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.

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

How to Get the Most Out of Medicare

How to get the most out of Medicare? Shop plans every year? How often should I change Medicare plans? Can I keep my doctor? Who can help me? GA Medicare expert Bob Vineyard helps.

How to get the MOST out of Medicare
How to Get the Most Out of Medicare

Get the Most for Your Medicare Dollars

How to get the most from your Medicare dollar is a popular question with close to 100 million responses from a Google search.

My clients say “Why didn’t I call you first? You answered all my questions. Never pressured me to buy.”

Do you really want to spend time searching the internet for answers? Or allowing strangers in your home. Agents who will try to SELL you something you don’t want, don’t need and can’t afford.

Here is my “pitch”. Call. Give me 10 minutes to answer your questions. Any question. Then decided if you want my help or not.

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

How to Get the BEST Medicare Plan in Georgia

GA Medicare expert Bob Vineyard reviews the BEST Georgia Medicare plans, news and options. Review our videos. Bob will help you find the RIGHT plan that fits YOUR needs and budget. Call (404)252.5859 or email [email protected] Watch our Medicare videos on YouTube.

There is nothing wrong with buying a Medicare plan online as long as you are prepared for a LOT of phone calls from agents wanting to sell you something you don’t need, don’t want and can’t afford.

If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medicare supplement plan in Georgia. Full report with Medicare supplement rates for ALL Georgia Medigap carriers. Anthem GA Medigap rates include Silver Sneakers

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

Shop and compare Georgia Medigap rates online. Instant quote. Up to 30 plans.

FREE REPORT for over 240 different GA Medigap carriers available on request. We quote Medicare supplement rates by phone and email your custom report. No obligation.

Comprehensive Part D Medicare drug plan review for new and existing clients. Learn the secret to saving hundreds on prescription drug costs. A drug plan deductible is your friend

How Does Medicare Work?

Medicare has 4 parts. Your red, white and blue card is broadly accepted by doctors and hospitals alike. No networks! No referrals. No prior authorization.

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%.

When you have original Medicare, YOUR DOCTOR AND YOU decide on the care you need. You don’t need approval by an insurance carrier before can receive testing or treatment.

Many 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.

Here is what I tell folks Without a supplement plan 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.

Do All Doctors Take Medicare Advantage Plans?

How to get information on doctors that take Advantage policies? Did you know that some doctors and hospitals do not accept ANY Medicare Advantage plans? What happens if your claim is DENIED?

Did you know that 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. Referrals are not required.

All 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. How are Medicare Advantage plans like a store credit card?
https://youtu.be/p0j41FsfHbA

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Most importantly, 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.

Is Cancer Treatment Covered by Medicare?

Medicare DOES cover your cancer treatments. However, Advantage plans issued in Georgia have a LOT of out of pocket expenses. In other words, you will pay a lot more for treatment under an Advantage plan.

Also, many Advantage plans often require prior authorization BEFORE you can be treated for cancer. Your doctor does not decide your care, the insurance company makes those decisions for you.

ORIGINAL Medicare does not have networks. Prior approval is NOT needed for cancer treatment or any other care. Medicare and a Medigap plan have minimal out of pocket costs.

Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.

#BESTMedicarePlansGeorgia #GAMedicareExpert #GAMedicareVideos

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 Medicare.gov 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 https://youtu.be/uMROeyRxqEI

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