Medicare is an essential program for seniors over 65, however, many of its benefits are underutilized or misunderstood. Consider the annual “wellness” visit. During which a physician will assess your health risks, take your blood pressure and other routine measurements, test for cognitive impairment, and provide personalized health advice. It’s Free! Nonetheless, a surprising number of people do not take advantage of this benefit. This isn’t the only benefit that has gone under the radar. Many healthy seniors ignore a variety of free preventive services, ranging from bone density screening to cancer detection. Other benefits such as home health care, are also frequently unused due to their strict eligibility requirements. Below you’ll find all the ways to make sure you’re using all of your benefits and getting your money’s worth.
Choose The Right Doctor
It is important to choose a doctor who accepts Medicare assignments in order to save money. If a doctor accepts a Medicare assignment, they accept Medicare-approved amounts as full payment, and you cannot be charged more. Most physicians who treat Medicare patients will accept Medicare assignments. Providers who don’t participate fall into two categories:
Non participating providers – These providers can charge up to 15% more than the Medicare approved amount for covered services and leave you responsible for the additional costs
Opt-out providers – These providers can charge whatever they want which is outlined in a private contract with the patient.
To locate physicians in your area who accept assignment, visit Medicare.gov to find doctors and other health professionals section. The search tool displays which physicians accept Medicare payments.
If you have a Medicare Advantage plan, check your plan’s provider directory or website to ensure you’re choosing doctors in the network. Keeping in mind that doctors may be added or removed at any time. Generally, you will pay more to see non-network providers. Make sure that you research different doctors. Confirm that they accept Medicare and are willing to educate you on what is and is not covered so that you are not overcharged.
Understand Your Policy
Medicare provides coverage for skilled services such as nursing, speech therapy, and physical therapy, but there are eligibility requirements. To qualify for these services, you must be homebound. Meaning you are unable to leave your home without assistance or because of a medical condition. Many seniors mistakenly believe that they are covered for these services, only to receive a hefty bill in the end. Before assuming something is covered, carefully read your policy’s guidelines.
Look Into Medicare Advantage
Medicare Advantage plans are offered by private insurance companies and offer the convenience of having Part A, Part B, and Part D services all bundled into one plan. Whereas traditional Medicare has you sign up for each plan individually. Medicare advantage plans may also include coverage for routine dental, vision, and hearing exams. Which are not available under Original Medicare. However, the biggest benefit of Medicare Advantage is the annual out-of-pocket maximums for seniors excluding
prescription drug plans. Which as of 2023 is $8,300. With Original Medicare, there are no annual out-of-pocket maximums.
However, you should also be aware of the disadvantages of Medicare Advantage. Original Medicare is widely accepted by physicians and hospitals all over the country. Whereas a Medicare Advantage plan will have a smaller network of providers. So, it’s possible that your doctor isn’t in their network. Next, you may be required to get a referral before seeing a specialist. Which is not the case for Original Medicare enrollees. There are also certain covered services that Parts A and B that may have a high copayment under a Medicare Advantage plan. Meaning you would have higher out-of-pocket costs with Medicare Advantage than you would with Original Medicare.
If you have a chronic or serious health condition and will likely visit the doctor frequently, you may want to consider a Medicare Supplement Plan. Medicare covers the majority of eligible medical expenses for seniors, but you are still responsible for 20%-25% of the total cost of care. Medicare Supplement Plans were designed to help cover a substantial portion of the medical expenses that come from having Medicare Part A and B, that you would otherwise be responsible for.
As with Part D, private insurers offer Medicare Supplement Plans and with Part D, there are a variety of plans to choose from. So you should shop around carefully to find the plan that fits you best. While yes, Medicare Supplement Plans do have premiums and can increase your monthly expenses, the additional coverage could give you peace of mind and eliminate some of the uncertainty that comes with your out-of-pocket Medicare costs.
Save On Medications
Even if you have Medicare Part D prescription drug coverage, your out-of-pocket costs can be astronomical, in part because Part D does not have a limit for out-of-pocket expenses. After you reach the catastrophic coverage threshold of $7,400 (as of 2023), the majority of people will continue to have to pay 5% of the cost of covered drugs. In certain instances, you can reduce drug costs by forgoing your Part D plan and paying cash. Big-box stores such as Costco and Target offer a variety of generic prescriptions for much cheaper, whereas many Part D plans have a high standard copay to fill a prescription. The only problem with paying in cash and not using your coverage is that the expense won’t count towards your deductible.
