Your Medicare Questions Answered

Your Medicare questions answered by GA Medicare expert Bob Vineyard. Where do you go for answers? Why does no one want to help until you BUY something? Can anyone help?

How about the Georgia SHIP staffed by volunteers? Or calling Medicare direct? Who has all the answers when you want to know who has the best Medigap plan? Is there a Medicare for Dummies, or Medicare 101 site?

Medicare questions answered

Where is the best place to find answers to ALL my questions without getting a SALES PITCH?

Medicare Questions Answered

Why Search the Web When All Your Answers are Here?

Georgia Medicare expert Bob Vineyard spends hours every day searching so you don’t have to. Don’t you have something better to do with your time?

Even after working in health insurance for over 45 years Bob still is learning new things. He spends times reading information on Medicare, health and senior fitness so you don’t have to. Bob also participates in several consumer forums, answering the tough questions.

Bob is dedicated to helping YOU understand how Medicare works. He also makes sure you find the right plan that fits YOUR needs and budget.

Welcome to the NO SELLING ZONE!

Your Medicare Questions Answered by Volunteers

Why not talk to a SHIP counselor? They aren’t selling ANYTHING. It’s a non-profit organization. What could be wrong with that?

Counselors are volunteers with limited training. Kind of a Medicare 101 crash course for dummies. It would be rare to find someone who has had years of experience working with Medicare beneficiaries and insurance carriers.

The belief by some is, because they are volunteers working for a taxpayer funded, non-profit organization, their advice must be unbiased. Your Medicare questions answered by someone who truly wants to help . . . and that is true.

Motivation to help is good, but how accurate and useful is that advice? Will you have a counselor dedicated to help you . . . or will you be handed off to the first available person? Is personal service meaningful to you, or are you willing to accept advice from just anyone?

Going to the Source

Call 1-800-MEDICARE 24/7 except federal holidays. Operators are standing by . . . and most of them speak English.

When you ask questions about Medicare their computer “listens” to the conversation and an answer pops up on the rep’s screen. They will read the answer to you and assume you understand.

AI (Artificial Intelligence) is great but it is no substitute for the real thing. Remember HAL 9000 from Space Odyssey. “I’m sorry Dave. I’m afraid I can’t do that”.

While 800-MEDICARE is good, just like volunteer organizations, they don’t understand the insurance side of Medicare.

Medicare is easy.

Insurance is hard.

One Source for Answers to Your Medicare Questions.

Bob makes life simple. He explains how Medicare works using words that you understand.

For example. Many folks get confused about Medicare supplement and Medigap. What are they? How are they different.

Bob’s answer is this.

Medicare supplement and Medigap are interchangeable terms. Like Kleenex and tissue.

How easy is that?

Where can you get your Medicare questions answered?

Call or email. Give us 10 minutes. Ask any question. Never any pressure to buy. You decide if the information is helpful or not. No selling ever!

This is my offer you can’t refuse.

Will Medicare Pay For Shingles Vaccine?

Does Medicare cover shingles vaccine? Will my Medigap plan pay for Shingrix? Can I get the shot for free during my Medicare Annual Exam?

GA Medicare expert Bob Vineyard answers your immunization questions.

Does Medicare Pay for Shingles Vaccine
Will Medicare Pay for Shingles Vaccine?

What is Shingles?

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus. The same virus that causes chicken pox is also responsible for shingles.

After having chicken pox, the virus can lay dormant in your body for years. The virus lives in your nervous system near your spinal cord.

According to Mayo Clinic:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

  • Pain, burning, numbness or tingling
  • Sensitivity to touch
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching
Will Medicare Pay for Shingrix?

What is the Shingles Vaccine and How Does it Work?

Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.

Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.

Is Shingrix Better than Zostavax?

Currently there are only three approved shingles vaccines. Zostavax, Shingrix and Varivax.

Zostavax, approved in 2006, was the only vaccine for shingles for many years.

Shingrix gained approval as a vaccine in 2017 and is considered to be 97% effective in adults age 50 to 69. Whereas Zostavax has a 50% effectiveness rate.

Varivax was approved in 2018. It is similar in price and effectiveness to Shingrix.

All three named shingles vaccines are approved by Medicare and should be included in all Medicare Part D plans.

How Much Does the Vaccine Cost?

Cash prices for Shingrix are currently $150 per dose. You need two doses for maximum effectiveness. Your second does should be given at least 2 months but no more than 6 months following your first dose.

