Medicare is a federal health insurance program for adults age 65 and older. Medicare is also available to people under age 65 with kidney failure or certain disabilities. There are 4 parts of Medicare coverage labeled Part A and Part B (sometimes called "Original Medicare"), Part C (Medicare Advantage) and Part D (Prescription Drug Coverage). Each part helps pay for different health costs.
Even though Medicare is a basic benefit that most of us living in the United States have earned, it takes planning to unlock its benefits, avoid penalties and make sure you are not paying for anything you do not need. To get the most out of your Medicare, recognize the keys to Medicare coverage and be willing to revisit them every year.
3 keys to getting the most from your Medicare plan are:
Eligibility for Medicare Plans is based on strict timelines. To get the best plan at the best rate, you must apply within certain timeframes depending on your specific situation. And there are LOTS of different situations. When you call, we will ask you a series of questions that are designed to determine your situation. Your right to enroll in a plan will depend on your personal situation and is often the deciding factor on whether or not you are eligible for preferred rates. Timeliness is vitally important as they are one key to your eligibility for preferred rates.
Once eligible, you may be able to keep the preferred rating for the rest of your life. An agency that knows eligibility timelines for every situation can save you thousands of dollars over your lifetime by making sure you get the preferred rates you deserve.
Did you know that Medicare normally will not pay for health care or supplies you get outside of the U.S.? But according to Medicare, it will pay if "you're travelling through Canada without unreasonable delay by the most direct route between Alaska and another state…" Did you know that when you join a plan you are normally "locked into" that plan until January 1 of the following year? But there are 29 federal exceptions to this rule that may allow you to join a plan or switch to another plan that is a better fit for you.
The point is this: when it comes to Medicare there are hundreds of exceptions available to help protect you in your personal situation. It is usually difficult to answer Medicare questions with a simple "yes" or "no." The answer is almost always, "It depends!" The professionals at Venture Insurance Group know these exceptions and will help you navigate them. We show you how to cover your risk and also take full advantage of Medicare enrollment and coverage exceptions that will help you in your personal situation.
Do you believe the saying, "If it's not broke, don't fix it?" Generally, we believe that saying to be true as well. If something is working well for you, don't change it. Unfortunately, that strategy does not work when it comes to Medicare. Your plan will change every year whether you choose to change it or not. Since your plan will change, you should take steps to "fix it before it breaks."
Regardless of what plan you have, you should expect it to change in some way every year. By October 1 each year, Medicare Advantage and Part D Prescription Drug Plans across the country must make all plan changes public in a document called the "Annual Notice of Changes (ANOC)." These changes include changes to federal regulations which affect what services are covered and also reset coverage gap limits. Changes are also made to deductibles, copays and your monthly premium during this time. Your plan may increase in price. You may have to pay more at your doctor or for your drugs. Even if you stay with the plan that you have, that plan will be different on January 1. Plans stay the same in name only.
Some plans will decrease their benefits. New plans will be introduced into the market that may provide better benefits not available to you before. Due to so many changes taking place, during this time of year you may freely switch from one Part C or Part D plan to another in order to find the best fit for your situation for the upcoming year.
Original Medicare also changes. Every year there are expected changes to Medicare's covered services, limitations, Part B premium, income thresholds and deductibles. Proper planning is necessary annually to ensure that you continue to have the coverage you expect.
Venture Insurance Group reviews each of our member's coverage plan annually. We explain what has changed and let you rest comfortably knowing how your plan will work for you.
Medicare was designed in the 1960’s and was designed to cover the major risks of that era. Many people would argue that while treatment methods have changed, Medicare has not kept up with those changes. At the time Medicare was introduced, the major healthcare fear was that an illness would lead to a lengthy (and costly) hospital stay. This was before our current healthcare model of rapid discharge, at-home recovery, and the widespread use of medications.
Today, the cost for even common treatment can cause a burden. With the influx of the baby boom generation, the Medicare Trust Funds are strained. Covered services are being limited (such as outpatient physical therapy), and some are not being covered at all (most chiropractic services, dental, and vision). Even when services are covered, associated copays and coinsurance costs can be devastating.
Consider the drug Avastin. Avastin is approved to treat types of colon, lung, kidney and brain cancers. A typical fill of Avastin can cost more than $5,000 for just two vials, according to GoodRx. Over the course of a year, this can cost patients up to $100,000 in the United States, according to News-Medical.net. Even with Medicare, your portion of that cost would be $20,000 each year.
