You are maintaining coverage the qualifies you to exempt yourself from Medicare enrollment. That means you can continue to delay your enrollment until your group-sponsored plan coverage ends, or becomes “non creditable”, without the risk of incurring a penalty from Medicare for failing to enroll. However, you might wish to enroll in Medicare anyway, and enjoy the benefits of secondary insurance.

If your healthcare plan is not “creditable”… You must enroll in Medicare. If you fail to enroll on time, you will face a penalty in the form higher premiums for the rest of your life.

If it’s time to enroll in Medicare, remember that there are numerous options from which you can choose. You can go with Original Medicare, which is Parts A and B, and then add a Part D plan to help with the cost of your prescription medications. Or you can enroll in a Medicare Advantage plan, which rolls Parts A and B, and often Part D coverage, into one convenient plan that is easy to manage. These plans are managed by private health insurance providers, must meet certain Medicare standards, and operate through a network of providers.

We can help you sort through your Medicare options. Give us a call, and we can help you identify your priorities and then match you with a plan that meets those needs.


It’s Time to Start Thinking About Medicare’s Annual Election Period

As you might already know, Medicare’s Annual Election Period (AEP) begins on October 15 and runs through December 7 each year. During this time, you can evaluate your current Medicare plan and decide whether to stick with it or choose a different one. But with so many choices available to you, a structured plan is needed to help you sort out your options.

Gather your Medicare statements. Throughout the year, you should receive regular statements from Medicare or your Advantage plan provider, detailing your out-of-pocket expenses. You will need these to determine whether your healthcare spending is working for your budget. Even if you feel that your spending is in line with your expectations, it can’t hurt to investigate other Medicare plans. You might save even more money.

Look for your annual notice of change (ANOC). Each year, your healthcare plan administrator must send you an annual notice of change, notifying you of any upcoming changes to your current plan. Even if you like the plan, changes such as loss of a provider or a different structure to the plan’s formulary (list of covered drugs) could make it a poor fit for you going forward. If any pending changes will negatively impact you, it’s time to look for a different plan.

Make a list of your medications and preferred providers/facilities. This will help you when comparing Advantage plans, to determine whether your medications, providers, and facilities are even covered under each plan’s network.

Talk to an expert. Our Medicare specialists can help you determine which Advantage plans are available in your area, or whether Original Medicare might be a better fit for you. If you choose Original Medicare, you might also wish to add a Part D (prescription) plan, or a Medicare Supplement Plan (Medigap) to address any uncovered expenses.

Remember, if you do nothing, you will be automatically re-enrolled into your current Medicare plan(s). Comparing your options is always a wise move to help manage your budget.

4 Ways to Pay for Nursing Home Care

It is a common belief that Medicare will cover absolutely everything you need, regarding healthcare expenses, during retirement. But that unfortunately is not true. While Medicare does pay for hospitilization, doctor appointments, and some medical supplies, the cost of a nursing home is usually outside of the scope of coverage. So most people who enter a nursing home must find some other way to pay for it. But how?

Out-of-pocket. Some individuals simply pay for nursing home care out of their own pocket. But with nursing homes costing a few thousand per month, the bill might exceed your monthly income. In some cases a retirement account could be quickly drained when nursing home care is required.

Medi-Cal (Medicaid). While Medicare does not generally cover nursing home care, Medi-Cal might. The government-sponsored program helps with medical expenses for people of lower income status, so even if you don’t qualify for Medi-Cal when you first move into the home, you might qualify later when your financial status changes.

It’s a good idea to make sure the nursing home you choose will accept Medi-Cal payments, in the event that you self-pay but suspect you might qualify for Medi-Cal later. Because states use different metrics to determine Medi-Cal eligibility for those who reside in nursing homes, it certainly can’t hurt to apply for help.

Long-term care insurance. If you were proactive enough to think ahead, a long-term care insurance policy offers the obvious solution to the long-term care dilemma. Purchasing a policy before you retire, and younger if possible, helps you to lock in lower premiums. Some long-term care insurance policies cover nursing homes only, while others might provide for in-home services, adult day care, and other options. Compare policies, and choose one that provides for the type of care you think you might prefer.

Life insurance. Some cash value life insurance policies carry a rider that allows you to withdraw funds for expenses such as nursing home care. Check with your life insurance broker about your own policy to see what might be available to you.

If you’re concerned about the potential cost of nursing home care, give us a call. We can help you explore your options so that you hopefully won’t have to worry about this expense now or in the future.


