Cutting through the maze of Medicare and Health Insurance options can be a daunting task. I have been in the Personal Insurance business for over twenty-five years, and to say that Medicare Health Insurance is confusing, and frustrating is an understatement, even for a seasoned Broker as myself. Well, I took on the challenge; I have gone through the Medicare maze and hopefully translated the information for you to better understand your choices.
Let’s begin with, what is Medicare? Medicare is a federal health insurance program enacted by Congress in July 1965 under the Social Security Act for those 65 and older. Also, for people under 65 with certain disabilities and those with End-Stage Renal Disease (ESRD) or permanent kidney failure.
Great News! New York and Connecticut have NO HEALTH QUESTIONS, EVEN IF YOU HAVE A PRE-EXISTING CONDITION.
Medicare does not cover everything, for example: Eye exams, Eyeglasses or contact lenses, Dental care, Cosmetic Surgery, Routine foot care, Acupuncture, Routine hearing exams or hearing aids, Long-term Care. See chart below.
There are 4 parts to Medicare:
Part A Hospital Insurance (Federal) Covers costs associated with confinement in a hospital or skilled nursing home.
Part B Medical Insurance (Federal) covers physician services, outpatient care and supplies.
Part C Medicare Advantage Plan (Insurance Companies)
Part D Drug Coverage (Insurance Company.
Very Important: Make sure your Physician and medical institution signed an agreement with Medicare to accept their assignment. Physicians and hospitals may accept Medicare but haven’t signed an agreement with Medicare. This leaves you open to ACCESS CHARGES which Medicare and your Insurance company does not pay.
Let’s Look at Medicare Advantage Plans (MA)
MA plan is one-year contracts with the Federal Government and are administered by private Insurance companies. They contract with Medicare and Medicare pays them to provide you with your Medicare Part A and Part B. Some have monthly premiums, and some do not. The basics of MA is managed care with emphasis on preventive healthcare. The insurance company determines and approves your medical services.
They have contractual agreements with healthcare providers and facilities. You must choose one of their Primary care physician (PCP) who authorizes all care for the member including referrals. In Emergency situations the PCP must be notified immediately or in a reasonable amount of time otherwise you may risk your claim being turned down. This plan may not cover you in every state. Check to see if the hospital and doctor you are familiar with is in the plan.
(Out of network Specialist and hospitals can be very expensive causing you financial hardship.)
Your Medicare Part B monthly premium $185. will still need to be paid.
Most MA plans include the Part D (Rx plan) and they are called MAPD plans.
MA plans must cover all services that Original Medicare covers. They may also have additional coverage. Such as Eyeglasses, Dental (may be limited to only cleaning and x-rays, check first}.
Plans can have different out-of-pocket costs, co-pays, different rules on how you get your services. You may have to stay in network only and need Referrals for specialist. You may have to get approval from the Insurance company for medical treatment and or prescriptions.
Providers can join or leave a plan anytime during the year or your plan can change providers anytime. Hospital may leave Network.
Plans and benefits can change annually. NOT Guaranteed Renewable.
You have the right-of-option each year during the Annual Election Period (AEP) to keep your plan, change it to another MA plan or to a Medigap Plan.
Plans may not cover you out of state or out of country. If your plan has a cluster of networks that are in several states, you may be covered.
MA plans usually have an annual Maximum Out-Of- Pocket (MOOP) of $6700.
You do have the ‘Right and Option’ each year during the Annual Election Period (AEP) also called Open Enrollment period, October 15 to December 7 to keep your plan, choose a different plan or switch to the Original Medicare Plan with a Medigap plan.
Medical Expenses can be very expensive even devastating. Before choosing a Medicare Advantage Plan, ask yourself these questions:
How’s my health now and what would it be like in the near future?
How important is plan flexibility, choosing any doctor or hospital in the USA?
Will I be covered when traveling outside the Country or the state?
What is my financial risk?
