New to Medicare – What Do I Need to Know?

When you are new to Medicare you will have questions. But you probably don’t know who can help. Even if you did, what questions will you ask?

You don’t know what you don’t know.

new to medicare
New to Medicare – What Questions to Ask?

About the time you think you have it all figured out they change the rules.

Turning 65?

If you are turning 65 and new to Medicare you are about to enter the state of confusion.

Medicare may SEEM simple, but it is not. It is easy until you have a claim. Then it becomes complicated. Where will you turn then? Will you go to the friend that told you to buy the plan they have? Maybe you will call the agent that SOLD you the plan? Good luck with that. They may not even be in the business by now.

You could call the carrier where you went direct to avoid talking to agents. You call an 800 number, press 1 for English then get routed to voice mail. Someone will call you back in a few days while you are in the shower.

How well does that work for you?

Maybe your best choice is to find a GA Medicare expert.

New to Medicare?

Enrolling in Medicare

If you are approaching age 65 and new to Medicare you know the drill. For the last year your phone has been ringing. Pushy insurance agents calling to SELL you a plan you don’t want, you don’t need and can’t afford.

Your mailman hates you because of all the junk mail that arrives at your door every day.

What do you keep? What do you throw away? Where do you turn for answers to your Medicare questions? Check out Medicare plans in Georgia.

Who Can Help Me?

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.

When you are new to Medicare how do you find the RIGHT plan?

All I ask is for you to give me 10 minutes by phone. Time to answer YOUR questions. You will NEVER be pressured to buy anything. This is your opportunity to ask ANY Medicare related question, then decide if you want to work with me or not.

It’s that simple.

It’s an offer you can’t refuse.

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

Medicare Advertising – What is Legal?

Medicare advertising kicks into high gear in the fall because of the annual open enrollment period. This year you open enrollment begins on October 15 and runs through December 7. You can expect your mailbox to be stuffed with all kinds of medicare mailmansolicitations and advertisements. Your email volume may pick up as well with promises of better coverage for less money.

How much is real? What is a come-on? Are some of them scams? Are insurance companies legally allowed to offer Medicare advertising for enrollment purposes?

Most of the people we talk to, that already have Medicare, are in the wrong plan, paying too much, or both. It doesn’t matter if you are turning 65 and going on Medicare the first time, or have been covered by Medicare and just got bad advise. We can help.

We offer instant online Medigap quotes. No tricks. Compare plans and rates side by side. Your information is never sold.

Medicare shop and compare

We have rates on more than 170 different Medicare supplement plans and will always give you the lowest rate by phone.

 

 

Medicare Advertising

I have been in the insurance business for 40 years and am always interested in staying on top of what is going on around me in
“my world”. I read news articles daily, subscribe to information on Medicare and Social Security, and continuously scour the web for anything that might be of interest to my clients.

have I got a deal for youJust today I received the following in a newsletter published by an “independent” Medicare adviser. Normally their information is spot on but this was just wrong on so many levels.

Dear Marci,

Last year around this time I started receiving a lot of notices in the mail advertising different health insurance plans for my Medicare coverage. I was overwhelmed by the amount of information I received, and I don’t want to experience that again. How can I sort through these notices and make sure that I am not being taken advantage of? How are insurance companies allowed to market their plans?

– Naomi (Pittsfield, MA)

Marci’s response follows in part.

Dear Naomi,

You are not alone—this is a common concern among beneficiaries. October 15 marks the beginning of Fall Open Enrollment, which is the time during the year when Medicare beneficiaries can make changes to their health care coverage. Starting October 1, Medicare Advantage Plans will start advertising their offerings for next year. While most plans abide by the marketing rules set forth by Medicare, not all plans do.

Some of Medicare’s marketing rules for plans are:

  • Unless you are already a member of a plan or have given permission, plans are not allowed to contact you in any way other than through the mail.
  • Plan names cannot suggest that the plan is preferred or endorsed by Medicare.
  • Plan representatives cannot approach you in public places, such as parking lots of malls. In health care settings, plans can only advertise in common areas such as cafeterias. They may not advertise in waiting rooms.
  • If you schedule a time to speak with an insurance broker about Medicare Advantage options, they cannot try to sell you products other than a Medicare Advantage Plan, such as a life insurance policy.
  • Plans cannot offer gifts worth more than $15. Further, they must provide the gift even if you do not sign up for the plan.