What You Need to Know About Transparency in Coverage

As both consumers and providers of healthcare plans are aware, the details of health insurance can trigger confusion for those enrolled in a policy. That’s why the federal government created Transparency in Coverage rules in 2020, with several deadlines for compliance on certain parts of the new law. One of those deadlines just passed on July 1.

Beginning on July 1, all healthcare plan providers must provide cost-sharing data to consumers. This information is designed to help consumers understand healthcare service pricing and their own out-of-pocket spending.

How can you find this information? Providers are required to provide this data via machine-readable files, published on a publicly-accessible website. The data includes pricing information for all covered items and services according to in-network negotiated rates, and also certain historical data on out-of-network rates that have been allowed. Not all historical data is required; if there are fewer than 20 out-of-network claims for a service by any particular provider, that information is not required to be included.

A third set of data will disclose prescription drug rates. However, the deadline for that part of the Transparency in Coverage law has been delayed due to a need for further instructions. Therefore, that information might not yet be available from all insurance carriers.

The information in all of these files should be updated monthly to reflect changing rates and new data.

What does “publicly available” mean? Consumers are not required to create a user account, provide a password, or submit any other type of credentials in order to access this information. The information must be published on a website where the general public can access it. Ask your health insurance provider and they will direct you to the the appropriate website.

Again, these files should be published by July 1, so that consumers can access information on cost-sharing from this point forward. If you have any questions about compliance with this new law, or need help interpreting the data, call your health insurance representative.


Take Note of New Limits for HRAs and HSAs

Enrolling in a high deductible health plan (HDHP), sometimes paired with a health savings account (HSA) or health reimbursement arrangement (HRA), can serve as an effective way to manage out-of-pocket healthcare spending while reaping some valuable tax benefits. But of course, as healthcare costs rise along with inflation, your budget is impacted. Without occasional adjustments to certain limits, the benefits of these plans could become irrelevant over time.

So for that reason, out of pocket maximums for HDHPs do change. And because of that, the IRS sometimes issues changes to annual contribution limits for HRAs and HSAs.

First, let’s take a look at the changes to HDHPs, coming next year:

  • The maximum out-of-pocket limit (excluding premiums) for self-only coverage will rise from $7,050 in 2022 to $7,500 in 2023
  • The maximum out-of-pocket limit (excluding premiums) for family coverage will rise from $14,100 in 2022 to $15,000 in 2023

Yes, this means your out-of-pocket ceiling for spending will be a bit higher next year. But accordingly, the IRS will allow for greater contributions to HRAs and HSAs.

For those with an excepted-benefit health reimbursement arrangement (HRA), the annual contribution limit will rise from $1,800 in 2022 to $1,950 in 2023.

The annual contribution limits for health savings accounts (HSAs) will change as follows:

  • The contribution limit for those with self-only health insurance coverage will rise from $3,650 in 2022 to $3,850 in 2023
  • The contribution limit for those with family health insurance coverage will rise from $7,300 in 2022 to $7,750 in 2023
  • Catch-up contributions for those aged 50 and older will remain the same, at $1,000

Employers should update all of their communications with employees to reflect these new limits, before the start of next year. If you have any questions about these healthcare plans, or anything else concerning your healthcare insurance arrangements, call our office and we’ll be happy to assist you.

6 Great Reasons to Enroll in a Life Insurance Policy

Some of the benefits of life insurance appear obvious to most of us, but others might surprise you. There are many great reasons to purchase a life insurance policy, here are six of them…

Provide money for your dependents. This is the benefit most people associate with life insurance. When you die, your policy will pay a specific amount of money (called the death benefit) to your survivors. The most important reason to enroll in a life insurance policy is to provide for your loved ones in the event of your death. And remember, it’s not just wage earners who need a life insurance policy. Everyone has final expenses, such as burial or cremation.

Leave a legacy. You probably want more than subsistence for your loved ones. The lump sum of a death benefit can be used to cover taxes on your estate, pay for college tuition, set up trust funds for children, leave a gift to a favorite charity, and more. A life insurance policy allows you to leave behind something meaningful to the people you care about.

Tap into cash value. Some types of life insurance build cash value, that you can tap into via a loan against the policy. You can use this cash value for emergencies or even to help fund your retirement one day.

Access needed income if you get sick. Some life insurance policies include a clause, called a rider, that allows you to receive a portion of your death benefit if you become chronically or terminally ill. This rider can allow you to handle expenses and support your family during one of life’s toughest moments.