Let’s Look at Medicare Supplement Insurance Policy (Medigap)
Guaranteed Renewable for Life. (as long, as premiums are paid).
Your Doctor approves the service you receive not the insurance company.
Any doctor, any hospital, any specialist that accepts Medicare. No approval process to see a specialist.
Some plans pay 100% of doctors’ and hospitals’ Excess Charges.
Coverage is Nation Wide, and some plans cover overseas.
Several Plans to choose from to match your budget. Some with co-pay doctor’s office visits and deductibles. Some plans pay your co-pays and deductibles.
Plan F+ in NY is the most economical plan. It is offered as a high-deductible plan. If you choose this option, this means Medicare will pay their 80% of Medicare approved services and you must pay all coinsurance, copayments, deductibles up to the deductible amount of only $2,300 in 2019 before your policy pays anything. However, your premium can be as low as $78.00 a month. (Remember, Medicare Advantage has a $6,700 (2019) maximum out of pocket (MOOP).
NOTE: Coming in 2020 the F plan will not be available to those turning 65 on or after Jan.1, 2020. However, the G plan is the same as the F except it does not pay the Part B deductible $185. The original F plan will still be available to those who now have Original Medicare prior to Jan. 1, 2020.
***For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($185 in 2019) the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurances, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
Unlike the Medicare Advantage Plans, all the Medigap plans are the same no matter what insurance company you choose. However, there are some differences that don’t involve coverage.
You want to make sure you choose a company with an A or A+ AM Best rating or rating from other insurance Watchdogs. Many companies jumped onboard the Medicare train only to jump off or close their doors to new clients, which meant they needed to raise their premiums to make up for loses.
Ask how many years they have been in the Healthcare Insurance business. This too is very important because they have longevity and experience.
Premiums can vary significantly, so compare or you can choose an Independent Insurance Broker to help you, they are not tied to any company and usually loyal to their clients to get the best prices.
Service is paramount. Some insurance companies are so hard to reach or slow in paying your doctors and hospitals and this can be a big headache for you.
Part D Prescription Drug Plans
There are several competitive Prescription Drug Plans to choose from. Go to www.medicare.gov. There you can look up your prescription. You can choose company with the most competitive price. Or, you can ask your Insurance Broker to help you. It’s that easy.
Today, 60% of Medicare beneficiaries has individually purchased Medicare Supplement (Medigap policy.)
Should you select an HMO, PPO, or other type of Medicare Advantage plan, you should budget for any costs that the plan doesn’t cover. (Ask your provider).
Medical financial risk is real. In my years of experience, I have witnessed such financial tragedies and foreclosures due to medical and hospital bills. The numbers are staggering. Invest in your health wisely. Look over your plans and ask questions.
I hope this article clears up some of the confusion about Medicare Advantage and Medicare Supplement (Medigap). If you have any questions, please don’t hesitate to call me. Choosing the right healthcare is very important to your health and your future.
I can help you with the following:
Health Care Insurance
Finale Expense Insurance
Annuities, Long-Term Care
Illinois lawmakers voted to cap out-of-pocket insulin costs at $100 for a 30-day supply in the state, a measure advocates say is badly needed to address soaring prescription drug costs.
The Senate on Thursday signed off on changes made by the House a day earlier, and the measure is now in the hands of Gov. J.B. Pritzker, who supports it.
The price cap, which applies only to commercial insurance plans regulated by the state, would take effect Jan. 1, 2021.
People with diabetes have higher-than-normal glucose levels in their blood, and depend on prescription insulin to regulate those levels and prevent potentially life-threatening complications.
Story in the Journal.ie
Written by: Grainini Na Aohda
A NATIONAL HELPLINE for men and boys who are victims of domestic abuse has been launched today by the Waterford group Men’s Development Network.
The new advice line can be accessed on 1800 816 588 at the following times:
Counsellors will man the phones and provide an outlet for men, who are experiencing or have experienced domestic abuse in their relationship, to speak confidentially with professionals who are trained to advise on domestic crime.
