Do You Want Fries With That?

Would you like fries with your Medicare plan? What do you know about those who offer advice about Medicare?

Picking a Medicare Plan is as Easy as Ordering Lunch

Picking a Medicare plan while blindfolded is what happens too often. Almost no one understands Advantage plans. Medicare drug plan deductibles? Who can explain that? Much easier to pick a plan without a deductible. You can’t go wrong there.

Medicare supplement plans are easy. All plans with the same letter are identical. Just go with the plan with the lowest premium. Right?

Maybe you will appreciate my Shop Like a Boss video, explaining how to search for Medicare information.

No need to ask an insurance agent. They cost too much.

Questions You Really Should Ask

How long has the agent or carrier rep worked the Medicare market? Maybe feel more comfortable talking with someone at or a volunteer and a not-for-profit organization.

Surely they will be impartial?

Or will they?

Turning 65 Medicare Options

How does Medicare work?

Bob Vineyard explains in this Georgia Medicare Minute video

If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medigap plan. Here is your guide to understanding GA Medicare.

You don’t have to receive Social Security to enroll in Medicare insurance. CMS is the agency that oversees Medicare.

Senior healthcare insurance is commonly used to describe Medicare.

How to enroll in Medicare? You may sign up for Medicare 3 months before your 65th birthday, the month you turn 65, and 3 months following your 65th birthday. You may enroll online (highly recommended), by mail or by visiting a Social Security office.

Original Medicare has 4 parts.

Medicare Part A covers hospital inpatient charges and has a per admission deductible

Medicare Part B is for outpatient health care treatment. Doctor visits, labs, X-rays, MRI, CT scan (CAT scan), ambulance, ER, outpatient clinics, etc. Essentially any Medicare approved health care received outside the hospital setting. Treatment considered medically necessary under Medicare guidelines. Medicare Part B has a calendar year deductible. Once satisfied, Medicare pays 80% of the approved charge, you are responsible for the remaining 20%.

Most seniors worry about hospital stays, but your major expenses will more than likely fall under Medicare Part B outpatient expenses. Original Medicare stand alone has no cap on your out of pocket expenses.

You pay until you run out of money, get well or die.

Medicare Part C is now referred to as Medicare Advantage. More on that later.

Medicare Part D covers outpatient prescription drugs. Some Advantage plans have drug coverage built into the plan.

Medicare Supplement or Medicare Advantage?

Medigap and Advantage plans cover the same things, but what you pay out of pocket for your care, and where you receive your care, is very different.

Original Medicare does not have networks. You can use any doctor or hospital anywhere in the US. Another plus is the ABN form which is only used with Original Medicare.

Advantage plans are managed care plans. Some are PPO, some are HMO. In 2018 about half the plans are HMO with the balance being PPO.

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Your max OOP may also be higher. Some plans do not cap out of network charges.

Non-emergency out of network care charges may be denied if you have an HMO.

Medicare Questions – FAQ

How Much Does Medicare Cost?

In 2018 most Advantage plans issued in Georgia limit your out of pocket for approved in network health care expenses to $6700.

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

Some cancer centers, such as Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.

Medicare and Cancer

Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.

Chemotherapy drugs administered in a doctor’s office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.

This is why most of us chose a Medicare supplement plan in 2018. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.

We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.

According to the Mayo clinic, “new cancer treatments are routinely priced at over $100,000 per year of treatment.”

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

Who is giving you Medicare advice? An experienced agent who is enrolled in Medicare or someone that works in a fast food restaurant?

#GeorgiaMedicarePlans #GAMedigapQuotes #Turning65

Can Strokes Be Prevented?

Strokes. Can they be prevented? What is a stroke? Am I at risk for a stroke? How can I tell if I am having a stroke? What does Medicare cover?strokes rehab

Anyone at any age can have a stroke but the likelihood of strokes increases with age. Immediate treatment can minimize the long term effects of the attack.


Can Strokes Be Prevented?

The old saw that prevention is the best medicine is good advice. Before we look at what a stroke is and how it should be treated let’s review preventive measures.

Strokes threaten millions of lives — every 40 seconds someone in the U.S. has a stroke. And, on average, one American dies from a stroke every 4 minutes, taking 130,000 lives a year and making it the 5th-leading cause of death in our country. And, too, among survivors, it can cause severe long-term disability and handicap.

