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Home Posts tagged "Medicare"
Medicare Supplement OEP

Medicare Supplement OEP

By Ed Crowe | General Articles | 0 comment | 25 May, 2023 | 0

Medicare Supplement OEP

The best time to buy a Medicare Supplement policy is during your Medicare Supplement Open Enrollment Period.  After this period, your options to buy a Med Supp (Medigap) policy may be limited and the policy may cost more. Many people are not even aware of what the Medicare Supplement OEP is.

The Medicare Supplement Open Enrollment Period is an opportunity for individuals enrolled in both Medicare Part A & Part B to enroll in a Medicare Supplement (Medigap) plan without facing medical underwriting or higher premiums based on their health conditions.  This means, insurance companies cannot deny you coverage or charge you higher premiums based on either  your health status or pre-existing conditions. This is very important for individuals with pre-existing health conditions, as they can secure coverage at a reasonable cost without facing medical underwriting or risk being denied a policy.

To see the benefits of each Medicare supplement plan side by side; click here

When is the Medicare Supplement OEP:

The Medicare Supplement Open Enrollment Period begins the first day of the month their Medicare Part B is in effect.  For many people, this is the first day of the month they turn 65.

This is a 6-month period that starts the first day of the month you’re 65 or older and signed up for Part B.  Once this time passes, there are fewer options to buy a Med Supp (Medigap) policy and the policy could cost more.

For example:  If Medicare Part B coverage begins on June 1st. then, the Medicare Supplement OEP starts on June 1st and continues for six months.  This means, it will end December 31st.

Those who delay enrollment in Medicare Part B due to creditable coverage through their large employer group plan will have their Medicare Supplement Open Enrollment Period when they lose group coverage and enroll in Medicare Part B.

Learn about your Medicare Supplement GI Issue rights

In some situations, there is a second opportunity for an OEP:

  1.  If you are under 65 and have Medicare coverage due to a disability, there are 2 Medicare Supplement OEPs available to you.  The first is when your Part B coverage starts before you turn 65.  The next one starts when you turn 65.
  2. Some individuals enroll in Medicare Part B and then choose to go back to work and receive employer coverage so they stope their Part B at that time.  Once they decide to retire again, they will re-enroll in Part B and therefore you start a new OEP.

Important:

You can enroll in a Medicare Supplement plan outside your OEP however, answering questions about your health history and medications is a regular practice. Your answers to these questions will determine if you the carrier accepts you into the plan or not.   This means, the key to enrolling in a Med Supp plan is; passing underwriting.

To avoid underwriting altogether, it is  best to apply for Medigap coverage during your Medicare Supplement OEP.

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Medicare and Medicaid Dual Eligible

Medicare and Medicaid Dual Eligible

By Ed Crowe | General Articles | 0 comment | 18 May, 2023 | 0

Medicare and Medicaid Dual Eligible

Although Medicare and Medicaid sound very much alike, they are different programs. Their similarities are that both help people secure healthcare and both are federally funded. Some people are qualified to receive benefits from both Medicare and Medicaid and can choose to do so. This group of beneficiaries is considered to have dual eligibility – Medicare and Medicaid dual eligible.

 

Medicare vs Medicaid

Briefly, here are some of the major differences between the two programs.

 

Medicare is a federally funded health program that provides insurance for people who are 65 and older at a reduced cost. Some people who are under 65 but have certain disabilities may qualify as well. Medicare is offered by the federal government. The cost of Medicare will depend on the coverage the beneficiary chooses and may include premiums, down payments, copays, and co-insurance.

 

Medicaid is a joint federal and state funded health insurance program. It seeks to provide health care and resources to vulnerable populations such as those on limited income, pregnant people, and children. Medicaid is offered by state governments and therefore the cost to the beneficiaries will vary by location.

 

How to Get Medicare and Medicaid

In order to receive benefits from both Medicare and Medicaid, a beneficiary must qualify for both of these programs. For instance, someone who is over 65 years old and is also on a lower or limited income may qualify to receive both Medicare and Medicaid. The two programs may be able to work together to cover the majority of health costs. Some specific plans exist for those people that are dual eligible as well, such as the Dual Special Needs Plan (D-SNP). Because Medicaid requirements are dependent on location and state governments, however, Medicaid eligibility will vary.

 

There are beneficiaries that are considered part duals and full duals. Part duals are called this because Medicaid pays for some of the expenses that they accumulate under their Medicare plan. It may also pay for some cost-sharing amounts categorized by Medicare, like deductibles or copayments. Part duals can include people who are disabled and working, or have an income level above the state poverty line but below 125% of federal poverty level.

 

Full duals, on the other hand, are entitled to Medicaid coverage for services that Medicare does not cover, such as longer-term services and supports. Duals with lower income and assets will fall under full Medicaid benefits as well as their Medicare eligibility. Because this group of people can account for much of the federal and state spending in these programs, they are studied by researchers and policymakers to determine budgets and planning.

