Your New Medicare Card is Coming

New Medicare CardYou read about identity theft every day and we are deluged with information about various ways to protect ourselves. Nevertheless, those of us over 65 carry a Medicare card in our wallet or purse that, in most cases, displays our Social Security Number (SSN). Despite all the concern about protecting that sensitive SSN, the government has insisted on using that number for Medicare for many years. That is about to change!

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, contained a provision requiring the Centers for Medicare and Medicaid Services (CMS) to remove SSN’s from Medicare cards. Beginning in April, CMS will begin sending out new cards to Medicare recipients with an ID number that is randomly generated and bears no resemblance to your SSN. The cards won’t go out all at once but some will be mailed out each month until the process is finished in April 2019.

According to the CMS Press Release last month, “The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

After testing 10 different designs, CMS ended up staying with the familiar red, white and blue theme as shown in the photo above. The new cards will go out to about 58 Million people with instructions to securely destroy their old card once the new one is received. Even with the new card, Medicare recipients are advised to keep their Medicare Claim Number confidential to avoid claims fraud and abuse.

3 Reasons Not to Ignore Medicare AEP

AEP (Annual Election Period) for Medicare Advantage and Part D Drug Plans starts on October 15 and ends on December 7. Even if you have no complaints about your current plan, there are three reasons why it is still a smart move to review your options.

  • Your Plan Benefits or Premium May Be Changing: Every year companies review the plans and often change the premium and the actual benefits. Prior to AEP, they will send you notification of changes but many people ignore the notice. For instance, your plan may add a Drug Deductible of $300 to upper tier drugs and you will suddenly find that out in January when you refill your prescription. Or, they may have changed the “per day” hospital copay from $250 to $400. With an average hospital stay of just over 2 days, that means your next inpatient visit will jump from $500 to $800. And, of course, all companies adjust their premiums so the plan that was the best value for you last year may not be this year.
  • Your Particular Needs May Have Changed: During the past year, your doctor may have added a new prescription. You may find that your plan has a higher copay on that drug than another plan might. The copay for Outpatient Surgery or Primary Care Office Visits may have increased. You may now have a need for hearing aids or glasses for which many plans have benefits included. Some plans have Dental Care either included or available as extra-cost options. Many plans also include gym memberships at no additional charge.
  • Networks May Have Changed: Often the choice of a plan revolves around whether your doctor or specialists are considered “in-network” or not. Companies are always trying to expand their networks. A plan that did not include your doctor last year may include him this year, which now makes that plan a viable choice for you.

There is absolutely nothing wrong with being happy with you plan and continuing with it for years to come. If you decide to do that, you don’t need to do anything as the plan will be automatically renewed (as long as it is still being offered in your area) and your premium will be adjusted to the new year prices. On the other hand, It just makes good sense to take a few minutes during AEP to review the options to make sure your plan is still the best choice for your particular needs. Agents usually have all the details about the new plans by October 1. If you don’t have a local agent, and you live in the North Idaho area, feel free to contact me for an appointment at your convenience.

The Death of Plan F Medicare Supplements

Plan F is about to be killed by the Feds and you need to know that. For many years a Medicare Supplement Plan F has been considered the “gold standard” for supplements. There are two main reasons for this.

First, while most supplements pay the Medicare Part A (Hospitalization) Deductible, not all pay the Part B (Outpatient) Deductible. Plan F does this. Second, depending on the state you live in, doctors are allowed to charge up to 15% above the Medicare Allowable Charge for services. That means that Medicare pays 80% of the Allowable Charge, some supplements will then pay 20% of the Allowable Charge, but if the doctor charged 115% of the Allowable Charge then you are still on the hook for what is called the Excess Billing. Plan F covers that Excess Billing so you end with nothing out of pocket. Naturally, Plan F has carried a higher premium than other supplements but many people felt that the additional monthly cost was well worth the confidence of knowing that their doctor bills would be covered 100%.