In addition to being aware of these rules, you should consider these tips to help avoid becoming the victim of marketing fraud:

  • Always verify all information you receive from an insurance plan representative. If a representative says that a particular doctor is in network, you should call the practice to confirm with the doctor.

  • Be aware of your right to choose how you receive Medicare coverage. Medicare Advantage Plan representatives should not tell you that Medicare Advantage is your only option.

  • If you are feeling pressured, you can tell the plan representative that you will follow up at a later date. This will give you time to make your decisions.

  • Use government websites and official sources of information.

All of the above is good and helpful information, except it is not 100% correct.

The marketing rules above apply only to Medicare Advantage and Medicare drug plans.

Medicare advertising for supplement plans (Medigap) or about Medicare in general are not subject to the same rules and guidelines.

That being said, just because governance over Medigap advertising is somewhat relaxed does not mean carriers and marketers are free to say anything they wish.

 

Medicare Open Enrollment

Does the Medicare open enrollment affect you?

In some cases, yes.

If you have a Medicare Advantage plan or Part D prescription drug plan, welcome to open enrollment. In most cases you can change your Advantage plan without medical underwriting. There is never any underwriting for Part D.

Medicare supplement plans can be changed ANY time, not just during open enrollment. Unless you are a new enrollee, you will probably have to pass medical underwriting before you can make a change.

Just about everything you need to know about open enrollment can be found in our featured post, Medicare Open Enrollment 2015.

I suggest you click the link and take notes.

 

Are You Being Scammed?

Is the Medicare advertising misleading? Maybe, maybe not. Use common sense.

While perfectly legal, the Medicare Advantage literature quite often makes a big deal about $0 premium but (in my opinion) falls short in explaining the true cost of MA plans.car salesman scam

Advantage plans are great until you use them, then they can get quite expensive. That is usually when I get calls from people who say they can’t afford their $0 premium plan any more.

What they are really saying is they can’t afford to pay their medical bills. Unfortunately when it gets to that point they probably can’t qualify for a Medigap plan.

Here are a few things to watch out for if you are enrolling in Medicare for the first time or considering making a change.

Medicare Advantage –

  • Look for your doctors and hospitals in their provider directory
  • Find out if you need a referral to see a specialist
  • What is the penalty for using out of network (non-par) providers?
  • What is your in-network maximum out of pocket?
  • What is your out of network out of pocket maximum?
  • Do your drug copay’s change?
  • Are all your drugs on the formulary?

Medicare Part D –

  • Do your drug copay’s and deductibles change?
  • Are all of your drugs on the formulary?

Medicare supplement –

  • Don’t buy plan F
  • Don’t cancel any existing coverage until you know you have been approved by your new carrier
  • Don’t buy a Medigap plan based on price alone
  • All plans with the same letter pay claims and pay them on time
  • The only difference is the premium you pay
  • Never buy direct from the carrier
  • Use a local Georgia agent that knows the market

When shopping online bear in mind that most of the sites you go to are marketing sites. They gather your information and sell it to multiple agents.

When you get a quote from Georgia Medicare Plans your information is never sold. You get instant, online Medigap quotes. You will also get one phone call from me, usually within 48 hours.

I only call once. I will answer your questions, give you the best rates on plans in your area and give them over the phone.

No pressure. No tricks. Shop and compare now.

Medicare shop and compare

 

 

#MedicareOpenEnrollment #MedicareAdvertising #MedicareAdvantage #MedicareSupplementInsurance

 

Medicare and Diabetes

Does Medicare pay for diabetes treatment? How about diabetic supplies? Will my Medicare plan pay for insulin? How can I save money on my diabetic prescription drugs?

If you have diabetes, you need a good Medicare plan that will cover most of your out of pocket costs for care and allows you the freedom to choose your own doctor. Once you find a doctor that can help you regulate your sugar levels, you don’t need to be forced into changing doctors every few years.

This means finding a good Medicare supplement (Medigap) plan you can keep as long as you live. With over 170 different Medigap plans in Georgia, we can help you find the one that fits your needs and budget.