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Medicare Advantage Enrollment Trends

Medicare Advantage Enrollment Trends

By Ed Crowe | General Articles | 0 comment | 18 May, 2023 | 0

Medicare Advantage  Enrollment Trends

 

There are continually increasing populations of people who become eligible for Original Medicare and Medicare Advantage plans each year in the United States. Since 2006, the amount of enrollees for Medicare Advantage plans has grown steadily.  In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population. This number also accounts for nearly half of the federal Medicare spending.  Let’s explore the Medicare Advantage enrollment trends.

 

In 2022, the average Medicare beneficiary has access to nearly 40 Medicare Advantage plans, which is the largest number of plans available in over a decade. This looks like 2.2 million new beneficiaries between 2021 and 2022, which is an eight percent increase in enrollees.

 

Employer Group Versus Individual Plans

 

In 2022, of the 28.4 million beneficiaries enrolled in Medicare Advantage.   The smallest percentage were enrolled in special needs plans, at a mere 16%. The next smallest group of beneficiaries was those enrolled in union-sponsored or employer-offered Medicare Advantage plans.   These account for 18% of the total. The largest group of beneficiaries by far is those in individual plans –  open for general enrollment.   This group makes up 66% of the 28.4 million beneficiaries. That is about two thirds of this group, or approximately 18.7 million people. Since 2021, that is an increase of about 1.3 million enrollees. However, the share of those in individual plans open for general enrollment has not increased.  It remains steady at about two thirds of the enrollment since 2018.

 

Medicare Advantage Plans By State

 

The share of Medicare beneficiaries who are enrolled in Medicare Advantage Plans varies greatly by state and has a very wide range of percentages across the country. However, in 25 of the states, at least half of those eligible for Medicare Advantage plans are enrolled in them. The more rural a state is, the more likely it is to have lower funding for Medicare and lower enrollment in Medicare Advantage plans. South Dakota, North Dakota, Wyoming, and Arkansas are the states with the lowest Medicare Advantage enrollment, which is less than twenty percent, or fewer than one fifth of eligible beneficiaries. Puerto Rico, on the other hand, has the highest percentage of enrolled beneficiaries, with 93% of Medicare beneficiaries also enrolled in a Medicare Advantage plan. This is largely thought to be due to policy choice, as many people in Puerto Rico are dually enrolled automatically in Medicare and Medicaid.

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Medicare Part D History Timeline

Medicare Part D History Timeline

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

Medicare Part D History Timeline

Let’s take a brief look at the Medicare Part D history timeline.  Medicare Part D, or Medicare Prescription Drug Coverage, is not a part of the Original Medicare as provided by the federal government. The federal government contracts with private companies to sell this particular kind of supplemental Medicare insurance. There are two main sources of Part D coverage.

Stand Alone Plans

The first is Prescription Drug Plans, or PDPs. These are standalone companies that sell only prescription drug coverage and do not provide hospital or medical insurance coverage. United HealthCare is an example of the companies who provide these plans through their contracts with the federal government.

MAPD Options

The second source of coverage for Medicare Part D plans are Medicare Advantage Prescription Drug Plans, or MA-PDs. These are Medicare Advantage Plans, which cover hospital, medical, and prescription drug coverage in a single plan. In other words, these Medicare Advantage Plans cover Original Medicare and prescription drug coverage.  Medicare Part C is another name for MAPD. There are four main categories of MA-PD plan types.

 

Health Maintenance Organizations (HMOs):

These follow what is called a gatekeeper model, meaning that every aspect of the beneficiary’s coverage is controlled by the plan and the plan’s membership. The primary care physician must belong to the HMO, the beneficiary must choose specialists that are within the plan, and the prescription drug coverage must be taken from the HMO as well instead of a separate prescription drug plan (PDP).

 

Preferred Provider Organizations (PPOs):

This is similar to the previous HMO plan in that the beneficiary must choose a primary care physician, but they do not need to have a referral to see a specialist. While they can choose care out-of-network, they will pay more to do so. In PPOs as well as HMOs, the beneficiary must take the prescription drug coverage offered with the plan rather than choose a separate PDP.

 

Private Fee for Service Plan (PFFSs):

These are by far the most flexible plans, in which beneficiaries can choose any licensed provider in the United States who is authorized to provide services and agrees to treat them. Like the PPOs, however, members may pay more in fees if they choose to go to a provider who is not a member of the licensed group of practitioners that are contracted with the insurance company. Some PFFSs provide a prescription drug plan and some do not. If the PFFS provides a prescription drug plan, the beneficiary has to take the coverage offered. If the PFFS does not provide drug coverage, then they can choose to get their prescription drug coverage through a separate PDP.


Special Need Plan (SNP): There are three segments of the population who are eligible for these Special Needs Plans. 1. People who are considered dual eligible, meaning they have qualified for both Medicare and Medicaid. 2. People who are institutionalized. And 3. People who have chronic conditions. People who belong to an SNP must take the prescription drug coverage provided and may not go through a separate PDP to access alternative coverage.

Put your knowledge of the Medicare Part D history timeline to use.

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History Medicare and Medicaid

History Medicare and Medicaid

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

A Brief History of Medicare and Medicaid

Groom yourself for trivia night with this brief history of Medicare and Medicaid.  Original Medicare, or what is known as Parts A and B (hospital and medical coverage), is a relatively new feature in the United States. It was signed into law on July 30, 1965, by then-President Lyndon B. Johnson. Of course, changes have been made since then. In 1972, Medicare was expanded to cover people with disabilities, people with end-stage disease requiring dialysis or kidney transplants, and people who select Medicare at age 65 and older. Additionally, more benefits, such as prescription drug benefits have been added.

 

At first, Medicaid only offered benefits to a certain group of people: those receiving cash assistance from the federal government. Medicaid has changed since then as well, as a much larger group is covered now, including: low-income families, pregnant women, people with disabilities regardless of age, and those who need long-term care. Under these newer laws, states have the responsibility and ability to change their Medicaid programs to best cover their vulnerable populations, thus ensuring the best use of the federal and tax dollars that cover Medicaid.

Y2K Changes

In 2003, the largest change was made to the Medicare and Medicaid program in over 38 years: The Medicare Prescription Drug Improvement and Modernization Act. Medicare Advantage Plans or Medicare Part C became available under the MMA. This act also expanded Medicare to include an optional prescription drug benefit, known as Part D. Medicare Part D went into effect in 2006.

 

Since 2006, the largest change to Medicare and Medicaid has come with the Affordable Care Act (ACA).    ACA  created the health insurance marketplace and subsidized health insurance for millions of Americans. As a result, Medicare and Medicaid have been able to better coordinate how they cover their beneficiaries and provide quality health care services.

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What is the difference between Part A and Part B of Medicare

What is the difference between Part A and Part B of Medicare

By Ed Crowe | General Articles | 0 comment | 4 May, 2023 | 0

What is the difference between Part A and Part B of Medicare?

In order to help your clients choose the best healthcare coverage for their needs, you need to understand the coverage they already have: Medicare. There are four parts to Medicare.  Medicare Part A and Medicare Part B are provided by Medicare.  Those two parts make up the original federal health program.  Part A and B are referred to as Original Medicare.  Remember, Medicare is a US government entity.   Part C and Part D are purchased from private insurance carriers.

 

Medicare Part A is hospital insurance.  As hospital insurance,  Part A generally covers the following.

  • Inpatient hospital stays

  • Prescription drugs administered in the hospital

  • Skilled nursing facility stays

  • Mental health inpatient stays

  • Hospice care

  • Limited or temporary home health care

 

Medicare Part B is medical insurance.  As medical insurance, Part B generally covers the following.

  • Annual wellness exams

  • Doctor and specialist visits

  • Preventative services (flu shots, etc.)

  • Bone mass measurements

  • Tests and screenings for certain diseases

  • CPAP machines for sleep apnea

  • Certain diabetes equipment and supplies

  • Limited home health visits

  • Durable medical equipment (walkers, wheelchairs, etc.)

This is not a complete list of the medical services covered by Medicare Part B.  However, it is a starting point to help your clients understand where their gaps in coverage are and how to choose supplemental insurance to address those gaps.

Click here to learn how to compare Medicare Advantage plans.

Click here to learn how to compare Medicare Supplement plans.

Medicare Advantage and Supplemental Sales Video

What will Medicare pay for

What will Medicare pay for

By Ed Crowe | General Articles | 0 comment | 17 March, 2023 | 0

What will Medicare pay for

Because many people are unsure what will Medicare pay for, we are providing a quick summary of the parts of Medicare and what they cover.

Medicare is a federal health insurance program.  It provides coverage to people who are either 65 years or older, people with disabilities, and those with end-stage renal disease.  There are four parts of Medicare plans: Part A, Part B and Part C, as well as Part D.

What Medicare Part A pays for:

Part A or hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.

  1. Inpatient Hospital Stays: Part A pays for the cost of a semi-private room, meals, nursing care, and other hospital services and supplies. It also covers the cost of surgeries, anesthesia, and other medically necessary procedures.
  2. Skilled Nursing Facility Care: If you need to stay in a skilled nursing facility for a short period after being discharged from the hospital, Part A covers the cost of a semi-private room, meals, nursing care, and therapy.
  3. Hospice Care: If you have a terminal illness, Part A covers hospice care services, including pain relief, counseling, and medical care.
  4. Home Health Care: Part A covers some home health care services if you are homebound and need skilled nursing care, physical therapy, or speech-language pathology services.

