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Rising Premiums Discourage Americans From Obtaining Insurance

While paying higher insurance premiums has discouraged many Americans from opting in to health insurance, in truth not having health insurance means a person would pay the full cost of medical care if they were hurt or ill.

Americans demand the very best in health care. While medical technology is developing rapidly, with the advancements, the price of medical care is going up. Currently, the price of insurance is built into what the hospital/medical professional is charging for services.

Here is how that works. Health insurance carriers work with a network of medical facilities and physicians to negotiate fees for office visits, prescription drugs, various procedures and other costs. In order to take advantage of the negotiated rates, individuals need health plans. Health insurance plans will cover some or most of any medical costs for insured individuals. However, those who do not have health insurance pay full price for all medical expenses.

Anyone opting out of health insurance because they may think they are healthy does not allow for protection from sudden, unexpected accidents or illnesses. Medical costs escalate quickly and unforeseen medical events can ruin a person’s financial health.

In any situation that requires medical care, it is best to have some form of insurance to help defray expenses. If an employer does not offer medical plans then the individual marketplace is the best place to source affordable options. If you are self-employed, a small business owner, a student or entrepreneur, the individual insurance market is the best option to find a plan that suits your circumstances.

As the current administration has been implementing changes to the health care system, it is difficult to know what kind of policy will suit your situation and budget best. When in doubt, reach out and talk to an experienced insurance agent who can help you choose what type of health insurance policy will protect you at a price you can afford.

Posted on Friday, June 29th, 2018. Filed under Health Insurance.

Buying High Deductible Health Insurance Plans is Trending

Low deductible health insurance plans were once very popular, offering low out-of-pocket expenses in the event of a major medical claim or an emergency. Low deductible health insurance plans still exist, but the trend now is to buy high deductible plans instead.

There are a number of ways to buy a high deductible health insurance plan, with the most common way being to buy a Health Savings Account (HAS). Customers with families are able to save several hundred dollars per month by opting to buy a Health Savings Account plan. HSAs offer one deductible for the family with no co-insurance and once the deductible is met, those on the plan are 100 percent covered.

Many people have difficulty with HSAs and are not able to utilize the full benefits offered. Often, many people do not invest their savings into the account. Regularly adding money the account means the funds in it are tax deductible and any interest earned is tax deferred. HASs are a good investment in you and your health. Perhaps the biggest benefits for account holders is their account can pay for any medical bills. Additionally any funds left over will roll over each year.

When buying a high deductible health insurance plan it is best to add supplemental benefits. In fact the two most often bought plans are the Accidental and Critical Illness plans. Having extra coverage is a smart thing to do as roughly 59 percent of all medical claims filed are for critical illnesses and approximately 19 percent are filed as a result of an accident. It is also important to remember that a health savings account plan covers all wellness exams 100 percent. Wellness exams include immunizations, pap smears, PSA exams, mammograms and colonoscopies.

With the current administration the health insurance marketplace is in flux, if you take the time to research your options, you will find plans that suit your lifestyle and budget.

Posted on Friday, June 1st, 2018. Filed under Health Insurance.

When is the Best Time to Buy Medigap Coverage?

According to the Medigap website, the best time to enroll in Medigap policy is during the six month Medigap enrollment period which begins the month a person is 65 and has already enrolled in Medicare Part B.

Missing the enrollment period, often means that you will not be able to enroll. The most popular plans might already be closed. Therefore, it is best to buy what you need right away.

However, for individuals who did not buy a Medigap policy during the six-month open enrollment period, there are other ways you may search for a policy. The first route to take is visit the Medicare.gov website where under the “Supplements and Other Insurance” tab you will find a tool to help you compare Medigap policies.

When shopping for Medigap insurance remember that by law, all policies provide the same basic benefits. The only difference between the policies is the price. Depending on what you want and need make certain to compare deductible and co-pay amounts prior to buying a plan. If you want to localize a search to your home area, the Medicare.gov website can assist with that as well. Medicare supplemental plans can be found by clicking on “Find Health and Drug Plans,” which appears as a menu choice under the “Sign Up/Change Plans” tab.

Another way to find a Medigap policy, if you did not register during the enrollment period, is to check insurance company websites or talk to the AARP. Lastly, do research on the possibility of using Medicare Advantage Plans.

Before signing up for Medicare Advantage, make sure to have laid out the benefits you require and have an established budget. This is because some premiums may cost more than having a Medicare plan with a Medigap supplement.

Taking the time, before the enrollment period begins, to acquaint yourself with your options can save you time and money when choosing a Medigap plan.

Posted on Friday, December 29th, 2017. Filed under Medicare.

Does Medicare Provide Coverage Anywhere in the United States?

Increasingly Americans travel to other states to visit relatives, take vacations and take care of family. As people move between states it is important to keep track of Medicare coverage. For instance what happens if your home state is South Dakota and you take up residence in Florida to care for a family member? Do you need to get a Medigap plan in Florida or one in South Dakota? Would there be any out-of-network expenses involved here? These are some of the questions many people ask.