Instant GA Medigap quotes online. No waiting. We never sell your information.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Shop and compare now.

 

Medicare and Diabetes

If your diabetes has been under control for most of your life, consider yourself fortunate. I have friends that are diabetic, both type I and type II. Some have lived most of their life without major issues. Others have not.diabetic

Consider this. According to the Diabetes Care Project

  • 26 million people in the US have diabetes
  • 79 million have “pre-diabetes”, 7 million have UNDIAGNOSED diabetes
  • More than 90% of diabetics are type II and obesity contributed to most of those cases
  • The US spends $174 million each year to treat diabetics; $119 million in direct health care costs
  • $1 out of every $3 spent by Medicare is to cover the cost of care for diabetes
  • Diabetics have medical expenditures that are more than 2x that of non-diabetics
  • The average annual cost of care for diabetics is $13,700 with $7,900 of that tied directly to the disease
  • The costs of treating diabetes rose 41% from 2007 to 2012

The longer you have diabetes, the greater chance you have of incurring high medical costs and complications. This is not the time to manage your illness and out of pocket costs with a Medicare Advantage plan.

 

Medicare Coverage forDiabetes Treatment

Original Medicare Part B covers the cost of testing equipment and supplies, insulin pumps and therapeutic shoes.

Part B also covers regular screening, diabetes self management training, nutrition therapy services, A 1c and glaucoma testing and much more. Check out Publication 11022 for more details.

medicare diabetesOral medication and self injecting insulin (not for a pump) are covered by Medicare Part D.

Don’t get sucked into the deals that promise free diabetic supplies. If you get an unsolicited call offering FREE diabetic supplies, hang up. Diabetes Health has this to say.

Scammers often pose as federal employees or workers representing legitimate diabetes associations. They’re looking for Medicare and Social Security numbers, as well as other financial information, that they can use fraudulently on their own behalf or sell to criminal syndicates.

Fraudsters that actually do send diabetes supplies send supplies that are inferior in quality, and then turn around and fraudulently bill Medicare for the order. “Free” supplies offered include glucose meters, diabetic test strips, and lancets, as well as such items as heating pads, lift seats, foot aids, or braces.

If you get such a call, immediately hang up and call the fraud hotline (1-800-HHS- TIPS, 1-800-447-8477)

 

Medicare and Prescription Drugs

The weakest link in the Medicare program is Part D, the prescription drug plan. Nowhere is it more obvious than when it comes to covering the cost of diabetic drugs.

Insulin can be very expensive, especially if you use a pen instead of a needle. The NovoLog patient assistance program can be a financial lifesaver for those who qualify.

Other PAP’s (Patient Assistance Programs) are another option.

We will review PAP’s in more detail in a future post.

 

Don’t Pay Too Much for Your Medicare Supplement Plan

Almost every day we talk to people who have bought the wrong Medicare plan for their needs, are paying too much, or both.

We recently compared plans for a lady who lived in zip code 31630, was turning 65 and going on Medicare. After talking with her friends she had decided to buy plan F from either Blue Cross or United Healthcare (through AARP). She was told that plan F  “pays everything” (which is true) and that she should go with a big carrier that will pay all her claims.woman shaking fist

Of course no one told her that ALL the carriers pay 100% of the contractual claims approved by Medicare. The normal claim process is your doctor files with Medicare, Medicare approves the claim, your supplement plan pays their portion.

A routine claim will take a couple of weeks with Medicare and about another week with the Medigap carrier.

Any doctor that participates in Medicare will also accept ANY Medigap plan, regardless of the issuing carrier.

Blue was going to charge this woman $168 per month. She could save a few dollars with the AARP/UHC plan F for $166.

But she can save even more by using a carrier I represent that will pay her claims in the same manner as Blue and UHC but with a monthly premium of $126 per month. That $40 per month savings adds up quickly!

Maybe she should consider new friends.

Better yet, introduce me to her friends so they can save money too.

Medicare shop and compare

Diabetes can be expensive. Let us show you a number of ways to minimize your out of pocket costs.

 

#MedicareDiabetes #Insulin  #DiabeticSupplies  #MedicareSupplement #MedicareAdvantage

Do I Need a Medicare Supplement Plan and Medicare Advantage?

