Medicare Blogs Medicare Advantage Plan Coverage... How It Works While Away From HomeJanuary 7, 2021How will a Medicare Advantage plan work if I have an emergency away from home, while visiting family or on vacation?That’s a very common question and concern from Medicare beneficiaries when considering a Medicare Advantage Heath plan.In most cases, Medicare Advantage plans will cover your care if you obtain emergency services or if you are taken by ambulance, while away from home. In many cases, the hospital may not be part of your plans provider network. Most plans have a cap on how much you could be charged for the visit. A typical co-pay could be as much as $150 to $200 for an emergency room co-pay. Your Medicare Advantage plan materials will detail in and out of network provisions.If you need continued care while you are out of town, your Medicare Advantage plan will usually request that you are transferred, once you are stable, to one of its network hospitals.Should the physicians treating you at the out of network hospital deem that you are not able to be transferred because your conditions aren’t stable, the Medicare Advantage plan will have to pay for the care you need until it’s safe for you to be moved to an in network facility. The time to know how how these provisions work is before you need them. If you are unsure as to your coverage provisions, call your agent or insurance company for the details. New Program for Renal Disease PatientsDecember 29, 2020The United States Department of Health and Human Services Secretary, Alex Azar, said in September that about 1 in 3 Medicare patients dealing with end-stage renal Disease will be enrolled in a program that rewards them with more convenient comfortable options like home dialysis.The program would not only be convenient but also curtail exposure to vulnerable kidney patients to COVID-19 by eliminating visits to clinics.Medicare will begin increasing the amount of pay to its providers for home kidney treatments to encourage the change. The move will actually save Medicare about 23.5 million over five years. The new regulation also increases government support for people to donate their organs, including financial compensation for lost wages, child care and elder care. In September, it was estimated about 92,000 Americans are on waiting lists for kidney transplants. Source AARP bulletin November 2020 Medicare Annual Election PeriodNovember 5, 2020Our Medicare Annual Election Period season is off to a brisk start! Of course, we are busy with the normal Part D "Prescription Drug Plan" and MAPD "Medicare Advantage Plan” questions this time of year. We have clients that may wish to switch from Medicare Advantage Plans to Medicare Supplements and vice versa. There’s something for everybody! Your Action May Be Required:Minnesota Life's Journey Rx - This year’s open enrollment is especially busy because of the exit of a carrier from our market, Minnesota Life's Journey Rx. Everyone currently on the Journey Rx plan must select a new plan with a different carrier for next year. Prescription Blue Preferred PDP - Blue Cross Blue Shield of Michigan has dropped Prescription Blue Preferred PDP for 2021, their mid-tier plan, and increased the premium of their previously least expensive plan by nearly $50, Prescription Blue Select PDP. Needless to say, this may cause most clients to move to another plan. Many of our clients have begun doing their own Part D studies on Medicare.gov and sending us the results for consultation, which is working out quite well. Thanks to all those doing their own studies! Although you may have already been contacted by our office, if you are on Minnesota Life's Journey Rx plan or Prescription Blue PDP Preferred in 2020, and are unable to complete your Part D studies, please contact our office and we would be happy to help you! And so it begins…the 2021 Medicare seasonAugust 18, 2020 Believe it or not, just like the NFL, there’s a huge “preseason” to the Medicare Annual Enrollment Period (AEP). The 2021 Medicare season officially begins on October 15th, however our preparations begin in early July. Insurance agents are required to be re-certified annually, completing training and certification exams regulated by the Centers for Medicare and Medicaid Services or “CMS”. With our CMS training out-of-the-way, we will now become re-certified with each insurance company that we plan to represent in 2021. Our Medicare team has attended product training sessions with the following carriers: Blue Cross Blue Shield, Health Alliance Plan, Aetna, United Healthcare/AARP, WellCare, Humana, Priority Health & Silverscript. All of this preparation in the “preseason” makes our team well prepared and knowledgeable to serve our clients in an exemplary fashion! Should I Stay or Should I Go... Medicare Part A & BJuly 23, 2020If you are approaching age 65 or over age 65, and are still working for a company with less than 20 employees, you have healthcare decisions to make that can result in thousands of dollars in potential savings or lost opportunities.Of course, the decision I am referring to is whether to either stay on your employer health care plan or go off onto a Medicare Supplement and a Part D plan with Parts A and B, or a Medicare Advantage plan. Note that the decision to get Part A & B won’t be yours.If you work for a company with less than 20 employees, in most cases, Medicare will be primary for your health care needs and your group carrier will be secondary. For many people, the cost of a Medicare Advantage plan with prescription Rx or a Medicare Supplement with a Part D Prescription Drug Plan will probably be less than the total premium for the employer group insurance. The big determinant is, who’s paying the premium? If you are paying the premium, perhaps through payroll deductions, it may be much