Original Medicare offers coverage anywhere in the United States provided medical professionals accept Medicare and nearly all do. When you have Original Medicare, you should also consider Medigap plans which offer additional coverage for copayments, deductibles and coinsurance. For anyone traveling inside the country it is important to note that once you have a plan, you may retain that plan regardless of your location in the United States.

If you decide to move out of your home state, you can keep your current Medigap policy as long as you have Original Medicare. If you want to switch to a new Medigap policy, however, you will have to check with both your current and new insurance company to see the Medigap policy options they offer. There are 10 standardized Medigap plans, this means that you may be able to reaming with your plan. Therefore, you may get a Medigap policy in South Dakota or in Florida.

What if you decide to switch to a Medigap issuer in Florida? You can certainly do that once you have established residence there, but it is not required that you do so. If you do make the decision to switch, you might be charged more in Florida because you do not have “guaranteed first rights.” “Guaranteed first rights” are rights that you have in certain situations when insurance companies are required to offer certain Medigap policies.

Your situation may look different if you are enrolled in a Medicare Advantage plan or in Medicare Part D when you decide to move out of state. If your current Advantage plan is not available in the area you are moving to, your plan is required by Medicare to disenroll you. If this happens outside of the special election period (SEP) you will be returned to Original Medicare. However, if you notify your plan provider before you move, you SEP will be changed. The SEP will begin one month before the move and last three months. If you forget to notify your provider about your move, you can still do so the month of the move. In such a situation, you will also receive a three month SEP, which begins the same month of the move.

Always check with an experienced insurance agent if you have any questions about how changes in your situation may affect your Medicare coverage.

Posted on Friday, December 1st, 2017. Filed under Medicare.

A Look at How Medicare Pays a Hospital for an Inpatient Claim

Recipients of Medicare, should have an understanding of how the system pays hospitals for an impatient claims. Understanding how Medicare works can demystify the process.

Here is an overview of Traditional Medicare. Traditional Medicare came into being in 1965 through the federal government. It covered approximately two-thirds of adult Americans over 65. Traditional Medicare was never created to and was never intended to cover all heath care expenses.

In 1997 the Balanced Budget Act created the Managed Medicare/Medicare Advantage option, meaning commercial insurance agencies sold traditional Medicare but with possible added services specific only to each insurance company selling them. Then in 1982, Congress changed how hospitals received reimbursement when a beneficiary was an inpatient.

With traditional Medicare, the hospital is paid based on the diagnosis of the patient treated during a stay as an inpatient. In other words, invoices indicating total time spent are submitted, but the hospital is paid for the diagnosis – not the charges. Furthermore, the payment system is different for every insurance plan, Medicaid (on a per state basis), traditional Medicare and managed Medicare Advantage.

Below is a hypothetical example:
Jane spent two weeks in ICU. The final bill was $130,000. Jane has traditional Medicare and a supplemental insurance plan that pays the inpatient deductible. (For 2017, the deductible is $1,316)

The hospital is paid one sum for the aggregate diagnosis. That one payment is referred to as a diagnosis-related group (DRG) payment.

The total hospital bill for Jane is $130,000
The diagnosis-related group payment from Medicare is $12,000
Medicare holds on to the deductible, which is $1,316 (due either from patient or supplemental insurance)
Total Medicare payment is $10,684

Anyone receiving that kind of a bill would likely have trouble finding the funds to pay it. However, here is the twist to this example. The “hospital” must write off the difference between the $130,000 ICU cost and the diagnosis-related group single payment of $12,000. That means there is no additional amount billed out to the patient other than the inpatient deductible.

Posted on Tuesday, October 31st, 2017. Filed under Medicare.

Choosing Between Original Medicare and Medicare Advantage

When enrolling in Medicare insurance it is important to do it on time. The enrollment period is individually based. Open-enrollment occurs three months prior and three months after an individual’s 65 birthday. If you miss the enrollment deadline you could end up paying higher premiums.

The first decision to make when enrolling in Medicare whether to choose Original Medicare or Medicare Advantage. Original Medicare, which is Part A and Part B, covers hospital expenses, some non-hospital costs including supplies, outpatient care and certain kinds of medical appointments. Medicare plans are offered by the federal government and permit beneficiaries to use any health care professional that accepts Medicare.

On the other hand, Medical Advantage offers beneficiaries a variety of health insurance plans from private insurance companies, which are typically PPOs, HMOs and EPOs. Most of these offerings charge a monthly premium in addition to the basic Part B premium. These plans may also a greater range of coverage choices.

There is no right or wrong when choosing the plan that best suits you and your circumstances. However, it is important that you make the right choice that suits you when you enroll, otherwise you stand to lose access to some options once open enrollment ceases. During open enrollment for Medicare Advantage, plans offered are not allowed to decline health insurance coverage. If you miss open enrollment health insurance providers could decline to issue health insurance to you.

For those choosing to go with Original Medicare, they might want to consider basic coverage with a Medigap plan. These plans are sold by private insurance companies and offer coverage for health care expenditures that do not fall under Part A or Part B. Once the decision is made to purchase a Medigap plan, you need to consider which type to get. There are 10 different standardized options (the same coverage is available no matter where you live or who is selling it).