Medicare supplement and Medicare Advantage. What’s the difference? Do I need both? What is the difference in Medigap and Medicare supplement? Do AP20C7Advantage plans have more advantages? Can I change plans every year during open enrollment?

Which plan is better? Should I have an Advantage plan or Medigap?

That is a question only YOU can answer.  Consider the differences and then decide which plan fits your needs and budget.

Are you turning 65? Do you need help navigating the Medicare maze?

Call us. We can help.

 

Medicare supplement and Medicare Advantage

What is the difference?

A lot.

Do I need both a Medicare supplement plan and an Advantage plan?

Nope. Even if you wanted both, Medicare says you can’t have both.

So pick one or the other.

 

Medicare supplement plan F rates

What is the difference in Medicare supplement and Medicare Advantage?

Medicare supplement plans work with original Medicare.

  • No networks
  • Use any doctor, lab or hospital anywhere in the U.S.
  • Referrals not necessary to see a specialist
  • Keep your current doctor(s)
  • Your doctor cannot be dropped from the plan mid year
  • You can keep your plan every year.
  • Annual review not needed (for your supplement plan)
  • Out of pocket is clearly outlined and can be budgeted
  • Pick a drug plan that covers the drugs you need

 

Is Medicare Advantage Better?

The advantages of a Medicare Advantage plan are, the monthly premium is lower.
The disadvantages are:
  • you are limited in most cases to docs and hospitals in the network
  • the Rx is often paired with the plan and may not include the meds you need
  • your doctor can be drop out of the plan at any time
  • you may have to change your plan every year
  • you have to review the plan every year (participating network providers, meds, cost of health care, etc)
  • your out of pocket for in network only claims is almost always higher than Medigap
  • your out of pocket cap averages $6,700 (most 2018 plans) + out of network claims + Rx copay’s
  • you can find yourself out of network and incur penalties any time, anywhere
But other than that, the Advantage plans are great until you use them.

Can I change plans every year during open enrollment?

Medicare supplement plans do not have annual enrollment periods. When you first turn 65 you can purchase any Medigap plan with any carrier, no questions asked.
Medicare Advantage plan and Part D drug plans can be changed every year, but only during open enrollment. Most retirees will change their Advantage and Medigap changedrug plan every year or so, whether they want to or not. Each year the plans change and you MUST review to make sure you are not going to pay more for your health care than you expected.
Never ever take the “automatic” renewal option. Always ask your agent to shop and compare plans for you every year.
One of my Part D clients was prepared to take the automatic renewal from Cigna. Their new rate was dropping a few dollars and other than the addition of a deductible, the plan seemed like a good buy.
What they did not know (until I reviewed it for them) was this.
The renewal plan did not include all of her medications.
The renewal offer was $7 less than the Cigna plan I suggested but the difference in her out of pocket costs was significant.
Her expected annual prescription drug cost for the renewal offer was $2880.
The projected drug premium for the plan that was $7 higher but her annual prescription cost was only $1530. That additional $7 monthly premium saved her more than $1300 in out of pocket drug costs.
Had she accepted the automatic renewal she would have saved $84 in premiums but would have paid out more than $1300 for her medications.

Comparing Medigap plans is easy

Kind of.
Benefits are standardized and assigned a letter of the alphabet from A through N.
But Medicare only uses 9 of the letters
Medicare supplement plan F is the most popular. Also the most expensive and most oversold.
Plans G and N offer exceptional value.
Some carriers don’t offer all the plans.
AARP/United Healthcare does not off plan G. Neither does Blue Cross of Georgia (BCBSGA). Nor does Humana.
Mutual of Omaha (Omaha Insurance Company in Georgia) does not offer plan N. They did at one time, but not any more. Makes you wonder why, doesn’t it?
We never recommend a plan that does not have at least a 5 year renewal rate history.  That is to protect you.
Manhattan Life and Omaha Insurance Company have only been offering Medigap for a little over a year. Same for Companion Life.
There are over 250 different Medigap plans in Georgia. We have Medigap rates you won’t see anywhere else, but you can start your online shopping experience by clicking this button.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices