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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

• Many plans have $0 deductibles, no copay for a primary care doctor’s visit, and lower copays for specialists.

• Beneficiaries are restricted to a list of certain doctors, hospitals, and suppliers.

• The beneficiary must also be enrolled in Original Medicare (Parts A and B).

• Most policies do include at least some Part D coverage (prescriptions), as well as limited hearing, vision, and dental.

• 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

• These programs can be expensive, but the monthly payments are predictable.

• Plans K and L have annual out-of-pocket cost limits.

• Limited plans available do cover some vision, dental, and hearing services.

• International travel coverage is available.

• Beneficiaries will have to enroll in Part D separately, as Medigap does not provide prescription coverage.

• 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:

• Cancer

• Diabetes

• Epilepsy

• Heart disease

• HIV

• Obesity

• Smoking or tobacco use

The following pre-existing conditions have a low impact on premiums:

• Anxiety

• Asthma

• Depression

• High blood pressure

• High cholesterol

• 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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2024 CMS Regulations Compliance: Medicare Advantage Advertising

Agents must stay abreast of the yearly changes to the Center for Medicare and Medicaid Services’ (CMS) regulations. For the coming year, 2024, there are new regulations to observe in the realm of advertising and marketing.

For Third Party Marketing

• TPOs submit all marketing materials for Medicare Advantage and Prescription Drug Plans, or Part D plans to CMS before use.

• Use only Marketing materials  approved by CMS.

• Online videos or television advertisements used in marketing are subject to a 45-day review period by CMS.

• Allow  carriers to preview and approve materials  before submitting to CMS’ Health Plan Management System (HPMS).

These new guidelines mean that even advertisements that do not mention any specific plans by name are considered marketing materials and must be submitted to the CMS HPMS for approval prior to their use.

What Agents Need to Know

Use either carrier-created advertising materials or create communications rather than marketing materials. Communications are defined as ads that do not have intent or content.   These are compliant with CMS, state, and federal guidelines. Because communications are not marketing materials, they do not need to be submitted to CMS prior to use.

CMS will withdraw any marketing materials that are no longer in compliance.

Agent-created multi-plan marketing materials will need to be submitted separately to compliance. Send these to the carriers listed for review and possible approval. After approval,  file the materials with CMS’ HPMS. The insurance carriers will conduct their own reviews. All submitted materials will need a Standard Material ID on them (SMID), and agents and their agencies are responsible for creating and tracking those IDs.

Disclaimer Requirement

Include an additional disclaimer on all marketing materials.  This is required for the 2024 contract year Agents who do not sell for all carriers in a service area must include the following on their materials on and after September 30:

We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

For agents who do sell for all of the insurance carriers in a service area, the following disclaimer is required:

Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.

These disclaimers must be written on printed marketing materials, visible on email communications, and visible in any television or internet ads, as well as displayed on websites.

FAQs:

Q: Are all marketing materials impacted?

A: Yes. All partners who create or use multiplan marketing materials must submit their materials to the compliance email address. Use the carrier created ad materials.

Q: Can I market new plans prior to October 1st?

A: No, agents cannot market new plans for the coming contract year prior to October 1st.

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Connecticut Medicare Demographics

Agents need to be up to date on the latest trends for all aspects of marketing, educating, and enrolling beneficiaries in Medicare insurance policies. Medicare Advantage, Medigap, and Medicare Part D are all provided by private carriers who are accountable to the regulations from the Center for Medicare and Medicaid Services, and these regulations change yearly. In addition to keeping up with changes, it is helpful for an agent to know the demographics of their area. Understanding Connecticut Medicare demographics helps best serve clientele.

At last count, when the survey was conducted in 2021, over 700,000 people in Connecticut were enrolled in Medicare. That is a large number of people, particularly for such a small state; Medicare beneficiaries make up 19% of the state population. Of those 700,000 people, 363,399 of them enrolled in Original Medicare. In other words, 52% of the eligible population in Connecticut is enrolled only in Medicare Parts A and B. Medicare Advantage or other health insurance policies make up the remaining 48%. For agents, it may be helpful to think about these numbers like so: Over half of the eligible people in the state may need your help to choose an additional Medicare Advantage or other plan.

Understanding the Connecticut Medicare Demographics

However, Connecticut is among the states with the highest percentage of eligible people enrolled in a Medicare Advantage insurance plan. Part of this has to do with Connecticut having some of the strongest Medigap consumer protection laws in the nation. It also has to do with the widespread availability of Medicare Advantage plans. In 2023, all of the counties in Connecticut had access to 44 or more Medicare Advantage plans. Some counties had access to as many as 58 options.

In addition, there are 13 different insurers who offer Medigap plans in Connecticut. The state requires that all of those plans are guaranteed-issue and community-rated at all times. As for Medicare Part D or prescription drug coverage, there were 24 stand-alone plans available in 2023. Premiums tend to range from $7 a month to $124 a month, making them accessible to a wide-range of people on varied incomes. This is likely a factor in why over 40% of Connecticut Medicare beneficiaries have stand-alone prescription drug coverage.

