Medicare Scams
There are several reasons why Medicare is rife with people trying to scam beneficiaries and businesses alike. For one, the rise of automated and exclusively-online enrollment means that it can be easier to use technology to scam the unsuspecting. Additionally, the population who uses Medicare is mostly elderly, and the elderly are often targets of scams. Medicare also covers an enormous population of people – 65 million at last count in 2023. Additionally, more people become eligible and enroll each year. The federal Medicare program continues to warn beneficiaries to watch out for scammers. Warning particularly people who try to take Medicare ID numbers in order to file false claims. The purpose of Medicare scams is to obtain Medicare payments, which is usually done by filing false claims for services, items, procedures, or equipment. It is estimated that Medicare fraud costs taxpayers billions of dollars each year.
Here are the top three Medicare scams to watch out for right now.
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Offers of free genetic testing
With how popular DNA testing has become, it’s no wonder scammers have been using that buzz to commit fraud. The “free genetic testing” is offered under the guise of helping test for diseases or susceptibility to certain illnesses, and find the right medications. The offers most often come over the phone but there are some reported door-to-door attempts as well.
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Calls or emails about free medical equipment
Scammers are also disguising themselves for other scams. Some people attempting to commit fraud are pretending to be Medicare representatives and making unsolicited calls to people under the guise of offering them free medical devices such as back braces, canes, walkers, or even wheelchairs. These callers have been reported to be extremely persistent, even asking the beneficiaries to accept the equipment simply because it is free if they do not need it. When the beneficiaries agree, the scammers then ask for their Medicare ID number, which gives them access to their private medical information and records.
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Solicitations for other services
These attempts at fraud are sometimes called Medicare Call Scams. Often they are robocalls, but there are live people making these calls as well. Their goal is to get the Medicare ID number, social security number, or other personal information about their targets. The scammers often do this by doing their research, knowing some things about their target, and pretending to be Medicare representatives.
In order to protect themselves against these three common scams, Medicare beneficiaries should always remember that Medicare will not reach out to beneficiaries via call or email unless they are answering their inquiry. Medicare will also never offer free gifts, medical equipment, or any other service for free. Calls requesting health care information should, as a rule, not be trusted.
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Medicare Supplement Plan N
There are a large variety of Medicare Supplement plans to choose from. Medicare Supplement Plans, also known as Medigap, are plans that private insurance carriers sell to Medicare beneficiaries to remedy some of the gaps in coverage that occur in Original Medicare. Medicare supplemental plans can help pay the beneficiary’s share of out-of-pocket costs such as copays, coinsurance, or other fees. Medigap policies are named after letters of the alphabet in all but three of the continental United States.
Increasing Popularity
Medicare Supplement Plan N has become increasingly popular due to its wide range of coverage. Plan N covers 100% of the Medicare Part B coinsurance costs. Beneficiaries are left to cover a $20 copay for office visits and a $50 copay for emergency room visits. These low costs are appealing to many purchasers. Medicare Plan N also provides the following benefits:
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For hospitalization, Plan N pays for Part A (of Original Medicare) coinsurance plus coverage for an additional 365 days after Medicare benefits end. That is an entire year of additional hospitalization coverage.
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Plan N also pays for Part B’s coinsurance, excluding a $20 copay for office visits and a $50 copay for emergency rooms. Copayments for hospital outpatient services are also covered.
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The first three pints of blood each year are paid for by Plan N coverage.
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Perhaps most vitally for many seniors, Plan N covers the hospice care Part A coinsurance.
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Skilled nursing facility care is covered under Plan N.
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The Medicare Part A deductible for hospitalization is covered under these benefits.
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And, Plan N provides travel abroad medical emergency help.
There was a previously very widely used Medicare Supplement Plan called Medigap Plan F. Plan F was discontinued in 2020, and carriers were no longer allowed to enroll additional beneficiaries in Plan F. Because of this new gap where the popular plan no longer exists, Plan N is one of the Medigap plans that is growing increasingly popular because of its wide range of coverage.
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What Are Medicare Savings Programs?