The facts are that strokes are largely preventable, treatable and beatable – but action is required. In fact, research shows that 80% of all strokes are preventable by taking action. – Washington Times

An active, healthy lifestyle is the best prevention. If you are heavy, lose weight. Stop smoking. Monitor your blood and cholesterol levels.

Any of these conditions puts you at risk for a stroke.

Many cases of hypertension or hyperlipidemia can be controlled with diet and exercise, but if you need more help your doctor may prescribe medication. Have regular check ups. Monitor your blood pressure at home.


What Is A Stroke?

Strokes are classified in different ways.

  • Ischemic (ih-skee-mik): The artery gets blocked, often by a clot, and this prevents adequate blood flow. It is responsible for 87 percent of all strokes.
  • Hemorrhagic (hem-ur-ajic): An artery leaks or ruptures and the resultant leaked blood puts pressure on the neurons, causing damage. This can result from dangerously high blood pressures that overwhelm the blood vessel walls, chronic high blood pressures that cause wear and tear over time, and/or weakened blood vessels.
  • Mini-stroke:” A temporary blockage caused by a clot. This is also referred to as a transient ischemic attack (TIA). Unlike a stroke, the symptoms resolve and there is no permanent injury to the brain. A TIA is a warning sign for a future stroke and must be taken seriously: more than 30 percent of people who have a TIA end up having a major stroke within 1 year if they do not receive treatment. Recognizing and treating TIAs can reduce the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

The type of stroke you have often determines the treatment as well as long term effects. When the stroke victim is diagnosed and treated quickly the chances of recovery are much improved. Triage in the hospital ER will determine if the patient needs a clot busting injection or surgery.


Am I Having A Stroke?

Most of the time you will know something is wrong but it may take people around you to see the visible signs and call for emergency care. How do you know if you are having a stroke? Think F.A.S.T.

  • FACE: Ask the person to smile. Does one side of the face droop?
  • ARMS: Ask the person to raise both arms. Does one arm drift downward?
  • SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • TIME: If you observe any of these signs, call 911 immediately (even if they resolve)

If you are with someone and see any of the above symptoms do not hesitate to call 911.


Does Medicare Cover Treatment for Strokes?

Medicare does in fact include emergency treatment for your stroke. Medicare Part B covers ambulance transport and ER care. Your 2016 Part B calendar year deductible is $166. Once the deductible is satisfied Medicare pays 80% of approved charges and you are responsible for the remaining 20%.

That 20% is not capped. You pay until you are better, run out of money or die.

Medigap plans F and G will pay the 20% remainder after Medicare pays their portion.

ga medigap rates

If you are admitted to the hospital as an inpatient, your stay will be covered under Medicare Part A. Your Medicare per admission Part A deductible for 2016 is $1288. Supplement plans F, G and N pay this deductible for you.

Not all hospital admissions are as an inpatient. If you are admitted for observation the charges are covered under Part B. If you are then discharged to a skilled nursing facility (SNF) or rehab unit, Medicare does NOT pay for this care. In order for SNF or rehab to be covered by Medicare you must have had a 3 day stay as an inpatient.

If your post discharge stay qualifies under Medicare rules but exceeds 60 days you will be responsible for a daily coinsurance of $322 for days 61 – 90. That amount doubles to $644 per day for stays lasting longer than 90 days and up to 180 days.

All Medigap plans cover your Part A coinsurance and extends that coverage up to 365 days lifetime.

Private long term care insurance, short term care insurance and home health care are types of policies that should be explored to supplement your Medicare coverage.

Georgia Medicare Plans specializes in finding  Medigap coverage that fits your needs and budget. Bob Vineyard has more than 40 years experience in the health insurance industry. In addition, he is also a Medicare beneficiary covered by original Medicare and a Medigap plan.

With more than 170 different Medicare supplement plans in Georgia it is impossible to find the right plan without expert guidance. We shop the market for you and show you the best plans based on your needs.

GA Medigap rates

Click the image above for an instant Medigap quote. Compare up to 30 plans side by side. A free report showing all plans in your area will follow by email.


Stroke Aftermath

I have friends who have had strokes. Some have mostly recovered, while others would be considered an invalid requiring round the clock home health care. Medicare only covers a portion of the bills and provides no coverage for care that is not medically necessary.

Without additional insurance you and your family will bear the cost of attending to your activities of daily living.


Additional Resources For Learning About Strokes

Medicare Coverage for Skilled Nursing Facility

Long Term Care – Medicare, Medicaid and More

National Stroke Association – Medicare Basics

Caring – Will Medicare or Medicaid Pay for Long Term Care?