Unfortunately, in 2015 Congress passed the Medicare Access and Chip Reauthorization Act (MACRA) which takes aim at Plan F as well as the less popular Plan C. In their “wisdom”, Congress decided that people who faced no out of pocket cost when visiting the doctor would simply be running to the doctor for every little sneeze or splinter and running up the costs to Medicare. Now, I don’t know about you, but going to the doctor’s office is not high on my list of social options regardless of the cost. Nevertheless, from the protective bubble that exists around Washington, DC, that’s how our elected representatives see it. So, within MACRA is a new rule that forbids the sale of any Medicare Supplement plan from paying the Part B Deductible after January 1, 2020.

No need to panic if you happen to have a Plan F because the new law allows anyone who has such a plan prior to the cutoff date to keep their plan. However, that option may have its own problems as well. In the insurance business, history has shown us that any time a health insurance plan stops accepting new (healthy!) enrollees, then the claims tend to rise above normal expectations as the remaining enrollees get older and sicker. When that happens, premiums tend to rise more than would be typical based simply upon the increasing cost of medical care overall. While no company representatives I have talked to expect the increases to be immediate, within four to five years they all anticipate Plan F renewal premiums to increase faster than other plans.

For new Medicare enrollees, and for those already on Medicare looking to switch plans, there is a very good alternative. Plan G pays those Excess Charges just like Plan F, but it does not pay the Plan B Deductible so it is not affected by the MACRA rule. As a bonus, some of my clients are finding that the premium savings for Plan G versus Plan F are more than enough to cover the Part B Deductible. Let’s look at the numbers.

The Part B Deductible for 2017 is $183, so the math is pretty simple. If, for instance, a Plan G will save you $20 per month over a Plan F ($240 per year) then you are saving more than the deductible and are money ahead. The only caveat is that the Part B Deductible usually increases each year. In 2016 it was $166, so it increased about 10% for the current year. It is conceivable that the deductible could reach $240 in another three years if that increase is stable. Personally, I would want to see no less than $100 per year in savings to give me at least a few years’ cushion if that was my sole reason for selecting a Plan G today. However, as noted above, the premium savings today might not be the sole reason if you also consider what will probably happen to Plan F premiums after 2020.

The death of Plan F is certainly not the end of the world with regard to Medicare Supplements, but it is important to be aware of the upcoming change so that you won’t be taken by surprise. You can find more information about Medicare Supplements for Idaho Seniors by clicking here to visit our page devoted to that topic.


Some Seniors Refusing Needed Care at Home

According to a recent article from Kaiser Health News, some seniors are refusing important medical care at home. Sometimes this is because of pride in independent living but sometimes it is because they are confused about what “home health care” is and whether or not insurance covers it.

Home Health Care is not the same as Home Care but, unfortunately, the terms are often used interchangeably and that is confusing. Home Health Care means your doctor has prescribed home health care involving intermittent skilled nursing care, physical therapy, speech-language pathology or continued occupational therapy. These services are paid by Medicare although you may be responsible for a portion of the bill for some equipment like wheelchairs, walkers, and oxygen equipment.

Home Care, on the other hand, generally refers to 24-hour a day care at home, meals delivered to your home and homemaker services like laundry, shopping, and cleaning. Home Care also includes help with Activities of Daily Living (ADL) such as bathing, dressing and using the bathroom when this is the only care you need. These Home Care services are normally not covered by Medicare, and unfortunately, this is where confusion can occur.

To understand what Home Health Care is and how Medicare defines it, be sure to download this free publication from the Center for Medicare/Medicaid Services (CMS).

When Home Health Care is advised after a hospital stay, some seniors refuse the care mistakenly thinking that it is not covered by Medicare and they are concerned that they cannot afford to pay out of pocket. In these cases, important follow-up treatment is not received and medical complications can result.