less expensive for you to exit this coverage. If your employer is paying the entire cost of the health insurance, it’s likely to be more advantageous to stay on the employer health plan. However, you will need Medicare A & B in either case.Prescription drug costs can be the largest single variable in determining whether it makes sense to stay on an employer health plan or opt off and enroll in a Medicare Advantage Prescription Drug Plan (MAPD) or a Medicare Supplement and Part D plan.To make the best decision, it is imperative that you assess your out-of-pocket drug costs should you stay on the employer plan and compare those costs to the out-of-pocket costs that will be experienced should you move on to a Part D plan or a Medicare Advantage plan that covers prescription drugs.We recommend everyone does a Medicare Rx study available on Medicare.gov https://www.medicare.gov/ If you’re unfamiliar with the process, we would be happy to assist you. Reasons to consider staying on an Employer Group Health Plan: The employer is paying the entire cost of the insurance with no out-of-pocket cost to you.The employer plan is very strong and has very little out-of-pocket costs for both medical and prescription.Your spouse is not 65 and is currently covered on your coverage, preventing you from exiting.You determine through a Medicare Rx study that your out-of-pocket costs will be substantialPotential reasons to opt off of your Employer coverage in favor of a Medicare Supplement and Part D Plan, or Medicare Advantage Prescription Drug Plan. (MAPD) You take very few prescription drugs and will face little out-of-pocket costs on your Part D Prescription Plan or MAPD.The employer plan is costly, as you have to pay much of the premium and out-of-pocket costs.You are on the plan as a single and do not have a dependent spouse under the age of 65.You may enjoy a greater choice of physicians with either a Medicare Supplement or Medicare Advantage plan. Don't Believe the Hype About Plan FMarch 20, 2018:We are seeing substantial misinformation in the marketplace concerning the beloved Plan F, enjoyed by many Medicare age people. Unfortunately, many have taken the news of Plan F’s eventual removal from the Medicare menu of products to mean that it will become unavailable for all, regardless of those who have it or not in the next few years.To some degree, I think it may be just a misunderstanding from an agent standpoint, as many are claiming it is going away and scaring people off and on to Plan G prematurely.The fact is anyone who is old enough for Plan F now will always be able to retain it under the current rules, until they pass away. Plan F is slated for obsolescence with those who are turning 65 after 2018. Those who have the plan currently can keep it. Simply, those born after that date will not be able to sign up for it. Plan F will eventually vanish off of the product menu of many insurers, as fewer and fewer will be eligible to purchase it.As a rule, even if someone currently doesn’t have Plan F now, they will be eligible to buy it even after 2018, of they were born before 1953. Oops, Mom Has No Insurance! March 19, 2018It happened again…a Blue Cross Blue Shield of Michigan Legacy customer did not pay her bill because of a caregiver oversight. In this case, we believe the caregiver had an unfortunate illness herself and forgot to pay mom’s premium.The facts: Mom is 89 and lives in northern Oakland County and is currently without coverage. BCBSM Legacy Plan C is not willing to reinstate her plan.Fortunately, she was able to answer medical questions and was approved for another Medicare Supplement policy from United Healthcare / AARP. Health Alliance Plan was also able to accept her to one of their Medicare Supplement Plans. Some beneficiaries are not so lucky, as they are unable to answer medical questions and obtain new coverage during the year. They would likely go bare without any coverage but original Medicare until the annual enrollment period. During which time, they could be signed up for a Medicare Advantage Plan.Result: Happy ending! Mom will have insurance again in April and will be paying less than before on her Medicare Legacy plan. Changes in Blue Cross Legacy Coverage March 19, 2018:Our phone is ringing off the hook with customers and prospects that are disappointed over their new higher rates for the BCBS Legacy Plan C. Blue Cross Blue Shield of Michigan has elected to raise rates on both customer types, those who are over 65 with Medicare A & B and those who are under age 65 who are disabled, with Medicare Part A & B.Presumably, Blue Cross Blue Shield of Michigan is still experiencing “unfortunate underwriting losses” on their historic Legacy product. You may recall that in 2017, Blue Cross Blue Shield of Michigan raised the rates from approximately $134 a month to a new premium rate based on age, sex, and geographic location. For example, males in Oakland County over the age 80, experienced their rates rise from $134 per month to nearly $299 a month. Others pay somewhat less, but everyone faced the large rate increase last year. The increase was supposed to assist with the nearly $200 million per year underwriting loss that BCBS was experiencing. Part of the loss was due to the state of Michigan, mandating that Blue Cross Blue Shield keep the rates very low and “vastly under market“. In fact, the majority of customers that experienced the rate increase did not move and payed the increased premiums. Unfortunately, it does not appear that the rates are adequate to cover the losses that Blue Cross is experiencing.Right Now:As of April 1, 2018, Blue Cross Blue Shield is raising rates about 4%. Some of these seniors are going to be charged over $300 a month. The new rate will be based on age, sex and zip code. Rates will also be rising even more for disabled