#Stroke #Medicare #LongTermCare #ShortTermCare #HomeHealthCare


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.

Your information is NEVER sold!


#FreeColonoscopy #FreeAnnualExam #GeorgiaMedicarePlans #MedigapPlanN  #GAMedigapQuotes


Identity Theft Prevention Act

The Identity Theft and Tax Fraud Prevention Act of 2015 is proposed tax formslegislation whose time has come. Retirees are easy targets and carrying a Medicare card with your Social Security number on it is an open invitation to thieves. Medical identity theft is a so-called “victim-less” crime that often goes unnoticed until thousands of dollars in fraudulent claims have been filed.


Identity Theft and Tax Fraud Prevention Act of 2015

Sen. Sherrod Brown of Ohio has introduced legislation aimed at curbing identity theft by offering more consumer protections for your Social Security number.

The Identity Theft and Tax Fraud Prevention Act of 2015, among other things, would:

  • Allow the IRS to prohibit employers from displaying a worker’s full Social Security number on W-2 forms.

  • Phase out “unnecessary storage and display of Social Security numbers by Medicare and private health care providers.” Brown said the Centers for Medicare and Medicaid Services has been asked for years about removing Social Security numbers from Medicare cards but claims it needs congressional approval to do so.

  • Give victims the ability to pursue civil action against people who’ve committed fraud against them. – Cleveland

Georgia Medicare Plans supports this move to protect citizens from identity theft.


Protecting your Medicare card

In the past we have suggested carrying a copy of your Medicare card that has blacked out all but the last four numbers of your Medicare claim number which is also (usually) your Social Security number. This was not our original idea. We got it from Money Magazine.

But we have been taken to the woodshed by a MOM (Medical Office Manager) in this revealing post by a fellow blogger.

I was a bit perplexed when not once, but twice in the past few months, I had patients who presented a photocopy of their Medicare Card with their billing number (which is their social security number) blacked out. Each time I gave the “card” back to the patient and said I could not accept a photo copy, I needed the original card with all the information visible. You see, the only way I can get my doctor paid is to bill Medicare for your service and I need that number to bill. – InsureBlog

As Kelley goes on to say …….

because of identity theft and the ability to change insurances during the open enrollment each year (and sometimes more often), the physician has to confirm each time you visit that you do, in fact, have insurance, and that insurance is, in fact, yours. This is done by confirming your Insurance Number and Name with outside entities that assure your doctor that, yes, the insurance is active and you are you.

Thanks, Kelley, for pointing this out and helping us understand these issues from a doctor’s office perspective.


Medigap may offer more protection

In the battle against medical identity theft, a Medigap plan may offer you more protection than a Medicare Advantage plan.

As the Cleveland article pointed out, many insurance carriers use your SSN as part of your member ID number. Most retirees will review and often change Advantage plans on an annual basis. Each time you change that is more exposure to potential identity theft.

Contrast that with having a Medicare supplement plan that most will keep for years without making a change. We have clients who have had the same Medigap plan with the same carrier for 5 years or longer.

Contrast that with Advantage plans that are changed every 2 – 3 years.

When was the last time you reviewed your Medigap plan? Most of the people we talk to are paying too much for their plan by an average of $450 per year. We show them even more savings by swapping their expensive plan F for plan G or N.

With more than 170 different Medigap plans in Georgia, how do you find the best plan for you?

Shop and compare GA Medigap quotes

Instant online rates

Your information is NEVER sold.


#IdentityTheft #TaxFraud #MedicareCard #SocialSecurity #GAMedigapQuotes

How to Max Out Your Social Security

If you want to max out your Social Security benefit you will need to plan ahead. You can begin receiving Social Security at age 62 but most baby boomers will come out ahead to wait until FRA (full retirement age) at 66. Regardless of when you begin Social Security, most of us will go on Medicare A & B when we turn 65. How much is the spouse benefit?

How much does Medicare cost? Should I stay on my group plan or is it better to begin Medicare at age 65? Can I have Medicare without Social Security?


Social Security at age 62 or wait?

If you need to begin Social Security at age 62 for financial reasons, go ahead. It is your money. But if you want to max out your benefits the longer you wait the more you will receive each month. Apply for Medicare

The Catch 22 in your benefit is this. How long will you live?

If you are in relatively good health and your family has a history of living into their 80’s or older there’s a good chance you will have a long life too.