What Medicare Part B pays for:

Part B is also called medical insurance. It covers medically necessary services and preventive services that are not covered by Part A. Here’s what Part B pays for:

  1. Doctor’s Services: This includes office visits, consultations, and surgical procedures.
  2. Outpatient Services: Part B covers services that include diagnostic tests, laboratory services, and imaging tests.
  3. Preventive Services: These services  include flu shots, cancer screenings, and annual wellness visits.
  4. Durable Medical Equipment: Beneficiaries receive coverage for the purchase of durable medical equipment, including wheelchairs, walkers, and oxygen equipment.
  5. Ambulance Services are covered if they are medically necessary.

What Medicare Part C pays for:

Medicare Part C or Medicare Advantage (MA plans). It is an alternative to Original Medicare, which includes Part A and Part B. Medicare Advantage plans are offered by private insurance companies. In most cases, they include additional benefits, such as vision, dental, and hearing coverage. Medicare Advantage plans must cover all the services that Original Medicare covers, but the cost-sharing and rules may be different.

What Medicare Part D pays for:

Some people refer to these plans as prescription drug coverage.  Private insurance companies offer this coverage to cover the cost of prescription drugs.  Part D plans typically have a formulary, which is a list of drugs that the plan covers. The cost-sharing and rules for Part D plans may vary.

In conclusion, Medicare covers a wide range of medical services.  This includes hospital stays, doctor’s visits, preventive care, medical equipment, and prescription drugs. Understanding what each part of Medicare covers can help you make informed decisions about your healthcare needs.

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Florida Blue First Look 2023

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By Ed Crowe | General Articles | Enter your password to view comments. | 6 July, 2022 | 0

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Aetna Medicare Over The Counter Catalog 2019

By Ed Crowe | General Articles, Medicare, Medicare Advantage Plans | 14 comments | 24 October, 2018 | 6

Aetna Medicare Over The Counter Catalog 2019

The Aetna Medicare Over The Counter (OTC) Catalog 2019 is now available.

To view an updated post – Click here for details

Carriers now offer a Medicare over the counter (OTC) benefit  to their members.  In addition to your plan benefits, over the counter benefits  defray some of the cost of necessary healthcare items not covered as a medical or pharmaceutical expense.

Aetna Medicare offers members an Over-The-Counter benefit.

This benefit pays up to a $25 maximum amount every month for over the counter  (OTC) items.  The catalog lists eligible items.    Only items listed in the OTC catalog are covered by the over the counter benefit.  Many products you would normally purchase from a drugstore are critical to a healthy lifestyle.  These items may include non-prescription medications, vitamins,  and eye care.  In addition to these you can purchase every day items that impact your health, like hand sanitizer.  This benefit allows you to purchase these items from the catalog at no cost to you.  Accordingly, the cost of these items is part of your Medicare OTC benefit.

  1. The over the counter benefit in 2019 is up to $25/member every month.  However, there are rules with regard to how items must be ordered.
  2. The over the counter  benefit is included with all Aetna Medicare Advantage plans in 2019.
  3. You must order from the catalog or online. Items purchased from a retail store are not part of the benefit.
  4. Because this is a “use it or lose it” benefit,  benefit dollars do not carry over month to month.  Therefore,  be sure to check the catalog each months for items you will need.
  5. You cannot use your CVS Extra Care card toward these purchases.
  6. Free shipping!  There are no shipping or handling fees.
  7. Orders typically take two weeks to arrive.  Plan ahead for adequate supplies.

You can place an Over the Counter order 2 ways.  You can order either by phone at 1-888-628-2770 Monday through Friday 9:00am to 8:00pm EST, or you can order online at visit:myorder.otchs.com.

Choosing a Medicare plan can be confusing!  Remember, that is what we specialize in!    If you still need help determining which Medicare option will suit you best,  call us at 203-796-5403 and schedule an appointment today.

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Applying for Medicare in Connecticut

Applying for Medicare in Connecticut

By Ed Crowe | General Articles | 0 comment | 25 May, 2017 | 0

Applying for Medicare in Connecticut

This post will try and give you some help when you are applying for Medicare in Connecticut.  This can be overwhelming for some people.  We want to make it easy for you.  If you are 65 years old, or are under 65 and qualify for Medicare because of a disability or other special circumstance, you are eligible for Medicare.  (Note:  You must be a US citizen or a legal resident for at least 5 consecutive years to be eligible for Medicare.)

Apply for Medicare can be done online by CLICKING HERE.  You can also enroll by phone at 1-800-MEDICARE.  Or, you can enroll in person at your local social security office.  You can call 1-800-772-1213 for help locating your local social security office.

 

Click here for more details regarding choosing a Medicare plan in CT.

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Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033

All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here

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