individuals with Medicare. What to do? Strategy #1: Consider moving to another Medigap / Medicare Supplement plan in April. Most people over age 65 should apply to other Medicare Supplement providers to obtain lower rates. Medigap or Medicare Supplement policies do not follow the same rules as Medicare Advantage plans and maybe applied for any month of the year. Following this logic, participants may change insurance companies any month provided they pass underwriting for the new insurance company.Many are surprised we can find them a company who will approve them at a better rate midyear. There is no risk to apply to see if someone can get approved or get a firm price. We commonly give people an idea of their perspective price just with a few questions over the phone. Should this be successful, some will save hundreds of dollars per month. Since health conditions are a key factor when considering moving to other Medigap /Medicare Supplement plans, participants should not procrastinate. Health conditions could change for the worse, therefore prohibiting the move to another carrier. Strategy #2: Some will not be able to move Medigap or Medicare Supplement plans at this time due to a temporary health challenge, however, they may reapply when they become healthier. Should their health not be likely to improve, they can pay the increased premiums on their Legacy plan until the end of the 2018 plan year and consider moving to a Medicare Advantage plan “MA” during the annual enrollment period. Why These Individuals Should Consider MA? Competitive premiums.No medical questions to apply.No extra charge for advanced age as with Medigap plans.No extra charge for those with disabilities that are under age 65. Things to Verify Before Potential Change Those that elect Medicare Advantage plans will need to pay attention to how their pharmacy needs will be covered under these plans. Also, many of these plans have provider networks that must be scrutinized as well. While many doctors accept Medicare Advantage plans, potential insureds should verify their doctors are in network.Call us to discuss your options or options for your parents. We will assist you to determine if a new Medigap / Medicare Supplement plan is a possibility. We can also help with a pharmacy study to make sure that medications will be covered under a Medicare Advantage plan or a Part D plan. Strategy #3: Do Nothing and Pay the Rate Increase This has been the most popular decision regarding Blue Cross Blue Shield of Michigan Legacy rate increase. The vast majority of participants on the Medicare BCBSM Legacy plan have not moved and are just paying the rate increase. The Legacy plan is a very good insurance plan and it works well for participants. Anyone who has experienced claims finds it to be a very good coverage. Unfortunately, the rates may continue to increase, especially as underwriting losses increase.Should this happen, eventually, some will find it makes sense to consider other options as rates could increase year after year. What will be your strategy? Call us should you wish to explore your alternatives. Moving Mom or Dad Closer to Home February 8, 2018:We received a call yesterday from a daughter of a Senior citizen who is being moved to Michigan so that the family can better deliver care to her.This is the second case we’ve had recently whereby seniors are moving into Michigan to be cared for by their children.When this happens, the likely result is a loss of healthcare and/or prescription drug coverage by the senior. Under Medicare Part D ‘”Drug” and Part C “Medicare Advantage”, their plans likely terminate because a change in zip code. In other words, if the senior moves out of the service area they will lose their coverage and will need to select a new Medicare Advantage Plan C or Part D Prescription Drug Plan in their geographic area.In the cases we’ve dealt with recently, seniors were moving from Ohio to Michigan, to be with their children. The daughter that called our office yesterday is moving her mother into an assisted living facility near her home, and will need to establish a new Medicare Advantage Plan within 30 days of mom’s move to Michigan. Hoover and Associates in mind if you need help with such a move, or know someone who is moving their loved one to Michigan. We are happy to help you determine the best course of action before the move. The potential change of Medicare Advantage and Prescription Drug coverage is just one more thing to consider and an aspect of the move that is important not to be overlooked. Blue Cross Blue Shield Legacy A and C August 16, 2017:The Blue Cross Blue Shield Legacy A and C rate increase has caused quite a stir amongst Michigan residents.Beyond having the opportunity of appearing on two radio programs highlighting the problem, we are seeing a substantial increase in people seeking out our advice as to the rate increase among the disabled.The only Medicare Supplement plan in Michigan that disabled citizens can utilize is the Blue Cross Blue Shield Legacy plans A and C.Other carriers in the Medicare Supplement marketplace such as Priority Health, United Health Care / AARP, and Mutual of Omaha do not underwrite applicants under the age of 65.Most disabled individuals we’ve spoken to have Plan C with Blue Cross and the rate that they’ve enjoyed for many years has been $122.86. That rate is now jumping up to a proposed rate of $314.87 per month.The disabled people we have talked to our typically on a fixed or low income and are having trouble with the magnitude of the rate increase.People have found Hoover and Associates by searching Google for Medicare Supplement agents in Michigan and are reaching out for answers. Securities offered through Sigma Financial Corporation Member FINRA/SIPC.Hoover and Associates is Independent of Sigma Financial Corporation.