But we never know until we get there.

CNN Money addresses the question, “Should you tap your Social Security benefits early or wait?”.

Many people want to get their hands on their benefits as soon as possible, fearing (incorrectly) that Social Security will go broke. Others enjoy the sense of control they get from investing those funds instead of passively waiting for a higher payment down the road.

In spite of some claims, Social Security will not go broke. Technically, it already is. Excess payroll tax collections have mostly been borrowed by Congress to pay current obligations. The Trust fund is full of IOU’s but that does not mean Social Security will implode.

There are too many of us boomers out there and we are old enough to vote if they try and take Social Security away from us. Yes, I said us. I will turn 65 in September of 2015 and will go on Medicare. My plan is to delay SS until age 66 or possibly later.


Social Security planning

If you fail to plan you plan to fail. There is a lot to be said for that old saw.

Back in the old days when we wanted to go on vacation we planned ahead. Many of us ordered at trip planning kit from AAA that contained maps, information on lodging and restaurants and even included brochures of places to see.

That was then.

Now we go on the internet and let Google be our friend. We may map out our trip to get an idea of trip times but rather than bulky maps that never can be folded up neatly we rely on GPS to get us from point A to point B.

We don’t have a retirement GPS and we do need to plan ahead.

Of the items mentioned in the video, long term care planning is often the one that is most overlooked. I have a business associate that handles long term care for me. Let me know if you need an introduction.


Turn 65, go on Medicare?

At one time you had no choice. Most people retired at age 65 and some even a few years earlier. If you worked for a “big company” like AT&T or IBM you had a retiree health insurance plan.

But those days are mostly gone.

att retiree health insuranceMany large employers have cancelled their retiree health plan and shuttled their employees off to consultants like Aon or Towers Watson. Instead of a company health insurance plan you are forced onto Medicare. Your former employer may have set up a retiree HRA and made a deposit to help you pay for your Medicare Part B and either a Medicare Advantage plan or Medigap plus Part D.

The advice given by the service reps at Aon or Towers Watson is mostly inadequate. You may have also been told the only way to participate in the HRA was to buy your coverage through the consulting firm.

In many cases that may not have been completely accurate.

We helped several retirees find a plan that fit their needs and budget and still retain access to the HRA funding. In every case the premiums for plans we suggested were lower than those for comparable plans through Aon or Towers.

With more than 170 different Medicare supplement plans in Georgia, how do you find the right one for you? I will be glad to discuss the plans I considered as well as the one I will pick when I go on Medicare.

You can begin your search on our site. View plans side by side to compare benefits and rates. Of course we are always available to answer any questions you may have.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Still have questions?

Social Security can be confusing, even more so than Medicare. You are not the only one with questions.

Here are a few links to help you find your path and max out your Social Security benefits.

How to Max Out Your Social Security Checks

How to Calculate the Spousal Benefit

Social Security Spouse Benefits – The Rules of the Road

If you found this post to be of benefit please share it with your friends. Let us know how we can help.


#SocialSecurity #Medicareturning65 #AT&T

Health Care Fraud – Medical Identity Theft

Health care fraud and medical identity theft is a growing concern for Georgia retirees on Medicare. Stone Mountain nurse convicted of health care fraud. New study finds medical identity theft grew by 22% last year.

The recent Anthem Blue Cross hack is just one more example of how thieves gain access to your information and can file fraudulent claims using your identity. Here is just one example of how this “victim-less crime” can impact you.

When thieves use your information to file claims everyone pays. Retirees on Medicare aren’t giving birth but their medical ID can be used to gin up claims and diagnoses that have nothing to do with you.

For instance, your ability to obtain needed pain medication could be compromised if a junkie is using your Medicare card to commit health care fraud and obtain prescriptions for pain killers.


Health care fraud, the victim-less crime

One reason why health care fraud is difficult to track is because most of the time it isn’t discovered until after the fact. There are no hidden camera’s to record a thief using your Medicare card to obtain medical services. When the crook uses your identity to fill prescriptions a fraud alert does not show up on the pharmacy hacker

Have you had your medical identity compromised?

In most cases the only way to know is to regularly review your claims. One way is by using iBlueButton to track your Medicare claim activity.

Unfortunately, too many people don’t look at Medicare claims or health insurance claims as their money. Claims paid by Medicare doesn’t come out of your pocket (directly) so why care?

Would you report a shoplifter to the store manager?

Most people probably would.