At last count, in 2023, there were over 65 million Americans enrolled in the federal healthcare program Medicare. There are additional people qualifying for and enrolling in Medicare every day. It is an extremely valuable program that helps to ensure that some of the most vulnerable populations have the access to healthcare that they need. However, it is not a perfect program, and, despite its subsidization by the government, there are out of pocket costs (OOP costs) associated with Medicare. Most people will not have to pay a premium for Part A (hospital insurance), but the majority of enrollees will pay a premium for Part B, which is medical insurance. There are also copayments, deductibles, and coinsurance. All of these costs can add up quickly, particularly if a beneficiary has chronic health issues. What Are Medicare Savings Programs?
That’s why there are Medicare Savings Programs. Medicare Savings Programs are special benefit programs. State Medicaid agencies sponsor these programs. They are designed to help adults who have limited assets and income by relieving some of the out of pocket expenses associated with Medicare.
MSP Levels
There are four different Medicare Savings Programs (MSPs) that help to cover premiums, deductibles, coinsurance, and copayments.
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Qualified Medicare Beneficiary (QMB): This program helps to pay for Part A premium and Part B premium. It also covers deductibles, coinsurance, and payments.
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Specified Low-Income Medicare Beneficiary (SLMB): This program helps pay for Part B premium.
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Qualifying Individual (QI): This also helps pay for Part B premium.
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Qualified Disabled Working Individual (QDWI): This helps pay for Part A premium.
Beneficiaries cannot choose the program that they want to enroll in. Rather, they will be assigned to the program that most closely matches their assets and income, as well as other details that the enrollee provides on their application. The guidelines for who qualifies for which program differ by state.
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Medicare Advantage vs. Medicare Supplements/Medigap
While Medicare does cover the majority of elderly Americans and provide access to some essential health services, there are many aspects of healthcare that are not covered at all by the federal program. To fill in these gaps, many eligible people end up enrolling in a Medicare Advantage policy or a Medicare Supplement policy, also known as Medigap. But which is the right choice for your unique situation? Here’s a comparison Medicare Advantage vs. Medicare Supplements/Medigap.
Medicare Advantage
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Many plans have $0 deductibles, no copay for a primary care doctor’s visit, and lower copays for specialists.
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Beneficiaries are restricted to a list of certain doctors, hospitals, and suppliers.
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The beneficiary must also be enrolled in Original Medicare (Parts A and B).
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Most policies do include at least some Part D coverage (prescriptions), as well as limited hearing, vision, and dental.
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There are limited policies available that allow for out-of-network provider coverage.
Medicare Advantage is provided by private insurance carriers, and essentially replaces Original Medicare as your primary insurance provider. Some plans require more authorizations to access care under these plans. Most people will have over 30 Medicare Advantage policies to choose from, but not all plans are available in all areas.
Medicare Supplements/Medigap
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These programs can be expensive, but the monthly payments are predictable.
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Plans K and L have annual out-of-pocket cost limits.
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Limited plans available do cover some vision, dental, and hearing services.
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International travel coverage is available.
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Beneficiaries will have to enroll in Part D separately, as Medigap does not provide prescription coverage.
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These policies only cover one person – spouses need separate plans.
There are 10 Medigap plans to choose from that provide standardized care and help pay for things like deductibles, coinsurance, and copays. In 2018, about 34% of the people enrolled in Original Medicare had coverage provided by Medicare Supplements to help cover costs – which is over 11 million people. These plans can help make the out-of-pocket costs more predictable and easier to budget. One thing that people do report positively from Medigap plans is the lack of restriction on in or out of network healthcare. The estimated average monthly premium can range from $150 to $200 a month, depending on the state that you live in and the insurer.
Depending on your situation, both Medicare Advantage and Medicare Supplement (Medigap) policies can be helpful for coverage gaps in healthcare for beneficiaries of Original Medicare.
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UHC OTC Benefits
Over the Counter Benefits from UnitedHealthcare are also called UHC OTC benefits.
For beneficiaries who are eligible for both Medicaid and Medicare, there are many benefits available that are often less utilized than the standard medical and healthcare services. By design, these benefits help those on fixed incomes or low incomes meet their needs and keep their health.