If you get your medical services through a Medicare Health Plan (such as a Medicare Advantage Plan), be sure to check your Summary of Benefits to see how Home Health Care is covered under that plan as it may be different than how Traditional Medicare covers it.

If you or someone you know is offered Home Health Care, be sure to discuss the options in detail with your doctor. Make sure you understand what is covered by Medicare and what is not. It is important that critical follow-up care is received to make sure that complete recovery occurs.


Seniors and Mental Illness

Older man in cafeThe month of May is Mental Health Month so it is very appropriate that we talk about mental illness as it relates to seniors. The National Council on Aging (NCOA) reports that one in four older Americans will experience some form of mental illness so this is not some rare occurrence we are talking about. Contrary to some negative stereotypes, it is not a normal part of aging to feel lonelier or more unhappy as people get older.

In an article published on May 4, the NCOA discussed the two major areas of concern: anxiety and depression. No one should have to suffer under the assumption that nothing can be done or that help is not available. If you or someone you know exhibits symptoms of anxiety or depression, it is important to seek help immediately.

There are many symptoms and diagnoses for anxiety. It is important not to “self-diagnose” any illness, but some symptoms to be on the alert for are panic attacks, nightmares, phobias or chronic worry about everyday activities. The nonprofit organization Mental Health America (MHA) has developed a free, anonymous online screening tool for anxiety. To be clear, this is not the same as a medical diagnosis, but some may find it helpful to use the screening results to start a conversation with their own physician.

Depression can also take many forms. You may notice in yourself or others symptoms such as poor sleep, extended periods of sadness, loss of enjoyment in everyday activities or loss of energy. Many articles have been written about depression creating a greater risk for suicide, but depression can also lead to an overall lower quality of life and even to physical health problems. Here again, MHA has developed an online screening tool for depression that people may find helpful in determining to seek professional help.

For people over 65, Medicare helps cover a wide range of mental health services including tests and visits with a physician, psychiatrist or social worker. Part D coverage can also help cover the costs of many medications prescribed to treat mental illness.

Although the month of May is designated as a time for heightened awareness of mental illness in our country, we should always be on the alert for symptoms in ourselves and in those we love. The stigma of the words “mental illness” have often caused people to avoid even discussing the issue. Just as with any other health issue, you should never hesitate to discuss your concerns with your family or you personal physician.


Beware of “Observational Care” in Medicare

Many people on Medicare are getting surprised by big bills after what they thought was an in-patient hospital stay. What they are discovering is a situation known as Observational Care. This is a weird occurrence that is happening due to certain Medicare rules.

Under Medicare, in order for your doctor to admit you to the hospital, he or she must verify that your condition requires at least two days (known as the “two midnights” rule) in the hospital. If the doctor is not certain but feels you are too sick to go home, then you may still stay at the hospital under “observational care”. In this case you are considered too sick to go home but not sick enough to be admitted to the hospital. Yes, it sounds odd and it is.

In this circumstance, you may not only be observed, buy may also receive short-term treatment and tests. The key, with regard to Medicare, is that since you are not an inpatient, the costs are considered outpatient care which is paid at a different rate under Part B of Medicare instead of Part A. Depending on your Supplement or Medicare Advantage plan, you may be looking at significantly higher copays and coinsurance than you would if it were actually a hospital stay.

In addition, any days spent in Observational Care do not count toward the three days (three-midnight rule) hospitalization necessary to make a stay in a Skilled Nursing Facility eligible for Medicare coverage. That can be a huge surprise if you end up having to pay out of pocket for a few days recuperating in such a facility.

Because many people were unaware of the difference between being an in-patient and observational status, the US Congress did take some action. Now a person must be notified within 36 hours of being under observational care that this is their status and what the ramifications of that status might be.

As always, you are your own best advocate. If you find yourself headed to the hospital under your doctor’s direction, make sure you know whether it is as an in-patient or for observational purposes. The difference can be expensive!


