Free Colonscopy

Free colonoscopy! Courtesy of Obamacare, everyone is entitled to a free colonoscopy when it is age appropriate. You may also be eligible for a colonoscopy at no charge (to you) based on your medical or family history. Normally this procedure is $1200 – $1500 but the folks at Obamacare have said you can have it at no charge along with over 100 different preventive services.find medicare information

Free birth control was not part of the law but it just sounded so good they decided to shoehorn that in because it worked into the overall political pitch. Along with you can keep your plan and your doctor why not throw in free contraceptives?

Nothing has been more confusing in the law than the much touted “free” colonoscopy. I still get calls from clients when they open a bill from their doctor and are surprised to find they owe several hundred dollars for this free procedure.

In fact, I had a call just this morning and had to explain the difference in free and not exactly free because we were only kidding.


Georgia Medigap plans & Prices
Georgia Medigap plans & Prices

Free colonoscopy that really isn’t

For starters, let’s address the meaning of the word free.

FB Groucho Marx3Free doesn’t mean there is no cost, it simply means you don’t pay directly for this procedure. Think about that for a moment.

The doctor doesn’t work for free. The exam room, drugs, equipment and assistants aren’t free. Someone has to cover the cost. That someone is everyone else that has coverage through Medicare or a private insurance plan.

Providing these “free” services means the premiums you pay for your insurance are higher than they would have been if not for these “free” services.

In the case of the free colonoscopy it is only free until it isn’t.


Why a colonoscopy?

Depending on your age or medical history, a colonoscopy might be appropriate. Dr. Stephen Schimpff offers this explanation.

The concept and purpose of colonoscopy is to find a polyp and remove it before it turns into cancer. Colon cancers arise from polyps. Polyps are common but only a minority of polyps progress to cancer. But if removed they obviously cannot become colon cancer. Colon cancer is the third most common cancer in men and women in the USA with about 150,000 new cases per year, behind only lung, breast and prostate cancers. And it causes about 50,000 deaths per year. Prevention obviously makes sense. – Kevin MD

No one really wants to go through the procedure but most don’t want to get cancer either. If you are in a high risk category you probably should schedule your procedure sooner rather than later.

I have a close relative that has a significant family history when it comes to cancer. Her mother and father both died from cancer. All of her fathers siblings died from cancer and (if I remember correctly) so did two of her mother’s siblings.

So far she has been cancer free but has been conscientious in taking care of her overall health and making sure she has regular screenings.


When does a colonoscopy change from free to not free?

You are not the first one to ask and you won’t be the last. Even doctors can be confused about the free colonoscopy.

A check at stated that colonoscopy was covered by the ACA and that, “if your doctor finds polyps inside your colon during testing, these growths can be removed before they become cancer.”

I decided to call the doctor’s billing office to check. After the clerk talked to her supervisor she called back to say that I was correct that there was to be no deductible if it was a simple “screening” colonoscopy. But since the doctor had found and removed a polyp it became a therapeutic procedure. Medicare and Medigap (and apparently commercial insurers as well for those under 65) do not recognize this as a preventive screening procedure under the ACA guidelines. Hence I was on the hook for the remaining $65.52.

Now $65 for a colonoscopy isn’t bad at all, but when you were expecting free you deserve an explanation. When the government designed Obamacare it was obvious they had no idea how insurance works and were completely clueless with regard to the claim process.

ricky ricardoWith the free preventive screenings, the intent was good. Encourage people to get tested for as many things as possible and keep the entry fee for those screenings at a minimum. If something can be caught early it won’t be as costly to treat over the long haul.

Kind of like routine maintenance on your car. Change the oil on a regular basis, check the fluids and you can get a lot of miles out of your car and avoid expensive repair bills in the future.

It isn’t foolproof but certainly better than no preventive maintenance at all.

But when it comes to coding medical care there are different codes for preventive procedures vs. diagnostic.

Generally, once something out of the ordinary is discovered the coding changes from preventive to diagnostic and the procedure is no longer free.

Someone neglected to tell that to the Congress critters when they were writing the legislation.

I sometimes feel like I am Ricky Ricardo talking to Lucy. “Lucy, you got some splainin’ to do”.



Dr. Schimpff and his Medigap plan

The doctor makes several references to his high deductible Medigap plan. After all was done and billed his out of pocket cost for the procedure including doctor, facility fee and anesthesia was $250. Not bad for something that was billed out at $2634 but more than “free”.

I presume Dr. Schimpff  is referring to a Hi F plan where after Medicare does their part his share of the cost is to pay the remaining balance up to $2160. Once the deductible is satisfied the Medigap plan pays 100% of remaining approved Medicare A and B charges for the balance of the year.

dr houseIn some areas and at some ages the high deductible plan made sense at one time. Here in Georgia someone age 65 could buy a Hi F plan from Blue Cross for less than $40/month a few years ago.