Because when someone steals from a store that store has to raise prices to compensate for the lost revenue. Similarly, when someone steals from Medicare or the insurance carrier prices have to rise. In the end, you pay more.

Higher health care costs.

Higher Medicare premiums.

We save our clients an average of $450 per year in Medigap premiums and over $1,000 yearly in out of pocket drug costs. Shop and compare now.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Medical identity theft impacts millions

The Anthem hack made headlines for many reasons, including unauthorized access to 80 million personal records.

my medicare cardAccording to Forbes, the distinction between medical identity theft and other types of identity theft like consumer financial information or credit cards is important for many reasons.

  • Data breaches in healthcare (like the Anthem breach) often involve permanently identifiable information like Social Security numbers and date‒of‒birth. This makes the data itself much more valuable, with a much longer shelf-life and easier for criminals to sell.
  • The direct out‒of‒pocket costs to victims of medical identity theft are significant. While the financial liability for consumer credit cards is often limited to $50 (and the card itself can be easily cancelled and replaced) the Ponemon study suggests that 65% of medical identity theft victims had to pay an average of $13,500 to resolve the crime.
  • Unlike credit card theft, medical identity theft victims are rarely informed by a healthcare entity about suspicious and potentially fraudulent activity for health services.
  • On average, medical identity victims typically learn of the fraudulent activity more than three months after a crime has been committed and 30% do not know when they became a victim. Of those who found an error in their Explanation of Benefits, about half didn’t know who to report the claim to.
  • Full resolution of medical identity theft is hard to achieve and the Ponemon research suggests that only 10% of respondents reported achieving a completely satisfactory conclusion.

Think about that.

If someone gains access to your credit card your liability is minimal as long as you report the fraud on a timely basis. Your card is revoked and a new one is issued.

Game over for the crook.

Not so when they have your name, Social Security number and date of birth. They can continue to use your identity to commit health care fraud for years.


Health care fraud hit’s close to home.

A stone mountain nurse filed fraudulent claims for services that were never provided.

Prosecutors say that between May 2013 and September 2013 Daphne Patterson billed five health insurance companies, including UnitedHealthcare and Aetna, for services she did not provide, reports WABE.

The indictment says Patterson “sought reimbursement for at least approximately $2.2 million for the various allergy tests and treatments that had not been provided to the health care benefit program beneficiaries.”

The indictment adds, “In total, Patterson received more than $1 million from the health care benefit programs as a result of the fraudulent claims.” – Atlanta Business Chronicle

All of that took place over 5 months. Consider the damage that could have been done if allowed to continue for years?

Protect yourself against health care fraud by regularly reviewing your claims.  Report Medicare fraud when you discover it.

Save money by allowing us to help you shop and compare over 170 different GA Medigap plans.




#healthcarefraud #medicalidentitytheft #anthem #medicare

Health Care At Your Fingertips

Health care. Now there’s an app for that.  At Georgia Medicare Plans we believe in open access to health care information. When patients, consumers and their medical providers have access to relevant information the level of health care goes up and the cost of health care comes down.

OK, the video is a bit corny but it get’s the point across.

Something that isn’t corny is saving money on your Medigap plans. One carrier lowered rates while others are raising rates. Maybe your Medicare supplement carrier is increasing rates. Shop and compare GA Medigap quotes now. 

Your data is never sold.


Health care and iBlueButton

It is surprising how many retirees on Medicare are not aware they can view their health care records online by logging in to If you have not already created a user account, do it now. Optimized-iBlueButton

You will also need to install iBlueButton on your mobile device or Chrome enabled computer.

Once you have installed iBlueButton you can download your medical data from MyMedicare directly to your smartphone or tablet.

It’s that simple!


Medical Identity Theft

Anthem made headlines recently when they disclosed that their computers had been hacked and 80 million current and former policyholders personal information had been compromised.

ibulebuttonvideoMost of the headlines and news reports have focused on traditional identity theft. Things like using your name and Social Security number to create a “new you” so someone in Bangladesh can buy a Ford.

No doubt someone can pretend to be you and establish a new line of credit but the bigger threat is medical identity theft. Georgia Medicare Plans has posted on this before and you might want to review our earlier posts.

We also found this online WSJ article to contain very useful information.

Medical records typically sell on the black market for about $50 each, says Mr. Pascual. The thieves, often hackers from overseas, are rarely caught, and medical clinics and hospitals compound the problem by having poor record security and holding personal data for long periods.