Some common indicators of male domestic abuse include; verbal abuse and belittling, possessiveness and jealousy, on-going accusations of being unfaithful, trying to control where you go and who you see, trying to control how you spend money or deliberate default on joint financial obligations, making false allegations about you to your friends, or threatening to leave you and preventing you from seeing your children.
The most-recent research from the National Crime Council details that up to 88,000 men across Ireland have been severely abused by a partner at some point in their lives. The advice line’s initial roll-out is working toward facilitating up to 5,000 calls a year.
Sean Cooke, CEO of the Men’s Development Network said that although more women are affected by domestic abuse than men, only 5% of men report incidents to the Gardaí, indicating that the majority of men suffer alone.
“…Our research shows that most men suffer their abuse in silence because they are ashamed and believe it makes them less of a man.
The stereotype that exists around being a man in Ireland suggests that a man should be physically and emotionally strong, successful, confident and the list goes on.
This creates a barrier that can be impossible to break through and prevents men accessing support when they need it the most.
Cooke said that research has indicated that talking to a trained listener can help a caller make better sense of what’s happening and create a plan to deal with it.
by Janelle Allbritton, MPH
It you haven't heard of the celery juice craze yet, then welcome to the discovery!
The Westchester County Post staff does not include a licensed physician or nutritionist (yet), but this author confidently recommends this book if you want information you can use today that could help you start feeling better tomorrow.
In a world where we are exposed to radiation, pollution, herbicides, pesticides, fungicides, and all kinds of micro-organisms, it is amazing that we manage to survive as well as we do. How can we thrive instead of merely survive?
WesCoPo Book Club's First Recommendation
There is a source of information that can help you start thriving. Check out Anthony William's book series launched a few years ago with Medical Medium: Secrets Behind Chronic and Mystery Illness and How to Finally Heal.
Soon after that, in fairly rapid succession, came:
• Medical Medium Life-Changing Foods: Save Yourself and the Ones You Love with the Hidden Healing Powers of Fruits and Vegetables
• Medical Medium Thyroid Healing: The Truth Behind Hashimoto's, Graves', Insomnia, Hypothyroidism, Thyroid Nodules and Epstein-Barr
• Medical Medium Liver Rescue: Answers to Eczema, Psoriasis, Diabetes, Strep, Acne, Gout, Bloating, Gallstones, Adrenal Stress, Fatigue, Fatty Liver, Weight Issues, SIBO & Autoimmune Disease
His latest is Medical Medium: Celery Juice, the Most Powerful Medicine of Our Time Healing Millions Worldwide. You can buy it HERE.
Recommending this book is a personal gesture for me, because Anthony William's information not only gave me hope in the first few pages; he gave me recipes that helped me feel better within a few days. His words even had me breaking down in tears of relief because he was one of the few people I had met who could be so comforting (it isn't your fault), encouraging (your body is made to heal itself, so let's feed it properly), and generous (you are meant to have abundant health and happiness in your life).
Some Health History
In 2003, I discovered in an unconventional way that my health issue was hypothyroidism, after suffering for many years with symptoms that increasingly impaired me from living the life I wanted to live.
That discovery that day set me on a path that has taken me through many challenging places as I pursued healing for my body and spirit. As recently as 2015, I was still struggling to find balance for my thyroid function with supplements and nutrition. Blood tests were not indicating much improvement and it was frustrating.
Fast forward to today, when I no longer feel exhausted all the time and the brain fog has been swept far away. The only thing that has changed (besides no longer taking thyroid supplements) is my relationship with food. I understand which foods are the best for helping my liver clear the toxins that have been accumulating from all those years, e.g., antibiotics for various chronic respiratory infections.
I now understand which foods feed the Epstein-Barr Virus that I didn't know I had until a recent blood test. That virus has, according to William, been wreaking havoc in my body for decades partly because I was feeding it all its favorite snacks: eggs and dairy, for example.