Blue Cross no longer offers Hi F. I assume they lost too much money on the plan. Depending on your age, gender and zip, you can get Hi F for $58 per month. Still not bad, but not great either.

You still have to pay the first $2160 in charges before the plan pays so it probably is a good value as long as you are healthy.

But most clients would rather pay an extra $30 per month and get Medigap plan N with no deductible and a $20 office visit copay.

Plan N is also a good alternative to Advantage plans where you have doctor and hospital networks to contend with.  Most Advantage plans cap your OOP (out of pocket) expenses for approved, in-network claims at $5900 to $6700 while others have no cap.

Why have a plan if there is no upper limit on your OOP expenses?

If you live in Gilmer county there are 7 Medicare Advantage plans available to you but over 170 different Medigap plans and everyone of them, including Hi F, have less out of pocket than the Advantage plans.

Why pay upwards of $90 per month for an Advantage plan that has a network but does not limit your OOP expenses when for the same monthly premium you could have plan N?

Have you checked our plan N rates lately? Plan N is not for everyone but we have a lot of clients looking for great value and they pick plan N based on their needs and budget.

Shop and compare GA Medigap quotes.

Instant rates.

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#FreeColonoscopy #FreeAnnualExam #GeorgiaMedicarePlans #MedigapPlanN  #GAMedigapQuotes


Bill Jones Didn’t Have to Die

Bill Jones lived in Lumpkin, Georgia and died of a heart attack because the nearest hospital was 40 miles away. But Bill Jones didn’t have to die.

Pam Renshaw in Folkston, GA had a similar challenge when her 4-wheeler crashed and caught on fire. The nearest hospital was 9 miles away but it had closed 6 weeks earlier. It was 2 hours before Pam could get to the nearest hospital, in Florida, and receive much needed attention.

stewart webster hospital small

Rural hospitals all over the country are closing and the south seems impacted more than other areas of the country. A combination of factors including a struggling economy and the decline of the middle class plus new rules imposed on medical practices under Obamacare have resulted in hospital closings.

When a hospital dies local residents lose access to critical care. The closing of Stewart-Webster Hospital in Richland, Georgia did not make national news. But residents of rural Stewart county Georgia are very much aware of the impact of the closing of their local hospital.

Georgia Medicare Plans has rates on more than 170 different plans in your area. We can’t stop the hospitals from closing but we can make sure you have access to the best hospitals in your area. Rates in Georgia have been trending lower over the last 2 years and you are probably paying too much.  Shop and compare Medigap plans instantly.


Bill Jones, farmer

Bill Jones was born in Cuthbart, GA, about 20 miles south of Lumpkin where he lived and worked. Bill did many things during his adult life but his love of farming became his life.

If Stewart- Webster hospital had not died in 2013 perhaps Bill would still be alive.

Stewart-Webster Hospital had only 25 beds when it still treated patients. The rural hospital served this small town of 1,400 residents and those in the surrounding farms and crossroads for more than six decades.

But since the hospital closed in the spring of (2013), many of those in need have to travel up to 40 miles to other hospitals. – USA Today

40 miles may not seem like much to some people. That’s the distance from Acworth, GA to Hartsfield airport. With no traffic that is a 42 minute drive down I-75.

But in an emergency that 40 miles can mean the difference in life and death.

If you are driving from Acworth to Hartsfield you will drive past Kennestone Hospital, Windy Hill Hospital, Piedmont Hospital and Grady. Other than Grady which is right off the interstate, you probably don’t think about the drive. But if you are in need of critical care things are different.

Perhaps that is the way Bill Jones felt that day as the ambulance took him past Stewart-Webster hospital and on to a hospital 40 miles away.


Dying Georgia Hospitals

obamacare bullet holesIn the last 4 years at least 7 Georgia hospitals have died. At least some of them closed because of Obamacare.

According to the USA Today article, rural hospitals are being squeezed in two ways.

The Affordable Care Act was designed to improve access to health care for all Americans and will give them another chance at getting health insurance during open enrollment starting this Saturday. But critics say the ACA is also accelerating the demise of rural outposts that cater to many of society’s most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law’s penalties for having to re-admit patients soon after they’re released are impossible to avoid and create a crushing burden.

Many U.S. counties had no hospitals after the Great Depression and World War II. But the 1946 Hill-Burton Act sought to change that with grants and loans for the construction of new hospitals. The number of hospitals soared, creating the backbone of today’s modern health system.

Obamacare changes the way hospitals are reimbursed, and penalizes those that have higher than normal readmission rates.

Hospitals are also required to upgrade to EHR (electronic health records) or face steep fines.

But the $1 million or more it was going to cost to change over to electronic records was one of the last straws for Randy Stigleman, former owner of Stewart-Webster.