The vast majority of beneficiaries new to Medicare choose Medicare Part D, which offers prescription drug coverage. However, this is optional, depending on what other Medicare plans you have selected. Original Medicare and Medigap do not offer prescription drug coverage, so it is recommended to choose Part D.

There are some Medicare Advantage plans offering drug coverage as a component of the basic plan but you need to ask about it during enrollment. If your Medicare Advantage plan does have good drug coverage, then you could skip Part D.

In general, always ask questions when making health care insurance choices because if you do not you may find that you are not covered for a certain procedure.

Posted on Monday, October 16th, 2017. Filed under Medicare.

What questions to ask when searching for a Medicare supplement plan for you and your family

There are a number of ways to save on Medicare supplements, but you definitely need to ask the right questions when shopping for what you need. To be fully informed it is best to allow at least an hour talking to a knowledgeable agent. Keep in mind that some agents only represent/sell for just one company, but others may represent multiple users, which expands your options exponentially.

What questions to ask when speaking to an insurance agent? Here is a list of some of the first questions to ask:

  • Are there any value added programs that would be of benefit to me?
  • Are there any value added programs that would be of benefit to me and to my spouse?
  • What types of value added programs are there?
  • What insurance companies offer them?

Furthermore, for couples, ask about household discounts whether both individuals are on Medicare yet or not. Also, ask about current rates, and do not forget to inquire about the company’s history of rate increases.

Of course these are not the only questions you want to ask. You need to be curious about what is definitely covered in your policy and what is not included. You do not want to be in a situation where you need immediate medical attention and surgery, but find out later the surgery was not covered for some reason stated in your policy.

It cannot be emphasized enough, but make sure to read your policy. If you know what it says, you will be able to ask questions and make informed decisions about your insurance policy.

Posted on Friday, September 29th, 2017. Filed under Medicare.

Age-related hearing loss and how Medigap plans can offer relief

As seniors grow older, some things do not function as well as they once did. Maybe your loved one is not as sharp as they used to be or they may suffer a partial or total hearing loss. In fact, according to the National Institute on Deafness and Other Communication Disorders (NIDCD) one in three people, in the United States, between the ages of 65 and 74 will experience hearing loss.

Age-related hearing loss occurs gradually, most often in both ears. The treatment for hearing loss will depend on the severity of the condition. However, there are several devices that can help seniors hear better. Hearing aids, are electronic devices that can help amplify the sounds entering the ears.

While hearing aids are necessary medical device, they are not cheap. The cost of hearing aids can go up to as much as $2,000 per aid. That adds up to $4,000 for both ears, if that is what is required. In addition, there is also the cost for the hearing exams and batteries. These expenses can add up quickly and Medicare may not cover them all.

However, some Medigap policies include free hearing screenings and discounts from 20 to 40 percent on hearing aids and free batteries for a year. Asking about added benefit, and others like it, can prove helpful when you are looking to buy health insurance.

Although Medicare supplement plans are uniform in what they cover, their pricing does vary from agency to agency and location to location. For help in choosing the appropriate Medigap policy with the best benefits speak to an experienced Medicare insurance agent.

Posted on Monday, September 25th, 2017. Filed under Medicare.

Many Medicare supplement plans may include no cost benefits

When making choices on Medicare and Medigap policies keep in mind that your decisions will have various effects on your finances. Often, Medicare and Medigap will cost you more than expected. To ensure that your premiums cost less, do your research on the numerous plans and their costs.

For instance, if you are looking to save money on a Medigap policy, then you want to stay alert for value added benefits. Value added benefits, in a Medigap policy, could include free access to various fitness facilities, hearing aids, eye exams and eye wear. Free services, like these, could save thousands of dollars a year. Such savings are important for seniors often struggling to get by on a limited income.

Many seniors miss out on these extra benefits. However, to find out about value added benefits ask what benefits are included with your policy. Do not assume that all Medigap policies have the same benefits or have any extra benefits at all, because they may not.

Remember to make it a point to find out what your Medigap policy covers. Additionally, find out what other benefits may be included that can save you money.

Posted on Friday, September 22nd, 2017. Filed under Health Insurance.

How to choose a Medicare supplement plan

There are a number of health decisions that need to be made when you turn 65. It is important to not wait until the last minute to decide what policies you want. Waiting too long can result in you not receiving the coverage you need because you had to make a decision quickly about which policy to choose.

Take your time and start checking out various options for health insurance before you turn 65. Prepare a list of questions that you want to ask. Ask questions about what added benefits come with your policy. Ask what is and is not covered. Ask what would be best for your financial and health situation.

As you begin your research into healthcare coverage, work on a list of things that you need and want, and what you think will be the most beneficial to you. Furthermore, preparing helps narrow the field when you are faced with multiple choices when it comes to health care coverage. Health insurance is an important decision and you want to make the most beneficial decision.

Posted on Monday, September 18th, 2017. Filed under Medicare.