Seniors and Traveling Abroad

Now that you’ve ditched that 9-5 job, you’ve pulled out the Bucket List and found foreign destinations on the agenda. Excellent! In addition to checking Expedia and those cruise line brochures. the US Department of State’s Bureau of Consular Affairs has a few tips for you. On their website they have an article appropriately titled “Considerations for Older Travelers“.

While I recommend taking the time to read the entire publication, here are some highlights to remember.

  • Travel Documents: Make sure they are all correct and up to date. Make sure your passport will be valid for 6 months beyond the end of your trip or some countries may not let you enter.
  • Sign up for the State Departments “Smart Traveler Enrollment Program” where your itinerary and contact information is stored securely. This allows the embassy or consulate to contact you in case of an emergency or a security situation.
  • The State Department reminds you that Medicare does not cover you out of the US and recommends that you obtain travel insurance. You can start on that project by visiting our Travel Insurance page right here on this website.
  • Medications: Be sure to take an adequate supply of your prescriptions and leave them in the original, labeled container to avoid problems at customs. Also, know the generic name for your drugs as the generic may be more likely known in a foreign country.
  • Financial: Be sure to know the currency of the countries you are visiting and whether you should convert prior to entering the country. Also, make sure your credit cards will be accepted where you are traveling. Finally, check the State Department’s “Country Information” page to learn about any ATM scams or other financial scams that might target US visitors.

You’ve probably spent years saving and planning for these trips so it only makes sense to be prepared. Do a little homework and plan on having the time of your life!

Changing Medigap Plans? Be Careful!

Shopping for Medigap PlansSo you have had your Medigap (Medicare Supplement) Plan for several years, the price has gone up and you’re thinking of switching. No problem there, but keep a few things in mind to avoid shooting yourself in the foot.

First, recognize that almost all plans have rate increases. It is important to compare your plan to others to see if the increase is reasonable. If you feel it is not, then go ahead and shop around. I suggest using an agent that specializes in Medicare products but you can certainly do it on your own.

Make sure you are comparing similar plans. This is easy with Medigap Plans because the federal government began requiring companies to standardize their plans many years ago. If you have a Plan F, then a Plan F from another company will be the same in all major respects. It doesn’t hurt to check a company’s AM Best rating just to see how it compares to others. Certainly, you want a financially sound company backing up your plan.

Most importantly, remember that Medigap Plans are medically underwritten if you are not in your Open Enrollment Period or in a Guaranteed Issue situation. This means that the company can take a look at your current health situation and legally decline to offer you coverage. Most applications have “key” questions that clearly state that a “Yes” answer disqualifies you for coverage. But even if you answer none of those questions positively, you may still be declined.

Even if your application seems to be perfect, never — and I repeat here NEVER — discontinue your current Medigap Plan until you have the new policy and ID cards in your hands. I say this even if it means that you pay two premiums in the same month while you wait for approval. The reason should be obvious. If you cancel your current plan, then two weeks later receive a declination from the new company, you have NO Medigap Plan.

So, shop wisely, purchase carefully and if you need help call me at (208) 263-2194 or fill out the Contact Form.

Will Trump Change Medicare?

As the Trump presidency looms ahead of us, it is important for those of us either on Medicare or soon to be to take a look at what the new administration may bring to Medicare. Although there are many possibilities, there are a couple of areas worth considering.

Republicans, and the President-Elect, have vowed to repeal the Affordable Care Act (ACA), also known as Obamacare. No one has yet offered a specific plan for replacing the program and there are differing opinions within the party whether to keep some of the ACA’s more popular provisions or throw the whole thing out. What does that have to do with Medicare? Plenty! Within the ACA are several provisions that directly impact the Medicare system. Despite the fact that candidate Trump campaigned on promises to keep Medicare intact, the fact is that the repeal of the ACA will severely damage Medicare.