Zostavax is a single dose immunization with a cash price of $225.

The cash price for Varivax is $150 per dose. The manufacturer recommends two doses a month apart.

How Long Before I Need to be Vaccinated Again?

Shingles vaccinations should remain effective for several years before you need another vaccination.

You can get Shingrix at age 50, when your chance of having shingles rises. Studies have shown that its protection remains strong for at least 4 years, but researchers hope it will last much longer because the immune response is stronger. – WebMD

Is the Shingles Vaccine Covered by Medicare?

Medicare covers the shingles vaccine as one of its preventive benefits. But, unlike some other vaccines that are paid through Part B, the shingles vaccine is covered by Part D.

Have You Had Shingles?

If you have chicken pox as a child? If you did you have a one in three chance of getting shingles as an adult.

Two years ago during my annual Medicare wellness visit my doctor asked if I wanted to get the shingles vaccination. We discussed the pro’s and con’s. She wrote a prescription for Shingrix.

I had every intention of getting the shot but all the local pharmacy’s were out of stock. They had no idea when they would have it in stock.

Two months later I woke up with intense itching and moderate pain. It started near my kidney and radiated around my left side.

My wife looked at it and said I had the Shingles.

Welcome to old age.

This was a weekend and my regular doctor was not available. On Sunday I went to a nearby urgent care facility. The doctor confirmed I had shingles.

I was given a prescription for the generic form of Valtrex.

Valacyclovir (Valtrex) is an antiviral medicine. It is used to treat or prevent infections caused by certain kinds of viruses. Examples of these infections include herpes and shingles.This medicine will not cure herpes. It is more popular than comparable drugs. It is available in generic and brand versions. Generic valacyclovir is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. –GoodRx

Using Part D the prescription would have cost nearly $50. Using the coupon and paying cash my cost was $9.

Pay Cash or Use Your Drug Plan?

If you use your Medicare Part D plan for generic drugs you will almost always pay more. Buying generics and paying cash will normally save money.

The approved Shingles vaccines are all brand names. There are no generics. But you may still save money using coupons or drug assistance programs. Check the Medicare site for Patient Assistance Programs.

Do you have Medicare questions? Call or email.

#ShinglesVaccine #Shingrix #GAMedicareExpert

My Medicare Rates Are High!

My Medicare rates are high! Do Medigap rates increase as I get older? Can I change my plan during Open Enrollment? Where can I find Medicare supplement rate increase history?

The plan was competitive when I bought it but now it is almost double. I don’t know how much longer I can afford it.

Why are my Medicare rates so high?

There is a good explanation for high Medigap renewal rates. You probably don’t want to hear it, and you probably don’t care why.

But you would like some relief.

Help is on the way. As long as you are healthy . . .

Why are my Medicare Rates so High?

Where Can I Find Medicare Rate History?

What you want is not easy to find. Even when you do find it you will discover the rate information is useless.

Most likely, your Medicare rates are high because your carrier left the market. It is rare for a Medigap carrier to stay in the same market for more than 3 or 4 years.

Once they leave a new carrier comes in to replace them. The new carrier has lower rates. The departing carrier is now free to raise renewal rates with impunity.

Since 2010 Omaha has introduced 4 Medigap carriers to Georgia and retired three of them. Each time a carrier is shelved the rates start to climb.

In that same time frame Aetna has also had at least 4 subsidiaries leave the market. They introduced a 5th new carrier earlier in 2019.

If your Medicare rates are high it is most likely because the issuing carrier is no longer writing new business in your state.

Maybe You Picked the Wrong Plan

Medicare supplement plan F has been heavily marketed as the “go to” plan for many years. Carriers and agents love the high premiums because it means more money for them.

If your Medicare rates are high you should have bought the G plan. But it is not too late to switch.

Unless you are unhealthy.

Then you are screwed.

Renewal Rates Higher Than Current Rates

When you get your renewal and start to look around you might discover that your Medicare rates are higher than new business rates from the same carrier.

I see that quite often but especially for carriers with closed blocks of business.

OLD business is charged a higher rate which subsidizes lower rates for new policyholders.

I call this the cable TV syndrome.

Last year you signed on as a new customer. You got 150 channels for $39 per month.

This month you get your renewal bill and now you are expected to pay $109 for those same channels.

But your cable company is still offering 150 channels for $39.