Declining revenues, new fines and penalties and the cost of upgrading put’s a nail in the coffin of rural hospitals.

Even if Georgia had expanded Medicaid the low reimbursement for Medicaid patients means hospitals lose money on every Medicaid patient they treat.


Access to health care

Obamacare was supposed to expand access to health care but instead has done just the opposite. Rather than increased access to health care the unpopular law is accelerating the demise of the rural hospital.

The law also impacts those on Medicare. lower premiums

Lumpkin, GA residents have only 6 Medicare Advantage plans including 4 from Humana, 1 from Care Improvement Plus and 1 from Wellcare.

If you live in Stewart county there are 7 hospitals within 30 miles of Lumpkin, Georgia. But only two hospitals are in the Humana Choice Medicare Advantage plan and the nearest ones are in Cuthbert, GA or Eufaula, Alabama.

When you have original Medicare and a Medigap plan you can pick from over 170 different plans and have access to all hospitals in your area.

Our Medigap clients save an average of $450 per year by helping them find a lower monthly premium for the same exact coverage. Our Part D clients save an average of $1,000 per year in out of pocket drug costs compared to a plan they picked on their own or bought through another agent.

Savings are meaningless if you can only use a handful of doctors and hospitals in your area. We have Medigap plans starting at $80 per month for a female, age 65 in Stewart county Georgia. If you are paying more than this or if you have to drive 30 miles or more to use a participating doctor or hospital, we need to talk.

Bill Jones didn’t have to die. We can’t bring back Stewart-Webster hospital but we can provide you unfettered access to health care in your area and probably save you some money.

How simple is that?georgia-medigap-button


#hospitalsclosing #obamacare #medicaid #medicaidexpansion

How Obamacare Impacts Medicare Advantage Plans

Obamacare affected under age 65 health insurance but left Medicare alone. That popular belief is incorrect. Obamacare (ACA) which-medigap-is-best2reduces funding for Medicare plans and cut’s reimbursement to carriers. Taxpayer subsidies to “poor” people (those earning less than $95,400 for a family of 4) are funded in part by cut’s to the Medicare program. These funding cuts amount to $700 billion from 2013 through 2022.

Depending on which side of the aisle you are on determines whether you refer to these cuts as lower funding or savings.

No matter what you call it, the federal government will spend less on Medicare each year in order to fund Obamacare for the “working poor”.


Obamacare impacts how Medicare Advantage carriers are paid

According to Benefits Pro as of January 2015 20% of the Medicare cuts have been implemented and retirees are paying more for their Medicare Advantage plans. These higher costs come as

  • higher premiums
  • higher copay’s
  • higher deductibles
  • higher out of pocket
  • smaller networks
  • more HMO’s
  • fewer plan choices

senior-scratching-headMost Medicare plans began receiving less pay in 2012 but the cuts are to be phased in from 2012–2017, so we have a ways to go yet.

Under PPACA, plans also can qualify for a bonus payment for providing better care. Plans have to report data detailing how many of their members are routinely getting preventive care under the plan, as well as how many get additional support in managing chronic conditions such as diabetes. Plans receiving higher star ratings get higher bonuses, with the desired result being that the bonus program will encourage plans to focus on delivering a higher quality of care, thus increasing the value of the health care dollars spent by consumers.

There is only one 5 star plan in Georgia. Most are 3 to 3.5 stars and several do not qualify for a star rating.


Benefit changes because of Obamacare

Original Medicare as well as Medicare Advantage plan have certain benefits that must be included in all plans. “No charge” annual preventive exams are now the norm as are “lifestyle” counseling and information pamphlets. medicare-age-65-enrollment2

But Medicare Advantage plans have had a more drastic makeover than original Medicare and Medigap plans.

PPACA also introduced a new mandatory cap for all Medicare Advantage plans designed to cut member costs. The cap limits the total out-of-pocket costs a member can incur for Medicare covered services each year. The limit is set to $6,700 in-network right now, which is substantially lower than limits many plans had before the law and thus results in higher spending by the plan.

Most plans now have out of pocket maximums of $6700 for charges by par providers. These charges can run significantly higher when you use non-par providers. This is considerably higher than the average max OOP of less than $4,000 from just a few years ago.

Compare that with less than $150 OOP for our most popular Medicare supplement plan AND no networks. Our second most popular plan has less than $500 OOP (and often less than $300) and features premiums that are about 20% lower.


Georgia retirees in rural counties hit the hardest

The number of Medicare Advantage plans available to those living  in outlying counties shrinks every year. In the last few years at least 7 rural hospitals have closed, at least in part because of Obamacare.