Medicare Supplement policies and Medicare Advantage Plans cap that risk. But there are numerous other considerations. Venture Insurance Group focuses on "double protection" strategies to cover known risks (such as costs associated with treatment) as well as unknown risks (such as costs associated with travel, lawn care, housecleaning services while you recuperate comfortably at home). These risks are best addressed with indemnity plans that pay you cash for you to use to cover whatever that risk is.
A rich coverage strategy layers medical coverage (Medicare Supplement or Medicare Advantage) with incidental coverage (indemnity plans) that address both the known and unknown costs. Ultimately, if you have a medical issue, how much your treatment will cost and how to deal with all the bills that follow should not be at the forefront of your concerns. With proper planning, you can recuperate more quickly and more comfortably. Venture Insurance Group is prepared to help you.
The Annual Open Enrollment Period (AEP) is also known as the Annual Election Period and applies to Medicare Part C (Medicare Advantage Plans) and Medicare Part D (Prescription Drug Plans). This is a defined period that occurs every year from October 15 – December 7. This time is set aside to make important decisions that will determine your coverage for the following calendar year. There are limited opportunities to change your plan outside of these dates. For many people, whatever plan they choose during this period is the plan they are "locked" into for all of the following year. Choosing a plan wisely is vitally important.
The most common mistake Medicare Advantage and Part D members make is to think, "This plan has worked well enough for me for the past year. I will just stay with it." The error in that thinking is the belief that you can keep the plan you have. It is true that plans will almost always automatically renew – meaning that if you do nothing then you will stay in your plan for the following year. But in reality, even if you stay with the plan that you have, that plan will be different on January 1.
Do you believe the saying, "If it's not broke, don't fix it?" If something is working well for you, don't change it. Unfortunately, that strategy does not work when it comes to Medicare. Your plan will change every year whether you choose to change it or not. Since your plan will change, you should take steps to "fix it before it breaks." Plans stay the same in name only. Even if you do not change plans, your plan will change on you.
By October 1 each year, Medicare Advantage and Part D Prescription Drug Plans across the country must make all plan changes public in a document called the "Annual Notice of Changes (ANOC)." These changes include changes to federal regulations which affect what services are covered and also reset coverage gap limits. Changes are also made to deductibles, copays and your monthly premium during this time. Your plan may increase in price. You may have to pay more at your doctor or for your drugs.
Some plans will decrease their benefits. New plans will be introduced into the market that may provide better benefits not available to you before. Due to so many changes taking place, during this time of year you may freely switch from one Part C or Part D plan to another in order to find the best fit for your situation for the upcoming year. During AEP, you can make as many plan changes as you would like. And there are dozens of exceptions to the AEP timeline. Even if you have already chosen a plan, contact Venture Insurance Group immediately to see if you could (or even should) make a plan change. Even if you do not change now, Venture Insurance Group reviews each of our member's coverage plan annually. We explain what has changed and let you rest comfortably knowing how your plan will work for you.
This is the question we get most often. Medicare Advantage Plans ARE NOT Medigap policies. On the surface, the difference between these two options may seem subtle. Some even say that it seems that telling the difference is like "splitting hairs." But in reality, the difference in these plans can mean an enormous difference in the way you receive your care.
Medicare Supplement (also called Medigap) policies work with Medicare to pay the costs that are left over after Medicare pays. When you have a Medicare Supplement policy, you carry 3 separate cards: your red, white and blue Medicare card, your Medicare Supplement card and your Prescription Drug card. Your Medicare card pays first. If Medicare approves the service, then your Medicare Supplement policy will pay some (or all) of the rest.
Medicare Supplement policies can make it easier for you to get care because more doctors accept them. With a Medicare Supplement policy, it does not matter whether or not your doctor accepts your Medicare Supplement. There are no networks and no referrals! All that matters is whether or not your doctor or hospital accepts Medicare. If they accept Medicare, then they will bill Medicare first. Once Medicare pays then your Medicare Supplement policy will cover some (or all) of the rest.
Though Medicare Supplement policies work well for people who like to travel or who want to pay lower copays at their doctor or hospital, the premium can go up as you get older. And there are only certain times that you are allowed to choose a Medicare Supplement policy if you have prior health concerns.
Medicare Advantage plans work differently. Whereas a Medicare Supplement policy supplements the costs of Original Medicare, a Medicare Advantage Plan provides your Medicare benefits to you directly. As a Medicare Advantage member, you retain all the rights of a Medicare beneficiary. But Medicare no longer pays your bills directly. Instead, Medicare pays your insurance company to administer your Medicare benefits. Under a Medicare Advantage plan, your insurance company pays instead of Medicare.