Lower your tax burden. Some loans against the value of a permanent life insurance policy can be taken as tax-free income. And the death benefits from both term and permanent life insurance policies provide your beneficiaries with a lump sum of untaxed income when you pass away.

Protect your business. In the event that one business partner dies or becomes disabled, the right life insurance policy can aid in business continuation by facilitating the transfer of ownership. This way you don’t have to worry about your business being interrupted, and your employees will be protected, too.

Give us a call to discuss these benefits of life insurance, and we can help match you to a policy that suits your individual needs.

Medicare Coverage for Mental Health Services: What You Need to Know

At some point in life, many of us experience a need for mental health services. And in a lot of cases, those circumstances come after retirement. Once the kids have left home, you’ve left your career, and your social life changes, feeling like depression and anxiety can surface. Many Medicare beneficiaries are uncertain of their treatment options, and might wonder about Medicare coverage for these services. Here’s what you need to know.

Medicare coverage includes preventive services for mental health. We all know that preventing a health condition is often easier, and wiser, than attempting to treat one after the fact. So along with other types of preventive services, Medicare offers screenings for mental health conditions:

  • A “Welcome to Medicare” visit within your first year of coverage, which includes an assessment for your depression risk
  • Annual depression screening via your primary care doctor
  • Alcohol misuse screening (one per year)
  • Annual wellness exams, during which you can talk to your doctor about mental health symptoms or concerns, or ask for a referral if necessary

Medicare coverage includes treatment for mental health conditions. If prevention fails, Medicare does offer coverage for a variety of mental health treatment options. The following services are offered on an outpatient basis:

  • Psychiatric testing and diagnoses
  • Therapy -both individual and group, depending upon your needs and preferences
  • Family therapy in some situations
  • Up to 4 sessions of alcohol abuse counseling

Medicare coverage does extend to inpatient services. In some circumstances, a patient might need more intensive mental health care. Medicare Part A does cover hospitalization, up to 190 days in your lifetime. Medicare Part B will cover services that you receive during your stay in the hospital.

Medicare coverage can help pay for certain medications. Yes, antidepressants and other medications used for mental health conditions can be covered by your Medicare plan. However, because Part D and Medicare Advantage formularies (lists of covered drugs) do differ from one plan to another, it is wise to check your list of covered drugs each year during the enrollment period. Taking this step will help you to maintain a plan that covers the prescriptions you need for your condition.

The plan you have matters.  Advantage Plans and Supplement Plans will differ in the way you access mental health benefits.  If you have any Advantage Plan, contact your broker or insurance company for details on how to access care. If you have Original Medicare, you can see any provider that will accept it.

If you have any other questions about Medicare coverage for mental health services, please contact one of our helpful representatives. We can help you compare and shop for Medicare plans that best suit your needs.


Understand Your Rights With Regard to Mental Health Care

Gone are the days in which mental health care was not treated with the same level of importance as care for physical health issues. These days, both the Affordable Care Act and California law set forth minimum standards for health care plans and providers, so that those needing treatment can seek and receive the services they require.

But as with anything else, knowing your rights is the key to accessing them. So here is what you need to know about mental health care and the law.

Under the ACA, mental health services are deemed “essential”, meaning any plan that seeks to be ACA-compliant must provide a certain level of care in this area of health. Services that must be provided under the plan include:

  • Treatments such as counseling and psychotherapy
  • Inpatient mental and behavioral health services
  • Substance abuse treatment

These mental health services are subject to the same standards as medical and surgical care in how care is managed and how deductibles and co-pays are applied.

Additionally, California law supplements ACA requirements by specifying a number of specific conditions for which care must be provided:

  • Major depressive disorders
  • Autism or pervasive developmental disorder
  • Bipolar disorder
  • Panic disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Obsessive-compulsive disorder
  • Anorexia nervosa
  • Bulimia nervosa
  • Serious emotional disturbances in children under age 18

California healthcare plans must cover inpatient and outpatient treatment, as directed by the overseeing doctor, and prescription drugs when needed.

Your health insurance plan, however, could stipulate how you access mental health services, so contact your insurance company or broker to learn how to access this benefit.

Finally, if you seek an initial consultation for mental health care, California law requires that the provider or facility provide you with a return appointment within 10 days. The same deadline applies to referrals for mental health care from your primary care provider.

We are fortunate that the law does take mental health seriously, and that we can all obtain care when we need it. Just as with any other healthcare need, seek services promptly when you need them to protect your health. And if you’re ever in doubt as to how your healthcare plan works, or what type of treatment it covers, contact your plan provider’s customer service team.


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