UHC OTC benefits offer more.
UCard
Clients who are dually eligible and enrolled in a UnitedHealthcare plan can utilize these benefits as a monthly credit loaded on to their UnitedHealthcare UCard every month. Use to purchase healthy food, over the counter products such as cold medicines, and even utility bills. UnitedHealthcare is currently advertising that their Mom’s Meals benefits works for dually eligible enrollees with their over the counter (OTC) benefit and Renew Active. This means that a member can order healthy meals using the loaded credit on their UCard for home delivery. Those members being discharged from hospitals or from nursing facility stays can also order these for delivery.
In addition to UHC OTC benefits, Mom’s Meals are fully cooked, refrigerated meals that can be easily reheated. Meals are re-heatable. In addition, consist of 28 meals over a 14 day period. There are many dietary specifications available as well, from meals that take renal health into account to gluten-free meals or purees for those with trouble handling solid foods. UnitedHealthcare advertises these meals as helpful for seniors who would like to avoid the hassle of shopping and cooking while still living independently and maintaining good nutrition.
Members who are interested in utilizing this over the counter benefit from UnitedHealthcare need to access their Renew Active portal. Under the “home delivery” tab, there is an option to order Mom’s Meals. Pricing is typically $7.59 per meal with some additional charges for dietary specifications as needed. All of the UnitedHealthcare plans that include Renew Active have access to home delivery of Mom’s Meals.
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Medicare AEP versus OEP: What’s the Difference?
Even for savvy clients, the enrollment process for Medicare can be confusing. One of the reasons for this is the multiple enrollment periods. The two most important time periods for both beneficiaries and agents to know the details of are the Open Enrollment Period (OEP) and the Annual Enrollment Period (AEP). Let’s compare the two:
AEP vs OEP – Open Enrollment Period
This is the time during the year when anyone who is eligible for Medicare can enroll in, change coverage from, or unenroll from a Medicare Advantage Plan or a Medicare Part D (or prescription drug) plan. This is the time when beneficiaries can make choices about their Medicare coverage without restrictions. It usually runs from January 1st to March 31st each year. To be eligible to enroll in a Medicare Advantage plan during OEP.
AEP vs OEP – Annual Enrollment Period
This is the time period that is specifically designed for beneficiaries who are enrolled in Medicare Advantage plans to change their coverage. It occurs from October 15th to December 7th each year. There are some restrictions as to what beneficiaries can do during this time period, but those actions that they can take include enrolling in a different Medicare Advantage plan, switching to or back to Original Medicare (parts A and B), or enrolling in a Medicare Part D plan (prescription drug coverage). In order to be qualified to do any of those things, the beneficiary must already be enrolled in a Medicare Advantage plan.
It is of vital importance that beneficiaries are aware of these timelines. If they are not aware of the time periods, missing OEP or AEP and failure to act can cause them to have lapses in their healthcare coverage or miss their opportunity to enroll in a different plan for the coming year.
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Do I Need a Medicare Supplement
Medigap is the common term for Medicare Supplement insurance. Medigap is extra insurance that beneficiaries can purchase from private insurance carriers. The purpose of Medigap is to help pay for out-of-pocket expenses that can accrue in Original Medicare coverage. Therefore, enrollees must be enrolled in Original Medicare in order to purchase a Medigap policy.
Medigap policies are standardized. This means that, unlike Medicare Advantage and other policies, all Medigap policies offer the same basic benefits regardless of carrier or location. There are ten different types of Medigap policy and they are lettered: there are plans A through D, F, G, and K through N. This is how companies distinguish which benefits and prices a plan has. Price is the only difference between plans from different insurance carriers with the same letter. However, in Massachusetts, Minnesota, and Wisconsin, standardizes Medigap policies differently. All other states use the alphabet system.
Original Medicare with a Medicare Supplement
There are many healthcare services that Original Medicare does not cover because it is not a blanket insurance policy. An example of where Medigap policies can be helpful is with copays and deductibles. Let’s say a beneficiary becomes ill enough that they need a say in the hospital. With Original Medicare, that hospital stay (bed and board) is 100% covered. Keep in mind the Part A deductible applies. However, the beneficiary may still owe up to 20% of other costs. An example is anesthesiologist fees. Those bills can be significant. Medigap policies can help with that coverage.