The ACA included provisions that strengthen Medicare by reducing its costs and increasing its revenue. These include reducing Medicare payments to providers, increasing revenue with higher taxes on high income individuals, closing the “doughnut hole” in the Part D Drug Coverage and much more. For a more thorough discussion, see this article from the non-partisan Kaiser Family Foundation. The bottom line is that if all of these provisions are repealed along with the ACA, the Congressional Budget Office estimates the additional cost to the Medicare program over the next 10 years will be $802 Billion! Yes, BILLION!.

How will that additional cost impact Medicare Beneficiaries? Higher Part A and Part B deductibles, higher premiums on Part B, higher premiums for Medicare Advantage plans, higher out of pocket costs for medical services and more.

A second area of concern is that House Speaker Paul Ryan has long advocated for the privatization of Medicare. Until now, he has not had the support in Congress to push it through. But with a Republican controlled House, Senate and now the White House, things are different. Ryan indicated in a recent Fox News interview that he is now ready to move ahead with his plan. Ryan continues to justify his plan by stating that Obamacare is causing Medicare to go broke. That is at complete odds with the Congressional Budget Office that, as indicated above, has already determined that the repeal of the ACA will cost Medicare nearly a Trillion Dollars.

Under Ryan’s plan, a person on Medicare would receive a voucher for a certain amount and would apply the funds (premium support) toward a private insurance plan. Supposedly, those on Medicare currently could continue with the plan. There is some doubt however, about the future of traditional Medicare if that happened. With no more new people coming into the program, those in it would become older and sicker and the program would probably go broke quickly. So much for being “allowed” to stay on original Medicare!

It is important to understand the strategy of the incoming administration and to pay attention to all proposals submitted. If there is an attempt to gut Medicare, rest assured that it will be sugar coated and quite possibly tucked away inside some other legislation. It is important for every beneficiary who depends on Medicare to be alert and let your elected representatives know how you feel about Medicare. There are those who believe that if Ryan and others in the GOP have their way, Medicare as we know it could be gone by next Thanksgiving.

Introducing Idaho Senior Insurance

Medicare Insurance Products

I am pleased to be able to launch my new website, Facebook page, and Twitter feed for Idaho Senior Insurance products for Medicare beneficiaries. While the introduction of these new media sites marks a significant change in my insurance practice, it is important to note first what is not changing:

  • I still work for North Idaho Insurance, an office of Alliant Insurance Services, Inc.
  • North Idaho Insurance still offers a full spectrum of insurance products for Business, Commercial, Auto and Home needs. In fact, our agency just moved into more modern and spacious offices at 509 N 5th Ave Ste H, in Sandpoint and added another experienced agent to handle the growth of the agency.

So, what is changing?

  • I am now concentrating my personal practice on Senior Insurance products such as Medicare Supplements, Advantage and Drug plans, Final Expense plans and Dental and Vision plans.
  • I will continue to service all of our agency’s individual and group health and life clients as well.
  • By focusing on just one area of insurance, a pleasant side effect is that I will usually be able to work less than 5 days per week.

Over the years many of my clients have found the area of Senior Insurance products to be confusing and intimidating. Unfortunately I was unable to devote the time necessary to expand this part of the agency as long as I was also committed full-time to our Commercial and Personal Lines products as well.

Now, by concentrating solely on this area, I have been able to take on the additional companies and products needed to offer my clients the widest choice of plans and pricing available. In addition to companies I have long represented such as Blue Cross, Regence, Bridgespan and Delta, I have now taken on Senior Insurance industry leaders like Humana, Aetna, Security Life, PacificSource and Transamerica, among others.

So if you are a Senior (like me!) and need to review your coverage, or you happen to be approaching that landmark Medicare age of 65, be sure to phone me for an appointment at (208) 263-2194 or submit the Contact Form.

For over 30 years I have enjoyed helping people find solutions to their insurance needs and I look forward to continuing that process with this new area of specialization.