Updated Medicare Advantage Guidelines

There are specific times of the year when you can enroll, disenroll, or switch from a Medicare Advantage Plan, also called Part C or MA Plans. These plans are sold by private insurance companies that are approved by Medicare. If you miss these enrollment periods, it may be hard to make changes to your coverage, or enroll in a new plan.

Initial Coverage Election Period (ICEP)

The Initial Coverage Election Period is when you are first eligible to enroll in a Medicare Advantage Plan. For most people eligibility begins when they turn 65. You are allowed to enroll anytime over a 7 month period. This 7 month period starts 3 months before you turn 65 and ends 3 months after your birthday month. This means if your 65th birthday is in May you have the ability to sign up from February through August.

The initial enrollment period is when you are eligible for Part A and Part B. If you delay enrolling in Part B, then your ICEP for Medicare Advantage will not take place until you enroll.

To be eligible you must:

  •         Have Medicare Part A and Part B
  •         Permanently reside in the service area of the Medicare Advantage plan
  •         Not have End-Stage Renal Disease (ESRD)

If you missed or did not utilize the ICEP, you can still join a Medicare Advantage plan during two other periods:

  1.    Annual Enrollment Period (AEP)

The Annual Enrollment Period occurs every year from October 15 through December 7, with coverage beginning January 1. This period is also referred to as the Fall Open Enrollment. During this period, people who are eligible can enroll in a Medicare Advantage plan. You can also switch plans and add, drop or change prescription drug coverage during the AEP.

  1.    Special Enrollment Period (SEP)

A Special Enrollment Period is a period when beneficiaries can enroll, or make changes to their Medicare Advantage plan outside of regular enrollment periods. If you qualify and get granted an SEP, your coverage will start the first of the month after you sign up. Certain situations are required to be eligible for a SEP, such as:

  •         Moving out of your plan’s service area
  •         Having full Medicaid coverage and Medicare
  •         Qualifying for a low-income subsidy program
  •         Tricked or misled into joining a plan
  •         Living in a nursing home, rehab hospital, or skilled nursing facility
  •         Enrolled in a State Pharmaceutical Assistance Program, or lose SPAP eligibility
  •         Joining a Medicare Advantage plan during your initial enrollment period when you turned 65. The first year is considered a trial period, so you can change to Original Medicare at any time within the 12 months.
  •         Receiving Extra Help to pay for your prescription drugs

In order to enroll in a Special Enrollment Period, you must apply and provide the necessary proof regarding the qualifying situation.

  1.    5-Star SEP

During the 5-star special election period, you can switch to a 5-star Medicare Advantage Plan from December 8 through November 30. The plan will go into effect beginning December 1. It is important to know that you can only use this SEP once per calendar year. After receiving your application, you will begin coverage the first day of the following month. To be eligible, you have to have Medicare Part A and B, and live in the service area.

What you can do during this period is:

  •         Drop Original Medicare and enroll in a 5-star Medicare Advantage plan.
  •         Switch from any Medicare Advantage plan to a 5-star Medicare Advantage plan.
  •         Switch from a 5-star Medicare Advantage plan to a different 5-star Medicare Advantage plan.

Medicare star ratings are updated every fall on Medicare.gov.

Medicare Advantage Disenrollment Period (MADP)

Another different kind of enrollment period is the Medicare Advantage Disenrollment Period. This period occurs from January 1, to February 14 every year. This is when you can drop your current Medicare Advantage plan and switch to Original Medicare with or without adding a stand-alone Medicare drug plan (Part D). You cannot enroll in a Medicare Advantage plan, or switch to another Medicare Advantage Plan during this period, only drop a MA plan.

Shopping around will help you save money while finding a plan that best suits your needs. Research has shown that people with Medicare Advantage Plans could lower their costs just by shopping plans every year. EZ.Insure can help you shop around and compare different Medicare Advantage plans in your area. You can speak to one of our agent’s one on one without any hassle or obligation. To get started, just call 855-220-1144, email at replies@ez.insure, or simply put your zip code in the bar below to get quotes. The process of choosing a plan or signing up should not be difficult, make easy for you.