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Travel Benefits with Medicare Advantage

If there’s one thing that many people look forward to about retirement age, it is the opportunity to do things that their work lives made it difficult to do previously. For many, this means travel. As people age, however, their medical needs often become more complex.  This means that it is necessary to think about medical benefits and how that coverage will be affected by travel. Here’s how travel benefits with Medicare Advantage can be affected by these situations:

Travel Inside the United States

Original Medicare covers beneficiaries in all 50 states, and the United States’ territories such as Guam, Puerto Rico, American Samoa, and the Virgin Islands. Over 93% of doctors and hospitals in the U.S. and its surrounding territories participate in the Medicare program, and coverage is almost universal within the country because of it.

For Medicare Advantage plans, however, coverage is far more dependent on the insurance plan and carrier. There are some plans that do not cover any medical or healthcare services outside of their area. Some plans will cover services outside of the designated area and network, but with significantly higher co-pays and fees. There are also restrictions like prior-authorization to work around with some plans. However, the Medicare Advantage plans are required to cover emergency care anywhere in the United States.

Travel Outside of the United States

There is far less coverage for beneficiaries if they are traveling outside of the country and its territories. For both Original Medicare and Medicare Advantage, there are very limited circumstances in which they will cover medical and healthcare services:

• Medical services received in Canada while beneficiary is traveling between the continental U.S. and Alaska are covered.

• Beneficiaries who receive care on a cruise ship will be covered if the ship is in U.S. territorial waters. That means within six hours of a United States port.

• In very few situations, both Original Medicare and Medicare Advantage will cover hospital services if the hospital at which they were received was closer than a hospital in the United States. The most likely situation in which this could happen would be if the beneficiary is at the border of Canada or Mexico.

For beneficiaries about to embark on any journeys inside or outside of the United States, it is important to be aware of what their insurance will cover and what will cost them out of pocket.

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Travel Benefits with Medicare Advantage is only one small piece of the picture.

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How to disenroll from Medicare Part B

In this post, we will go over how to disenroll from Medicare Part B.  Although it is a rare occurrence, you can terminate your Medicare Part B (Medical Insurance). Although you may need to have a However, you may need to have a personal interview with Social Security to go over the risks of dropping coverage.  They will also be able to help make sure you have everything you need to process your request.

If you  want help terminating your Medicare Part B or to schedule a personal interview, you can contact Social Security either at 1-800-772-1213 (TTY: 1-800-325-0778) or in person.  Click the following link to  find your local  Social Security office.

To cancel Medicare Part B, you will need to download and print Form CMS 1763.  Once you have the form, do not fill it out until you have your interview with Social Security.  They provide instructions on how to fill it out.  If you already have your Medicare card, you’ll need to return it.  You can do this either during the in-person interview or by mail once you complete the phone interview.

Some risks to disenrolling from Medicare Part B:

If you do not have health coverage, you could become injured or ill and be stuck paying for all your medical services out-of-pocket.

Any time you go without creditable coverage, you have a coverage gap and will pay a late enrollment penalty unless you have a SEP (special election period) once you do sign up.  You also need to wait until the next General Enrollment Period to get coverage.  This period runs from January 1 through March 31st annually.

Click here to learn more about the risks of late enrollment in Part B

Any month that you are enrolled in Medicare Part B, you will pay a premium.  Once you disenroll from Part B, it will end the first of the following month after you file the request. If you decide to keep Part A, you will receive a new Medicare card showing Part A only.

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Life Insurance vs. Annuity

Which is Right For You? Although both life insurance and annuities are very different, they can both play a role in providing financially for individuals and families as they age and retire. Here’s the quick version:

Life Insurance

Life insurance is an insurance policy that pays out to the chosen benefactor at your death. It can provide income for loved ones and cover final expenses such as medical bills, funeral costs, and even help clear debts. There are two common types of life insurance: term life insurance and whole life insurance. Term life insurance is more affordable, with lower premiums, and has an expiration date, which is typically 10, 15, 20, or 25 years after enrolling. Whole life insurance is just that, for the person’s whole life until death.

Annuity

Annuities are also a type of life insurance, but with a different structure. Instead of a death benefit, an annuity provides payouts over your lifetime. Because of this, it provides guaranteed lifetime income. There are also two types of annuities: immediate annuities and deferred annuities. Immediate annuities are contracts purchased with a one time payment to the insurance company and provide payments to you within the first year of purchase. Deferred annuities provide payouts that start at a future date instead of within the first year of purchase.

Which is Best For Me?

That depends on your situation. You’ll need to ask yourself the following questions:

• Is a steady income in retirement something I want or need? If so, an annuity may be right for you.

• Do you have loved ones that need to be provided for after you die? Life insurance is designed to do that.

• Or, do you want to provide both forms of financial support – steady income in your later years and a death benefit for your loved ones? If so, it may be best for your situation to include both life insurance and an annuity, either immediate or deferred, in your financial planning.

Talking to a licensed financial advisor would be a good next step for anyone considering either life insurance, an annuity, or even both.

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