Health Tips and Information

You navigated a web of decisions when you first enrolled in Medicare at age 65. But each year, you have the opportunity to revisit those decisions and compare your current plan to other ones during the Medicare Annual Election Period. From October 15 to December 7 each year, you should discuss your current plan and any concerns with a qualified insurance broker who specializes in Medicare plans. And yes, this conversation is an important step! It’s better to consult with a broker than try to sort through these decisions alone, and here’s why…

• You could potentially lower your out-of-pocket spending on healthcare, making retirement a bit more comfortable with regard to your budget
• You could access a network of providers that includes your preferred doctors and facilities
• You could lower your prescription drug costs by choosing a plan with a formulary that suits you better
• You can gain a better understanding of how your plan works, so that you can maximize its benefits
• You will learn how to avoid billing surprises
• Your broker can teach you about crucial time windows of coverage so that you can avoid some of the common pitfalls
• You might be able to avoid falling into a coverage gap
• You can become more familiar with your plan’s customer service features, so that you are able to access help any time you need it
• … And probably much more, depending on your needs

And the best news of all: It’s FREE to receive help with choosing a Medicare plan. No, you aren’t charged an extra premium, and you can access the exact same pricing you would access on your own. Broker commissions are already worked into the price of all Medicare plans, so if you don’t consult a broker you are technically giving up a valuable service that is already paid for.

Give us a call right now, while the Annual Election Period is ongoing, and we will help you compare different Medicare plans. You won’t know if a better plan is out there unless you investigate the options!

Not only do Medicare plans change with regard to their coverage and drug formularies; the monthly premiums can change from one year to the next, too. Medicare beneficiaries are sometimes dismayed to learn of premium hikes, so this year we have some good news: Your premiums will actually go down a bit in 2023!

Most beneficiaries receive Medicare Part A for free, because they accumulated enough work credits in their lifetimes. So for the most part, premium adjustments apply to Medicare Part B. For most of you, the new Part B premium for 2023 will be $164.90, which represents a small decrease of just over five dollars. Your deductible will go down a bit, too, at $226 for the year.

That premiums and deductible will apply to most Part B beneficiaries, but about 7 percent of Medicare recipients pay higher premiums due to falling into a higher income tax bracket. If you’re an individual earning more than $97,000 annually, or a married couple earning more than $194,000 annually, consult with your Medicare broker. Your premiums are higher, and are based upon the particular income bracket into which you fall.

As we mentioned, Medicare Part A is free to most. But a deductible does apply to hospital stays. For 2023, your share of the hospital bill will amount to $1,600 for the first 60 days of hospitilization. If your stay exceeds 60 days, you will pay a $400 coinsurance charge between 61 and 90 days, and $800 dollars per day thereafter.

The Medicare Annual Election Period is happening now, so this is the time to investigate your plan options. Give us a call if you’re concerned about your plan’s network, drug formulary, coverage limits, premiums, or anything else. We can help you compare different Medicare plans and choose one that suits your medical needs and budgt.

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.

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!

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.

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.

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.