What gives???

So you call your cable company to complain. You are told the $39 rate is only for NEW CUSTOMERS.

Medicare insurance carries pull the same tricks.

How Do I Find Affordable Medigap Rates?

Great question.

There are no easy answers. Here are a few tips.

  • Look for carriers that have been active in GA for 5 or more years
  • Don’t buy from someone that has been here less than 2 years
  • Don’t chase the low rate
  • Ask friends and relatives for an AGENT referral

Bob Vineyard is a GA Medicare expert with more than 45 years experience. Bob is also on Medicare.

Are your Medicare rates high?

Here is my offer. Give me 10 minutes on the phone. Call and ask ANY Medicare questions. If you don’t like my answer we part as friends. After all, it isn’t personal, just business.

But if you do like what you hear we move forward on your timetable. Allow me an opportunity to EARN your business.

I call this an “offer you can’t refuse”.

Full Medicare supplement rate reports for any plan. Just ask.

How easy is that?

Going on Medicare Age 65

Going on Medicare at age 65. Can I sign up online? What if I am still working? When is the best time to enroll? How much does Medicare cost? Where can I get help?

Going on Medicare Age 65
Age 65 – Enroll in Medicare

If you are turning 65 you have a lot of going on Medicare questions. You will have a lot of people sending you information by mail, each piece claiming their plan is better. And your phone will ring off the hook. With people calling to SELL you something you don’t want, you don’t need and can’t afford.

Where do you turn?

Consider talking to a Georgia Medicare Expert.

Ready for Medicare?

When you are ready to sign up for Medicare the process is fairly easy. You can go online to sign up. Or maybe you would rather do it by phone. Another way is to visit your local Social Security office.

You can enroll in Medicare Part A and/or Medicare Part B online at www.SocialSecurity.gov. By calling Social Security at 1-800-772-1213 Monday through Friday, from 7AM to 7PM. Or In person at your local Social Security office.

How easy is that?

Where Can I Learn About Medicare?

You can waste a lot of time searching for Medicare information online. But it seems so easy. You just Google “How to go on Medicare”. Or “Where do I sign up for Medicare”. If you know how to enroll then you ask “Who has the BEST Medicare rates“.

Turning 65 – Enroll in Medicare

Those steps will give you a lot of results. Some information is readily available.

But if you just want to know how much Medicare costs. You only want to see Medicare supplement rates WITHOUT talking to a pushy agent. That is a bit more challenging.

About to enroll in Medicare? Every time you fill in your name, email address and phone this is what happens. Almost immediately your phone rings. Someone calling to SELL you something when all you want is INFORMATION.

And your email box will be flooded with offers. Just click this link and all your questions will be answered.

By now you know this is NOT how you want to learn about going on Medicare.

You are like Charlie Brown asking “Why won’t someone just help me?“!

Medicare Help? Try This

Why search the web when all your going on Medicare questions can be answered here? Medigap rates. Advantage plan information. GA Medicare Expert Bob Vineyard can help.

When you are ready to sign up for Medicare, who would you rather talk to? A stranger on the phone whose last job was asking if you want fries with your meal? Or would you rather invest 10 minutes talking with someone who has over 45 years working in health insurance and is also on Medicare themselves?

You choose.

Here is my offer.

Give me a call. Invest 10 minutes by phone. Ask any question you want about Medicare. ANY question. Then you decide if my information is valuable or not.

If you like what you are getting, we move forward at your pace. If you don’t like what you hear, move on and we part as friends. It’s not personal, it’s just business.

I call this my offer you can’t refuse.

#GAMedicareExpert #GoingOnMedicare #Turning65

Are Medicare Advantage Plans Bad?

Are Medicare Advantage plans bad? Many people don’t UNDERSTAND MAPD plans. No premium, dental and vision come with a price. What’s not to love? How do I find the BEST Medicare plan? The one that is right for me?

GA Medicare expert Bob Vineyard explains

If Medicare Advantage plans are bad why do they dominate some areas? Why do so many people buy into the Advantage plan sales pitch? Good benefits, low OOP (out of pocket), decent networks.

It all sounds so good.

Still there ARE limits on access to health care. Policyholders can’t go anywhere they want. Networks do change from year to year. Over half the Georgia Advantage plans are HMO, the balance are PPO. Understand the difference!

“Your” doctor(s) may be in network this year but not next.