Double Check Your 2018 Information Now!

When enrolled in a Marketplace Insurance plan, it is important to make sure your household information is up to date every year. There may be benefits you are missing out on and possible consequences if you do not update.

What Changes To Report

  •         Changes to your income for the year, whether a raise or demotion
  •         Changes in health coverage: Whether someone in the household is getting job-based insurance, and/or receiving public coverage such as Medicaid, CHIP, or Medicare. Also, if someone is losing coverage that is job-based or public.
  •         Changes to your household or individual members:  If there is a birth or adoption, placement of a child for adoption or foster care. If someone becomes pregnant, and/or getting married or divorced. Child turning 26 years old. If there is a death, gaining or losing a dependent, and if you are moving to a permanent address.
  •         Make sure names, date of births, and Social Security numbers are correct
  •         Changes in status: Such as disability status, tax filing status, change in citizenship, whether there is American Indian member, and/or incarceration or released from incarceration.

Why You Should Report The Changes

If your income goes down or you gain a household member, then you may qualify for more saving than you are currently receiving. This can lower your monthly premium payments.

The flip side is if your income goes up or you lose a household member, then you could qualify for fewer savings. If you do not report this change, it will result in owing money when you file your federal tax return.

How To Update

Who you will contact for help is dependent on whether you got your plan from the Marketplace, or from a provider such as EZ.Insure. If you got a plan from one of our agents, you can always call 855-220-1144, or email us at replies@ez.insure to speak to your agent and update your information.

  •         You can report any change by updating your application online after logging into your account on Healthcare.gov. Click on your application, choose “report a life change,” and then save it when done.
  •         Contact a representative at the Marketplace Call Center at 1-800-318-2596. Or call your advisor at EZ.Insure.
  •         If you move to a different state, log onto your account in HealthCare.gov, select a new application; select the year for coverage, and the new state. Finally, choose “apply or renew” to start a new application.
  •         If you are switching to a job-based insurance plan, or to Medicare, make sure to cancel your current plan.

Do not forget to update your 2018 information, because it can cost you in the end when you file your federal tax return. And more importantly, you can possibly lose out on extra savings you should be receiving!

If you are looking for a new plan or have questions regarding your coverage, EZ.Insure can help. Our agents specialize in short term plans in your area and can answer any questions you have to find out if it is right for you. You will be given your own advisor who will go over different plans, and help sign you up free of charge. To start saving, enter your zip code in the bar above to get instant quotes, email us at replies@ez.insure, or call 855-220-1144. We guarantee we will be able to find you a plan that is affordable and meets your needs.

Trump Takes Action on Lowering Medicare Drug Prices

Medicare drug prices continue to increase making it harder for seniors to afford, President Trump decided to take action. Trump proposed a plan to bring down the prices of Medicare drugs by giving back to customers and focusing on raising foreign drug prices.

The federal government is not allowed to negotiate Medicare drug prices, so Trump said his plan will work without needing Congress’ approval. Insurers get discounts for the expensive name brand drugs, which are negotiated by pharmacy managers. Trump wants these rebates and discount distributed to the customers, which would help lower the prices. President Trump’s plan is to give at least one-third of the rebates to beneficiaries.

Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, stated that the rebates are a “convoluted system,” because they allow manufacturers to raise list prices. This, in turn, increases the amount of money that insurers and pharmacy benefit managers collect in rebates, giving them no incentive to keep prices down.

“When prices go up, patient cost-sharing also goes up,” she said in a speech before the American Hospital Association earlier this week. “We’ve all noticed the increase in the amount we have to pay at the pharmacy counter. For seniors who are sometimes on fixed incomes, the pain is real. This is not acceptable.”

The Trump administration wants to raise the prices of foreign drugs in order to reduce the drug prices at home. The reasoning for this is because foreign places keep their prices low while Americans continue to pay highly for their drugs. The foreign countries benefit from America paying high prices for these drugs and essentially their development. “The United States both conducts and finances much of the biopharmaceutical innovation that the world depends on, allowing foreign governments to enjoy bargain prices for such innovations,” the council’s report said. “Simply put, other nations are free-riding, or taking unfair advantage of the United States’ progress in this area.”