Do I Example
Here is an example. If a beneficiary is in the hospital for 60 days, they will be paying $400 a day, and there are similar copayments for nursing homes and other facilities. Those numbers can quickly add up to prohibitive costs, particularly for seniors on a fixed income or who are struggling with their health in their increasing age.
For anyone who wants an increased coverage for copays, fees, and deductibles, Medicare supplement insurance policies can be a reasonable way to mitigate possible costs.
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How to Get Life Insurance with Pre-existing Conditions
There are a lot of misconceptions and myths about life insurance, even among people who are otherwise informed about the insurance industry. One of these recurring myths is that people with health issues or pre-existing conditions cannot get life insurance policies because of those conditions. This is not the case. While having a pre-existing condition does make it often more difficult and more expensive to get life insurance, there are policies out there designed to cover people with this experience. There are several factors to consider:
Which Pre-existing Conditions Matter for Life Insurance?
How much a pre-existing condition will affect the price or availability of the life insurance policies depends on several factors. One of those factors is severity. If a person is otherwise healthy, they will likely have multiple options to choose from at more competitive prices. If the pre-existing condition significantly impacts their daily function, however, they may have fewer policies to choose from and the prices will likely be higher. Term life insurance policies may not be an option for those dealing with more severe conditions. The following conditions have a high impact on insurance premiums:
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Cancer
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Diabetes
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Epilepsy
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Heart disease
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HIV
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Obesity
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Smoking or tobacco use
The following pre-existing conditions have a low impact on premiums:
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Anxiety
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Asthma
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Depression
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High blood pressure
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High cholesterol
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Sleep apnea
How to Shop for Policies
There are several things people with pre-existing conditions can do to make their policy options greater. One of those is to manage their health condition. Any documentation of effective treatment could help them secure a lower premium on a life insurance policy. Additionally, working with a broker or insurance agent can be helpful, as they know the ins and outs of the industry and can work on finding a policy for the client’s unique needs. Lastly, buying life insurance sooner rather than later can be vital. As people age, and as their health worsens, premiums go up significantly, even for people without pre-existing conditions. There are many options out there, and one need only look in the right places.
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Five Reasons to Become an Insurance Agent
We get it: the insurance industry isn’t most people’s first choice. However, it is a diverse and fast-growing field that affects nearly everyone in the nation. Most people have insurance coverage in some form or another. Becoming an agent uses a variety of skills, and most agents earn nearly double the national average yearly salary. Here are five more reasons that become an insurance agent. It’s a solid career choice.
The abundance of opportunities
Not only does insurance touch nearly everyone’s life in the United States, but nearly 50% of the insurance industry workforce is estimated to be retiring in less than ten years. This will result in many more advancement or promotion opportunities than other industries have.
Ability to give back to community – become an insurance agent
If a job is only a paycheck, it just doesn’t feel the same. Having a job with a purpose and a paycheck is far more preferable. At its core, insurance is about protecting community members. It covers their healthcare needs and ensuring that their basic needs are met. When we all share risks, it helps protect all of us against tragedy.
Developing a broad skill set and using it
Yes, being good at sales is effective in the insurance industry. But that’s not all: an effective agent has high levels of communication skills and problem solving abilities. They need to be technology savvy, able to research and evaluate their own analytics. And they need to be organized enough to manage many accounts all at the same time. The industry is also constantly evolving, and people with cutting-edge skill sets in coding, digital marketing, and cybermedia are in high demand.
Job security – Become an insurance agent
During a recession, insurance has been shown to be far more stable than other fields. It is a centuries-old profession and it seems to be going nowhere fast. No matter what else is going on in the world, people will need healthcare and insurance policies can help them access it.
It’s east to get started
A college education is not required. A high school diploma or the equivalent is enough. Between choosing a specialty, studying for and taking the tests, and getting a license, the whole process of becoming an agent can take as little as a few weeks time.
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