This widespread problem of medical-record theft, which often targets children and the elderly, shows no signs of slowing.

The theft (of your medical records) can mean canceled insurance plans, damaged credit, misdiagnosed illnesses and unwarranted medical charges that can take over a year to fix. – Wall Street Journal

Unfortunately too many view medical identity fraud as a victim-less crime since, in most cases, the money loss comes from insurance carriers or Medicare. But theft always comes back in the form of higher prices, higher premiums and higher taxes.


Improving your health care

As we age we often go from one or two doctor visits a year to several. Our little black book usually has more names that end in M.D.

And as our medication list expands we may purchase prescriptions by mail as well as retail. Your doctor(s) need to know which medications you are taking before prescribing something new or even evaluating your current list of complaints.

When was the last time you had your Medicare prescription drug coverage reviewed? Over the last few years we have saved our clients anywhere from a few hundred dollars per year in out of pocket prescription costs to several thousand. Just last year we saved one client over $7,000 per year by showing them a Part D plan with a lower premium but more importantly, significantly lower drug costs.

We also find that most retirees do not have a Medicare plan that meets their needs and budget. Many are overpaying for Medicare supplement plan F. They bought plan F because that’s what their friends have. Almost without exception you can save anywhere from $300 per year to over $1,000 by making a switch.

Georgia Medicare Plans has access to over 170 different Medigap plans. Somewhere in that mix is a plan that is right for you and will save you a lot of money. When you pay more you don’t get more, you simply paid too much.

Shop and compare now. Instant online quotes.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices


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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


Playing Politics with Social Security

Many baby boomers thought Social Security would not be around by the time they had their 65th birthday. We are barely 4 social security ponzi schemeyears into the boomer generation, born from 1946 through 1964, but already the folks in DC are wondering how to deal with 10,000 of us crossing the finish line every day. The Social Security Trust Fund has been raided so often there is little left in reserve to pay our benefits.

  • What is the problem with Social Security?
  • How did this mess occur?
  • What happened to the Trust Fund where reserves were held in a lock box?
  • What steps are being taken to preserve Social Security?
  • How should I plan for retirement?


Social Security and an aging population

As Suzanne Fields writes in the Washington Times

At the beginning of the 20th century, a baby born in America was expected to reach the ripe old age of 47. My grandson, delivered on Christmas Eve, can anticipate living to the age of 79. If progress continues, his life expectancy will rise to 88. At the end of the century, the norm may be a cool 100.

Along with The Greatest Generation, Boomer are living longer, healthier lives. Improved lifestyles and the miracle of modern medicine allows us to live longer, more productive lives.

When Social Security was created the average life expectancy was 61. Only 54% of men and 60% of women lived to age 65. Congress only had to fund benefits for less than half the people born in 1935. The rest would pay into the system but never collect.

And to think they threw Charles Ponzi in jail for his scheme which involved using funds from new investors to pay returns to social security ponzi scheme 2the early investors.

Social Security was always designed to be a “pay as you go” system where retiree benefits were funded by payroll taxes on the current labor force.

Despite popular belief, you do not have your own Social Security account. When you reach retirement age your benefits are paid from the payroll tax revenues on current workers. Money you paid in over your working lifetime were used to pay retirees.

The flip side is, if you die before you retire you get nothing. Your estate will receive a $255 death benefit. The rest of the money you paid in is gone.


How did we get to this point?


The folks in DC found a way to turn a promise of “security” into a vote buying scheme. Promise more benefits with the belief socia security ponzi workers to retireesthat the next generation can fund the promises.

In the distant past, Social Security was a “pay-as-you-go” system, where current tax collections paid for current benefits. The Social Security trust fund idea gave us the illusion that we were advance funding Social Security benefits, in a manner similar to the private pension system. In reality, though, Social Security is still pay-as-you-go, with the difference being that future generations will pay for both the benefits outlay and the repayment of principal and interest on the special government bonds in the trust fund. – CBS News

Congress borrowed from Peter to pay Paul. Current workers are not only funding current retiree benefits but also paying back the loans (in the form of government bonds).

Part of the problem is there are fewer workers for each retiree than there were when Social Security began. People are living longer now and retiring earlier. This is a problem.


Fixing the Social Security problem

Congress has created a monster with an insatiable appetite so what can they do to tame the beast?