If you stick with your Medicare Part D plan’s list of “preferred” pharmacies you will typically pay less for your prescriptions. Also most Part D plans separate their drug formularies (list of covered drugs) into 5 tiers: preferred generic, generic, preferred brands, non preferred, and specialty. With preferred generics being the lowest cost-sharing tier and the most affordable for enrollees. If you find a drug that is approved for your condition on a lower tier than the one you currently take, ask your doctor if you can switch to the more affordable one.
Review Your Quarterly Summary
Your quarterly Medicare summary displays services and supplies for which Medicare was billed. This summary will also indicate whether or not any claims have been denied; if so it is important to contact the provider of the denied claim. If you believe the claim is unjust, you can appeal the claim denial by following the instructions on the summary’s final page. When admitted to the hospital, for instance, you will receive a notice outlining your Medicare rights. You may request an appeal of the decision and a review of your case if you believe you were discharged prematurely.
Use Your Preventative Care
Many Medicare recipients don’t realize that there is a long list of services that they can get for free. Medicare provides numerous screenings and annual wellness visits at no cost to you. These free preventative measures are important for detecting serious illnesses early. The screenings may include depression, cardiovascular disease, and other conditions. There are free counseling sessions for tobacco and alcohol abuse, as well as free vaccinations for flu and pneumonia. Additionally, you are eligible for a free “welcome to Medicare” preventive visit within the first 12 months of receiving Medicare Part B. During this initial appointment, you can also receive free assistance planning for end-of-life care. And your physician can help you draft an advance directive that outlines all of your wishes.
Utilizing these freebies can aid doctors in detecting major health problems before they worsen, thereby preserving your health. You might also have access to free wellness benefits if you have a Medicare Advantage plan. Some Advantage plans, for instance, include SilverSneakers membership at no extra charge. This program provides a basic gym membership and access to senior-specific group exercise classes.
Plan Yearly Expenses With The Out-Of-Pocket Maximum In Mind
Individuals’ Medicare costs can vary widely based on their circumstances and the type of coverage they have. Original Medicare typically covers 80% of a beneficiary’s Part A and Part B expenses. Such as doctor visits, hospital stays, and lab work. Individuals are responsible for remaining 20% of out-of-pocket costs, with no annual cap. Medicare Advantage plans offer predictable copayments and an annual limit on out-of-pocket costs. Once you reach your plan’s out-of-pocket maximum, all Medicare-covered services for the remainder of the year are covered in full. This cap can provide peace of mind if you have a sudden illness or are preparing for a major medical procedure.
Shop Around Every Year
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), is relatively simple. There is no need to shop around for Parts A or B because they come in a universal package. Where you should shop around is your Medicare Part D plan and your Medicare Supplement Plans. Medicare contracts with private insurance companies that offer Part D and Medicare Supplement Plans to provide seniors with a variety of coverage options. Moreover, these coverage options and their costs can change from year to year. This means that the plan you have this year might not be the best for you next year. The worst thing you can do is automatically enroll in your previous year’s plan without comparing options. This could result in higher out-of-pocket costs and for Part D could mean less coverage for prescription medications.
Get Help From EZ
If you’re looking for a Medicare Supplement Plan or Medicare Advantage Plan, you must compare the costs and benefits of each. This requires extensive research. Which can be time-consuming, as you will need to contact multiple insurance companies to obtain rate quotes. However, if you work with one of EZ’s agents, you can compare prices in half the time. Working with a licensed agent provides you with access to a variety of carriers and plans.
In addition to providing price comparisons, your agent can explain the differences between each plan. And explain the differences between each plan. In addition, your agent can assist you in determining which plan will be the most cost-effective for you in the long run by comparing out-of-pocket costs and premium costs. Call us today at 877-670-3601 or enter your zip code in the bar below to begin comparing.
When President Trump took office, one of his campaign promises was to get rid of Obamacare also known as the Affordable Care Act (ACA), and replace it with new health care. Trump delivered on this campaign promise, providing Americans with Trumpcare, also known as the American Health Care Act (AHCA). Trumpcare was voted on, and passed in the House on May 4, 2017. Since being passed, the number of Americans getting health insurance has gone up by 7 million. There are some similarities between Obamacare and Trumpcare. So why have Americans been signing up for insurance more now with Trumpcare?
Since Trumpcare was introduced, more Americans have been signing up for health insurance.
Short Term Plans
Short term plans used to have limitations of 3 months. As of October 1st, 2018, the short term health plans have a one-year policy term. Short term health insurance provides fast, flexible insurance with many benefits. You may pick your deductible amount from many options. You are also able to drop coverage without a penalty for a long term insurance option. Premiums are lower than ACA health insurance plans, and you get coverage as soon as a day after applying.