I was so happy with the results I had after following his advice in his first book that I pre-ordered every book after that and eagerly awaited their arrivals.
Now YOU can have the good fortune of buying them all at the same time so you didn't have to wait like I did. You can order it straight from Hay House Publishing or it might be on the shelves at Barnes and Noble.
What Are His Creds?
That is a good question. I recently read a disappointing but predictable piece in by a New York Times writer with apparently zero training in the health care field, but she did interview a few experts who happened to be skeptical and somewhat less than enthusiastic about Anthony William and his celery juice gospel. Vanity Fair also recently published a snarky piece written by a self-described "millennial living in gentrified Brooklyn."
To be I also understand that so many people want to "go viral" on social media, and one way to do that is to connect with a hashtag word or phrase to make sure one's fame rises with the popularity of the content. To that point, yes it can be tiring seeing Insta posts of fashionable, healthy youth sipping their celery juice in clear plastic cups.
But what is more gratifying for me is the success stories with before-and-after photos to document improvement after the Medical Medium's advise was implemented.
All I can say is, don't knock it until you try it and actually give it a chance.
Of course, if you:
• are highly skeptical,
• tend to believe snark,
• don't have a "mystery illness" that has you feeling worse over time without any diagnosis or treatment in sight,
then no need to read any of this unless you want to help someone else.
Make no mistake about this: Anthony William does not claim to be a physician, or a medical expert of any kind who can diagnose or treat anyone of anything.
He tells his story clearly and boldly, about how, at age four, he first encountered the Spirit of Compassion who told him that his life purpose was to help people heal their bodies and lives.
They would do it with information Spirit would tell him so that he could tell the world of the truth, and of facts that had yet to be discovered through conventional scientific and medical research.
He issues forth information about the (yet undiscovered) 60+ strains of the Epstein-Barr Virus, and how it migrates through the human body over decades, eventually attacking the central nervous system. (Interesting that Alzheimer's is a rapidly trending issue projected for the next 30 years.)
The skeptic might be interested to know that there is a long list of physicians and other health care professionals who consult him directly for help with their "mystery illness" patients. In fact, Alejandro Junger, MD, the New York Times best-selling author of Clean, Clean Eats, and Clean Gut, wrote the Foreword to the first Medical Medium book.
I recently watched Junger and William live-stream on YouTube, and they told the story of how they met, how William helped Juger with a medical condition, and went on to help with Junger's family, friends, and many patients as well.
In a society where people consult astrologers and tarot cards for answers to life's questions, why should it be such a stretch for us to consider that maybe Spirit is actually giving William life-saving information for free? (He streams on social media and his books are available in libraries.)
Would it be a stretch to consider the possibility that individuals, organizations, and industries stand to lose a fortune if the people become empowered and start practicing self-care that actually prevents disease, disability and death?
Fortunately, Anthony William, Medical Medium and his information have proved to be so helpful -- even life-saving -- to so many people by now that efforts to discredit him are ignorant at best.
A Manhattan man in his 30s with a history of smoking e-cigarettes is the second New Yorker to die from vaping products, Gov. Andrew Cuomo said Wednesday.
The Department of Health confirmed to Cuomo that a vaping-related illness turned fatal, based on a medical record review, according to the governor's office.
"Our message on vaping remains unchanged," Cuomo said in a statement. "If you don't know what you're smoking, don't smoke it."
The problem with Cuomo's statement is that people never imagined that what they were vaping might injure or kill them. We DON'T know what is really in those cartridges, and the vaping industry leaders such as Juul are not about to give out their recipes.
The e-cigarette is a device created to start and continue addiction. The e-cigarette / vaping industry are lurking in the shadows where they cannot be reached by legislation that has not yet been passed. They enjoy the secretive and deceptive practices that the tobacco industry giants enjoyed 30 years ago.
Janelle Allbritton, MPH, has a specialty in helping people quit nicotine addiction. Whether you are smoking, vaping, or chewing, and you want to quit, find out where the next FREE class will be -- click HERE.