Social Security is based on age assumptions rooted in the last century, but Social Security remains “the third rail of politics.” A president touches it at his peril. The last president who raised the qualifying age for benefits was Ronald Reagan, our oldest president. President Obama, with a new conservative Congress, will not likely do much more than talk about the problems of Social Security, although its pay formula remains unsustainable. – Washington Times

BOSTON, MA, USA - 30JAN02 -Three people are dreaming: National Security dreamer sleeps soundly; Houneland Security dreamer sleeps soundly; Socieal Security dreamer is wide awake. CARTOON: Clay Bennett / The Christian Science MonitorIn case you missed it, the normal retirement age for full Social Security benefits is no longer age 65 for the Greatest Generation, Boomers and those that follow.

People born in 1937 and earlier were the last generation that could draw full retirement benefits at age 65. If you were born in 1938 your NRA (normal retirement age) was 65 and 2 months. Born in 1939, NRA is 65 and 4 months and so on.

Age 66 is the new NRA for people born from 1943 through 1954. The last of the boomers must wait until age 67 to collect their NRA full benefit.

Every year our elected officials debate ways to keep Social Security solvent. Some of the ideas have already been implemented including raising the NRA and taxing benefits if you have earned income above a certain level.

Other ideas considered but not (yet) implemented include:

  • Chained CPI for future benefit increases
  • Raise FICA taxes
  • Increase the FICA cap on wages
  • Further increases in the NRA
  • “Means testing” for Social Security beneficiaries

We have no way of knowing which (if any) of these considerations will be implemented. What we do know is this. Congress can’t afford to keep kicking the Social Security can down the road and we can’t bury our head in the sand and pretend everything is fine.


Planning for retirement

Here are a few suggestions for those who will be retiring soon or are already retired.

  • Reduce pesonal debt
  • Improve your health
  • Match your Medicare plan with your needs and budget
  • Reduce your health care cost

Retirement planners and financial advisers suggest you enter retirement debt free but that isn’t always possible. In addition to a mortgage, many retirees still have student loan debt. Some is their own debt while others may be on the hook for loans as a co-signer. These calculators at Bankrate can be helpful if you have debts that still need to be paid off.

Improving your health has many benefits including lowering your monthly outlay for medication. Walking is something most of us can do and all it costs is a decent pair of walking shoes. I get mine at Kohl’s for less than $100. Best money I have ever spent on my health and I got a quick return.

Last summer I started walking 4 miles a day, usually in the A.M. before it got hot. Within a month I had lost 6 pounds and dropped my BP from 141/92 to a more respectable 126/82. Not bad for a chubby guy going on Medicare later this year.

My mother battled high BP all her life and died of a stroke at 82. I vowed not to follow in her footsteps and now maybe I am improving my odds.

Most people pick a Medicare plan based on the monthly premium. If you are like that you are looking at the wrong end of the equation. Retirees on Social Security should look at the cost of their health care rather than the premium. A low premium Advantage plan could leave you with several thousand dollars in out of pocket costs for health care or prescription drugs. Same can be said for Medicare Part D.

I ran a report for a new client that only takes two medications. He mentioned at $15 plan from Humana as one he had considered. When I ran a report for him a $20 plan offered a better value. Even with the $5 higher monthly premium he would save almost $400 per year in drug costs. It would have been very shortsighted to have looked at the premium alone.

This same client wanted Medigap plan F and was trying to decide between AARP/United at $180 and Blue Cross for $192. I showed him plan G for $132 but he insisted on plan F.

We compromised on plan F for $151 and still saved him money over plans he picked on his own.

He can stretch his Social Security check a little farther now by saving over $65/month on his medications and Medicare supplement.

We might be able to save you even more. It all starts with a free Medigap quote.


4 Money Saving Tips for Medicare Open Enrollment

4 money saving tips that can save you $1,000 per year or more with little or no effort on your part. No coupons to clip. No standing in line to make an money saving tipsexchange. All of these money saving tips can be done from the comfort of your home in a matter of minutes.

Our best money saving tips involve changing the way you buy your medications, and enrolling in a different Medicare supplement plan. Our clients save an average of $450 per year by keeping the same plan but changing carriers. Save even more with nominal cost sharing.

Click to shop and compare Medigap plans and rates.

Medigap rates are increasing in January. Apply before 11/15/14 and lock in today’s lower rates.



Money saving tip #1

Change your plan.

This is Medicare open enrollment. From now through December 7th you can change your drug plan or Medicare Advantage with a simple phone call or online enrollment.