The Food & Drug Administration is focusing on trying to introduce more generic drugs that are identical to name brand drugs. This way customers can opt to buy the generic brand and save some money. The agency is hoping that by producing more generic drugs will increase competition and eventually bring down the pricing of brand-name drugs.

Seniors have been struggling to obtain the medications they need due to how expensive they are. Some have to make drastic changes in order to get these medications because they can die without them. There are still talks amongst the Trump administration about reducing Medicare drug prices and they are hoping to make some positive changes in 2019.

Republican Tax Bill Cuts 25 Billion From Medicare

The GOP tax bill that the Republicans have been working on, can lead to major cuts in Medicare funding and spending in 2018. The bill is estimated to cut $25 billion from Medicare starting 2018, and resulting in $400 billion over the next ten years.

The Congressional Office has estimated a $1.5 trillion deficit to over the next 10 years due to the tax bill.

In 2010, Washington passed a “pay as you go” rule which requires any new laws to be deficit neutral. Basically if there is not enough economic growth to balance the money lost, then the Office of Management and Budget has to cut spending. Unfortunately, it is likely that one of the spending cuts will be to Medicare.

The tax bill is expected to pass, and while it does not exactly say that it will cut spending on Medicare, it will be an unintended result. Some Republicans stated that the cuts would affect doctors, health providers, and hospitals, not Medicare beneficiaries. They have also had talks to try and change the Medicare eligibility age from 65 to 67.

House Speaker Paul Ryan seems to threaten cuts to Medicare saying “we’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit. I think the President is understanding choice and competition works everywhere, especially in Medicare.”

A major issue with the possible cuts is that Medicare beneficiaries could end up being kicked off of their current Medicare plan, or receive fewer benefits.

Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation says,“these cuts could be one bad side effect of this tax legislation. Many providers may be able to absorb the payment reductions if they have a very diverse patient base. But others who rely primarily on Medicare may find this cut really difficult to deal with.”

Roughly 54 million Americans currently receive Medicare benefits. Many fear the cuts will leave many Americans without coverage or unattainable expense to have coverage. However, McCarthy claims lawmakers will find a way to avoid the Medicare tax cuts. The tax bill is expected to be voted on in early January, when we will begin to see the effects of the bill.

U.S. Government Proposes 1.84% Increase in 2018 Payments to Medicare Insurers

The US government and the Centers for Medicare and Medicaid Services, CMS, have proposed an increase in Medicare Advantage payment rates. The increase will be an average of 1.84 percent. This increase is up from the 0.45% that plans got last year from the government. Health insurers will receive these payments to help benefit the seniors eligible for Medicare.
The CMS stated that the average Medicare Advantage payment rate will increase by 3.1% after factoring in how members’ diagnoses are coded by health plans. This makes the increase 2.95% from last year.

Medicare Advantage enrollment data by the CMS shows a growth in medicare advantage enrollees of 9%, nearly 20.9 million in 2018. The estimate is that more than one-third of all Medicare enrollees, or 34%, will enroll in a Medicare Advantage plan.

The percentage insurers receive affects how much they will charge for their premiums and benefits. This percentage also reflects how much these insurance companies will profit. The government pays this percentage to these insurers in order to cover their member’s healthcare costs. So if the insurance companies do not get much of the percentage, then the member’s will not receive as much towards their healthcare costs. This means that the healthcare member will be charged more by their insurer, and have to pay more out of pocket.

With such a large percentage payment proposal coming in 2019, insurers will be able to provide more to their members. Benefits will be extended to their customers to include things like wheelchair ramps and other assistive devices in order to help reduce the effects of major health conditions. These benefits are hoped to help the customers live a more comfortable life and prevent conditions from worsening.

The CMS conducts Risk Adjustment Factors on a regular basis in order to keep track of their enrolled beneficiaries and their needs. These risk factors take part in how they pay for plans based on the beneficiaires needs, so that they can make the exact payments for enrollees with differences in expected costs. The risk adjustment allows the CMS to use bids as a base payment to plans. According to the CMS, the payment increase is based on better use of encounter data, which is information about the care that a beneficiary got from a provider. With this data, they can determine risk scores for plans.