  • Folkston – Charlton Memorial Hospital
  • Richland – Stewart-Webster Hospital
  • Hartwell – Hart County Hospital
  • Glenwood – Lower Oconee Community Hospital
  • McRae – Telfair Regional Hospital
  • Arlington – Calhoun Memorial Hospital
  • Eastman – Dodge County Hospital

stewart webster hospital smallOther hospitals like Ty Cobb in Lavonia may be shuttered before too long. CMS rules for Medicare Advantage plans require them to have a specific number of doctors and hospitals under contract in a given area before they are allowed to offer a plan. As regional hospitals close your choice of Advantage plans also dwindles.

Retirees in rural areas face higher premiums and PPO plans are being replaced with more restrictive HMO offerings. In some areas Advantage premiums of $50 – $70 per month (or more) are becoming quite common.

For a few dollars more you can have a Medigap plan, not have to worry about networks and have considerably less out of pocket.

Georgia Medicare Plans specializes in low cost Medicare supplement plans and tailoring a drug plan to fit your needs. Our average client saves over $1,000 per year in out of pocket drug costs. We showed one client how to save over $6,500 per year in premiums and OOP costs.

Don’t get tripped up by Obamacare changes to Medicare Advantage plans. Let us help.

Georgia Medicare supplement rates


#Obamacare  #MedicareAdvantage  #Medigap


My Doctor Was Fired – What Now?

What happens if your doctor was fired by your Medicare Advantage plan? It happens. With reduced Medicare funding under Obamacare it will be more difficult to keep your doctor no matter how much you like them. my medicare doctor was fired

Just ask Mary Ann Catalano


My doctor was fired

Mary Ann Catalano has been using the doctors at Dermatological Care for over 40 years. But all this is about to change. Her doctor was fired.

In 1990, doctors found two types of cancer on her face and scalp. Years later they flagged a type of cancer that they warned could also be on her colon. That led her to a colonoscopy and subsequent removal of pre-cancerous spot on her colon. Recently, they discovered her husband’s skin cancer.

Now, at 68 and in the middle of her contract term, UnitedHealthcare is kicking the entire Dermatological Care staff out of her Medicare Advantage network.

St Louis Post

This would not have happened if Mary Ann had original Medicare and a Medigap plan.

Funding cuts required by Obamacare mean all Medicare Advantage plans will have to get skinny if they are to survive.

United Health Care sent out pink slips to almost 1,000 docs in Missouri the first part of June. Medicare Advantage patients can still see their doctor if they want but out of network penalties may apply.

With 17 eligibilities for special enrollment, (insurance agent Bill) Steinlage said there’s an “excellent chance” many consumers will qualify for one. The best thing to do, he said, is visit an independent broker who can help you navigate the system.

Yes, but if your doctor was fired from the plan that is not one of those 17 SEP opportunities.

Mary Ann makes a tough choice after her doctor was fired

Moving to another doctor was not an option in Mary Ann’s mind.

For Catalano, in St. Louis County, she plans to stay with Dr. Larry Wang at Dermatological Care and pay out of pocket.

She recognizes this could turn into a financial burden after office visit fees, biopsies and more, but “that doctor knows everything about us,” she said. “I’ll just tell them I gotta make payments.”

Financial burden’s are not something seniors should stress about during their retirement years. Unfortunately, most seniors choose Medicare Advantage plans based on the low going in premium. They never think about how costly these plans can be once your health changes.

Nor do they consider the cost of health care when their doctor is fired.


United Health Care is not alone

Other carries will do likewise. Someone had to be the first. United Health Care has more seniors on Medicare Advantage plans than any other carrier in the country. If United is firing doctors to save money, how long before their competitors do the same?

 CMS released guidelines in April that will allow Medicare patients to change coverage one time during the year for whatever reason. Those guidelines won’t be implemented until 2015, though, and there’s one other catch. The guidelines state it would have to be a five-star plan, which are the highest rated Advantage plans.

In Georgia there is only one 5 star plan and it isn’t United Health Care.

Unless you qualify for an SEP under Medicare guidelines, if your doctor is fired you change docs or wait until the next open enrollment. Finding a new doc is especially challenging if you live in a rural area and have a medical condition that few doctors are able to treat.


Dave and Alice

I have clients that live in rural Georgia. At one time they had a Blue Cross Medicare Advantage plan, and then it went away. That did create a Special Enrollment Period for them. Both were in reasonably good health but living in a small town meant limited doctor choices. Their family doctor was not in any of the new plans and the only way for them to have the ability to use a doctor of THEIR CHOICE was to return to original Medicare and pick up a supplement plan.

Georgia Medicare Plans has access to over 170 different Medigap plans and can usually find a plan that meets YOUR needs and budget. We helped Dave and Alice find an affordable plan that allowed them to keep their doctors.

We can do the same for you. Shop and compare Medigap plans now.  Don’t wait until your doctor is fired or your plan is discontinued.





#Medicare Advantage