For many people, their drug plan is the most expensive part of their health care expenditure. It doesn’t matter if your drug coverage is embedded in your Advantage plan or if you have a stand alone Part D plan, drugs, and how you pay for them, are expensive.

Here are just a few money saving tips to consider

  • Don’t run all your medications through your drug plan
  • Consider buying online such as through a Canadian pharmacy
  • Change your pharmacy
  • Consider a drug discount card
  • Order maintenance med’s in 90 day refills
  • Use mail order when possible
  • Switch to generics
  • Look for free medications

pharmacyIf you hit expect to hit your donut hole consider buying some of your medications without using your drug plan. The 2015 donut hole kicks in when the retail cost of your drugs hits $2960.

Obamacare eliminates the donut hole by 2020.

Sounds great, but here is how it is accomplished.

You pay more.

In 2014 you must have $6,455 in covered drug charges to hit the catastrophic level.

In 2015 that amount is $6,680, plus your copay’s in the catastrophic level increase as well.

And your premiums will rise in most cases, as will your total out of pocket costs for medications.

Canadian pharmacy’s are a great way to save money. We have recommended (and personally used) the same pharmacy for over 10 years.

If you are buying locally at a retail pharmacy consider making a change. Using a different pharmacy can save you anywhere from a few dollars to several hundred dollars a year. One local pharmacy is almost always lower than any other in your area.

Drug discount cards are normally a waste but we have found the discount card from Needy Meds to be superior to any other card.

If you are taking Amlodipine, Lisinopril or Metformin, did you know you can get these for free? Check out your local Publix pharmacy. Ask them to price your other drugs to.

Then pick up a steak to celebrate your new found savings.


Money saving tip #2

Change your plan.

If you have a Medicare supplement plan you are probably paying too much. At any particular age and zip code, prices for plan F can vary by $100 per month plan for even more. All plans with the same letter are identical in every way except price.

When you pay more you don’t get more you simply paid too much.

More money saving tips.

The plan with the lowest price today may not be a good value next year. Currently Manhattan Life and Omaha Insurance Company are using low, introductory rates to write business.

Neither carrier has a 5 year renewal rate history.

We NEVER recommend a plan or a carrier that has not established themselves for at least 5 years in the Medigap market.

Buy the low price now and run the risk of a double digit rate increase next year.

Or pay a few dollars more for long term rate stability. We have clients that have never moved their plan (or had reason to) in 4 years time.

We also never recommend plan F. Changing to G or N, with the right carrier, can save another $600 or more AND offer more rate stability.


Money saving tip #3

Change your carrier.

plan nIf you have a Medigap plan from Blue Cross or one of the Mutual of Omaha carriers we can almost guarantee you a savings of $40 to $90 per month or more.

Sometimes you can save even more by switching your Medicare Advantage plan.

Too often retirees look only at the Advantage premiums and the add-on benefits such as dental, vision and gym memberships. The REAL cost of an advantage plan is in what YOU pay for your health care.

Your built in drug plan can be a money hole. We recently ran a report for a diabetic client and found the Advantage plan he wanted would have cost him almost $6,000 more for his drugs vs a different plan he had never considered.


Because only half his doctors were in network with plan “B”.

For a few dollars more we showed him a Medigap plan that allowed him to keep ALL his doctors, have less out of pocket than either Advantage plan, and pay less for his med’s than either Advantage plan.

All totaled he saved almost $100 per month in out of pocket costs and had less headache than the Advantage plan.

We had a similar situation with a client’s drug plan. Read “Lassie cant’ find a Medicare plan


Money saving tip #4

Review your drug coverage, and change your agent. If you got this far your current agent isn’t doing you a favor.

People who buy Advantage plans almost never bother to check pricing on their medication. If their doctor is in network, and their drugs are covered, they stop there.

Never, ever, ever buy a plan without comparing your actual cost for medications.

This is generally a lot easier with a Medigap and separate Part D prescription drug plan. When you have original Medicare, a supplement and a drug plan you can build the kind of coverage you need from scratch. With Advantage plans you take what is in stock on the shelf.

Either it fits or it doesn’t.

No tailoring allowed.

Georgia Medicare supplement rates


Money saving tips

These tips can save you hundreds to thousands of dollars each year, but you must act now.

The last day to apply for an Advantage plan or drug plan is December 7, 2014.

The last day to apply for a Medigap plan at 2014 pricing is November 15, 2014. We are taking applications now for December, January and February.


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