The risk scores for 2019 will be based 75% on fee-for-service data, and 25% based on encounter data. The scoring was based on 85% on fee-for-service data and 15% encounter data in 2018.

The CMS states the payment increase will promote stability and the resources needed to support beneficiaries. “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma.
Medicare Advantage has always competed with the traditional Medicare fee-for-service program. But due to the “baby boomer” generation, has increased enrollment in both Medicare and Medicare Advantage. In fact, Medicare Advantage enrollment is at an all-time high right now and continues to gain popularity with high satisfaction ratings.

If you would like to find out more about this increase and how it will impact you, EZ.Insure will be more than happy to help. One of our highly trained agents that specialize in your region will help you with all of your Medicare needs. You will be provided with your own personal advisor free of charge to guide you through the shopping process. To get started contact us by email at replies@ez.insure or call 855-220-1144. You can also get an instant quote by entering your zip code in the bar above, it’s that easy.

Five Ways To Get Better Health Plans At Lower Costs

Five Ways To Get Better Health Plans At Lower CostsHealth insurance premiums and deductibles can become costly, and continuously go u p every year depending on the plan. There are ways to help ease the burden of a high premium/deductible plan that is cost-effective while receiving the medical services you need.

Compare Plans

More than 90% of people end up not looking into their plan for the following year and renew last year’s plan by default. Not researching this can cost you greatly into the following year because your monthly premiums can increase, and/or what is covered can be changed.

Shopping around is probably the most important way you can save money. Prices can vary from not only plan to plan but from provider to provider. This is why it is important to not only shop around for price, but for the quality of services, and coverage also.

Plans with low premiums will have higher out-of-pocket expenses like deductibles and copays. These plans are more sensible for people who did not come close to meeting their deductible. Then there are plans with a higher premium and lower deductible that would be more sensible if you meet your deductible quickly.

Comparing plans with one company makes it easier. Every agency will give you the same plans, so EZ.Insure shows you all of your options in one place!

Shopping around and comparing different insurers and plans can become time-consuming, unappealing, and strenuous. EZ.Insure does all the work for you with our highly trained agents that specialize in your region. Your advisor will do the work for you and even sign you up for a plan that matches your criteria for coverage and price, all at no cost to you.

Use What’s Free

Free preventative care services are offered at no charge as long as you are within your insurance network. There are a lot of no-cost routine services to keep you healthy and catch problems early on before it becomes serious. Colonoscopies, mammograms, vaccinations, depression screenings are all free in insurance plans. Many people are unaware of these free services and thus avoided preventative tests. Make sure to go to the doctor and use these free services to stay healthy and prevent serious health issues and expenses later.

Choose Your Doctor

Make sure you choose a doctor that works with your plan. Some offices cost more than others, and some only accept a certain percentage of benefits!

A primary doctor can help you save money, which is why it is wise to do some homework an choose the right one. When you use a primary doctor who charges less then you can also find cheaper prices for outpatient services, specialist, and lab services. Talking to your doctor can lead to reliable information when it comes to quality care at a reasonable price. Your doctor can offer ideas on how to save money and help you find/refer you to less expensive prescription drugs, or diagnostic tests.

Avoid Unnecessary Bills

When talking to your doctor, there are questions to be sure to ask about medical tests and treatments that are overused. Many of them might waste your money. Some people choose to go to the hospital for an MRI or lab work which ends up costing you. Try to utilize Lab Corp or Quest Diagnostic independent labs to avoid high costs.  Hospitals will charge you double the cost of an independent provider.

Leverage Tax Breaks

Putting money into a health savings account (HSA) will help with high out-of-pocket medical costs. The account will let you put aside tax-free money to cover your medical costs. HSA allows you to put up to $3,400 for individuals and $6,750 for families within a year. You can use the money to pay for your deductible and other qualified medical expenses, and whatever you do not use will roll over into the following year tax-free.

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