Are Medicare Advantage plans bad?
Are Medicare Advantage Plans Bad?

Medicare Advantage Limited Access to Health Care

Some folks have medical conditions that require specialized care and there may be only a handful of Medicare Advantage providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO.

Chronic care is one area where the doctor-patient relationship is invaluable. I have insulin dependent diabetics including those with pumps. They have no desire to find another endo just because their insurance carrier and doc part ways.

The choice of plans is not JUST dollars and cents. Too many agents either ignore this aspect or don’t understand it. How Medicare Advantage plans are sold, what you are told and what is omitted, can make an impact on your buying decision.

I Was Told All Doctors Accept This Plan

When I talk with prospective clients I always talk about access to care. I can’t recall a single time when they were pitched an MA plan and they said “Oh yeah, the agent/carrier mentioned that but I don’t think it will be a problem”.

More often than not they had no idea how managed care plans work. For that matter, neither does the doctor’s office. When a patient mentions they will be going on Medicare they are usually told “No problem, we take Medicare”. Sometimes they will add “But we DON’T take Aetna (Humana, Cigna . . . whomever).”

Original Medicare offers unfettered access to care anywhere in the country. This includes specialty centers like Mayo, Sloan-Kettering, MD Anderson, etc.

The same cannot be said about MA plans.

Prior Authorization? What is That?

There is also the prior authorization issue. Something shared by almost every managed care plan, but NOT by traditional Medicare.

80 percent of Medicare Advantage enrollees are in plans that require prior authorization for at least one Medicare-covered service

Prior Authorization in Medicare Advantage Plans: How Often Is It Used?

How Prior Authorization Can Impede Access to Care in Medicare Advantage – Medicare Rights Blog

This goes hand in glove with claim denials. The problem is so big the OIG is investigating MA claim rejections.

The study found that 82% of the wrongful denials arose from appeals by providers for payment for services already rendered. While that is not surprising in a third-party payor system, what is surprising is the failure of insurer trade association AHIP to treat it as a significant issue.
Most medicare advantage denials really are wrong – And the biggest victims are the providers: A just-released report by the Office of Inspector General of the U. S. Department of Health & Human Services shows that most coverage denials from insurers and plans in the Medicare Advantage program were flat-out wrong.
Becker Hospital Review

If someone is in the middle of a major claim the LAST THING they need or want is to fight their insurance carrier over treatment plan or claim payments.

I Get Calls From People Who Have Advantage Plans

I get calls all throughout the year from people who have MA plans and they want to change. The two biggest complaints are:

I can’t afford them
They won’t pay my claims

Can’t afford does not mean the premium is too high. It means they cannot afford to pay for care.

The second issue, about claim denial, is addressed above.

Are MA plans evil or wrong for everyone?

No, but most people don’t understand what they have until it is too late to do anything about it. When you are faced with denial of care or big medical bills what is the worst time in the world to find out your insurance isn’t working.

Do I like Medicare Advantage plans?

Nope. Wouldn’t have one.

Do I SELL only Medigap?

No, I don’t SELL anything but I do explain how the plans work and offer prospective clients a choice.

Most people who find me already know they want original Medicare and a Medigap plan. The only thing I have to do at that time is SHOW them how I can help more than some bozo in a call center. Or the home office rep that is telling you how great their plans are and last week they were asking if you wanted fries with your order.

In addition to informing people about how Medicare works . . . and access to care . . . and prior authorization . . . and claim denials . . . I also talk about Part D.

We Have Videos

I have several videos about Medicare Part D including one that specifically addresses drug plan deductibles. Quite a few agents either don’t understand the deductible or know how to explain it.

Of course the easy thing is to only sell a plan that does not have a deductible. It doesn’t matter that the beneficiary will not only pay higher premiums but will also pay more for their Rx with a no deductible PDP. It was just easier to sell than taking the time to educate your client about drug plans.

I also show them how to save money, and sometimes avoid the donut hole, by purchasing some of their med’s outside the plan.

It would be so much easier if all I did was sell the PERCEIVED benefits of $0 premium plans, the lowest premium Medigap plan and only Part D without a deductible.

But then I would be like all the other 99 agents out there who are calling incessantly or knocking on their door to sell anything for a buck.

Stealing a line from the late Lee Iacocca, “If you can find a better plan than traditional Medicare and a supplement plan, BUY IT”.

#MedicareAdvantagePriorAuthorization #ManagedCareNetworks