Once someone signs up for a one-year short term plan, they may potentially renew it for up to three years. Insurers can ask medical questions and possibly reject consumers due to pre-existing conditions for a short-term policy. Once approved for the plan, if a consumer develops a ‘pre-existing condition’, rejection can occur during the renewal process
Individual Mandate
Obamacare enforced an individual mandate penalty for Americans who did not have insurance. The individual mandate was the requirement of people to obtain health insurance for the year, and if not then you had to pay a penalty during tax season. In December 2017, President Trump eliminated the individual mandate from Obamacare. Trump did away with the individual mandate because Republicans believed it discouraged people from buying insurance that costs just as much as the uninsured penalty.
Pre-existing Conditions
Like Obamacare, Trumpcare protects people with pre-existing conditions. People who stay insured, without a gap in coverage, will not pay a price for health insurance based on pre-existing conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. However, Trumpcare has given the states authority to change the pricing for people who do not stay insured
Pre-existing conditions are covered under Trumpcare, but people with them may have to pay more.
year round. In other words, once you choose to be uninsured, and stay uninsured for an extended period of time, you will face a higher rate for health insurance due to your pre-existing conditions.
Federal Invisible Risk Sharing Program
Trumpcare created the Federal Invisible Risk Sharing Program. It is a pool of funds the government sets aside to assist insurance companies in covering people with high expenses (people with pre-existing conditions). The risk pools are invisible to the customer. This means that high medical cost individuals would not know they’re in the risk pool. They are expected to pay the same cost for insurance as healthy people.
Trumpcare does exist, and has been slowly replacing Obamacare. Getting rid of the individual mandate, and extending short term plan’s length has been Trumpcare’s biggest changes, and main focus. These changes were made in hopes of getting more Americans to sign up for insurance, because the more that people sign up (especially healthy people), then the lower the insurance costs will be. Since more Americans have been signing up for health insurance, hopefully the costs will begin to go down.
Since President Trump and the Department of Health and Human Services cut cost-sharing reductions in October, some states have brought a lawsuit against the government. The lawsuit centers on the loss of federal funding, which jeopardizes basic health programs.
The Basic Health Program offers an alternative coverage plan for people with household incomes between 133 and 200 percent of the federal poverty level. The ACA included this as an option to make coverage more affordable. New York and Minnesota were the two states in which these programs were offered in order to provide a “standard plan” for those who didn’t qualify for employer coverage or other government programs. It is estimated that they offer comprehensive coverage for more than 800,000 low-income people.
The attorneys general of New York and Minnesota filed the suit against the government for over $1 billion a year lost from funding the basic health programs. The two states estimate that New York will get about $1 billion less funding in 2018 to run its Essential Plan, and Minnesota will get about $130 million less to run MinnesotaCare.
“The abrupt decision to cut these vital funds is a cruel and reckless assault on New York’s families — and we will not allow it,” state Attorney General Eric Schneiderman said in a statement trumpeting the suit. “I won’t stand by as the federal government continues to renege on its most basic obligations in a transparent attempt to dismantle the Affordable Care Act.”
“For each dollar Minnesota sends to Washington, D.C., we get just 53 cents back,” Minnesota Attorney General Lori Swanson said in a statement. “This lawsuit seeks to avoid Minnesota losing hundreds of millions of dollars of payments in the coming years.”
The administration told the states it would stop paying the “cost-sharing reductions component” of the basic health program funding, but continue to pay premium tax credits.
The two states have submitted proposals to restore the funding, but the Department of Health and Human Services failed to answer, and never considered the proposals. Because of this, the two states are asking a judge to intervene in order to force the government to pay the full federal funding.
The fear amongst the two states is that if the federal funding is not restored, and then costs will rise and coverage will shrink. “It could trigger major changes to the eligibility structure, the benefits or increases in premiums,” says Maureen O’Connell, president of Health Access MN, which helps people enroll in marketplace coverage.
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 [email protected] 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 [email protected], or call 855-220-1144. We guarantee we will be able to find you a plan that is affordable and meets your needs.
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.
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.
cost-sharing reductions in October, some states have brought a lawsuit against the government. The lawsuit centers on the loss of federal funding, which jeopardizes basic health programs.
“For each dollar Minnesota sends to Washington, D.C., we get just 53 cents back,” Minnesota Attorney General Lori Swanson said in a statement. “This lawsuit seeks to avoid Minnesota losing hundreds of millions of dollars of payments in the coming years.”