Since Medicare Advantage insurance companies administer the benefits, you will generally use the insurance company's network of doctors and hospitals. You are required to use the company's doctors for routine care under an HMO. Under a PPO plan, you are allowed to use doctors outside of the network but will pay more when you do. Medicare Advantage plans protect you by providing urgent care and emergency services without penalty outside of the network. But when you join a Medicare Advantage Plan you expect to receive most of your care within the company's network and according to their rules for referrals and/or prior authorization.
Medicare Advantage Plans work well for people who are willing to use the insurance company's network, do not travel out of the area for long periods of time, or are willing to share more of the cost for care. They are also a popular option as people age because the price does not rise based on your age. Also, you have the option to choose or change your Medicare Advantage Plan every fall during the Open Enrollment Period (October 15 – December 7).
It is said that "Ignorance of the law is no excuse." The same can be said for Medicare coverage. While your retiree plan is designed to cover the basics, it is your responsibility to take the initiative to understand the gaps in your coverage and prepare accordingly.
When you are retired, you want coverage for the care that you need. Venture Insurance Group' has identified 6 major retiree risk factors and offers strategies to cover those risks at whatever level your peace of mind and budget afford.
Those six factors are Hospital/Doctor, Prescriptions, Home Care, Rehabilitative Care, Cancer Care, and Long-Term Care. By itself, neither Medicare nor a retiree group plan fully covers all of these risks. A major claim in any of these categories has caused financial ruin for people who assumed they were well-prepared. Contact Venture Insurance Group and let us test your coverage for you. We will outline how your current plan scores in each category and provide you with planning options.
Retiree plans are offered by your former employer. If you are fortunate enough to have retired from a company or municipality that offers health insurance coverage for its retirees, be very careful. Any step you make could affect your group plan eligibility. If you mistakenly drop your coverage you may not be able to ever get it back.
Unfortunately, it is easy to unintentionally change your group plan and risk losing your coverage. During AEP, you have probably seen stores with booths manned by agents marketing drug plans. People sometimes sign up for these plans thinking they will improve the coverage they have, but Medicare does not allow you to have two Part D plans at the same time. When you sign up for one, Medicare may automatically remove you from the other. If you're on a group plan and sign up for another Part D drug plan then you run the risk of Medicare removing you from your group coverage.
That is not to say that you should not consider other coverage. Just be sure to work with a professional who takes the time to fully understand your current coverage and is willing to supplement your coverage but not necessarily change it.
Have you received a letter from your carrier notifying you that your plan is being cancelled? If so, it may look like this. Though it is unsettling to receive a letter like this, it is increasingly common and may be the best news you could get for your Medicare coverage. When a company terminates a plan, you become eligible for a one-time special enrollment right. You owe it to yourself to consider those rights and may be eligible for a richer plan at lower cost.
Venture Insurance Group knows how to help you take advantage of your rights to get the best plan for you. Take advantage of this one-time special enrollment and get the coverage plan you deserve.
Planning for long-term care is not just about protecting your finances – although that alone is enough risk to justify serious planning. Rather, proper long-term care planning provides recuperation options that are stress-free to you and your family. When the stress is removed, you can recuperate more quickly. With the burden lifted from your family, it allows them to maintain their role as your spouse or child instead of changing into the uncomfortable role of caregiver. Something as simple as long-term care planning can change your recovery from a financial and relationship burden into an enjoyable memory instead.
Long-Term Care services include those tasks that when we are healthy we are able to take care of almost without any thought. Examples of these tasks include housework, bathing, going to the bathroom, yardwork, and cooking. A mature discussion of Long-Term Care recognizes that even during a brief illness taking care of these tasks becomes very difficult. The stress of these responsibilities hinders recuperation and is dangerous to your health. If the brief illness becomes a drawn-out recovery then you will need someone else to take care of these tasks for you. When these services are needed over a long period of time, that is called "Custodial Care."
Medicare was not designed to pay for custodial Long-Term Care or Home Health Care. Care for long-term illnesses is a burden to family members as well as finances. The impact can affect generations – either positively or negatively depending on the planning you do now.
Too often, people end up in a nursing facility because they feel there are no other options. Since Medicare does not pay, you could be left with only the option of Medicaid paying for your care. And Medicaid only pays for long-term care after you have first become impoverished by having to pay for the care yourself.
Consider these two scenarios:
Mr. Jones is a 70 year old male who suffers a stroke. After stabilizing in the hospital, he is discharged to a skilled nursing facility for rehabilitation. For 3 months, he undergoes daily physical therapy to regain his strength and also speech therapy to regain the ability to swallow. At the end of the 3 months, he is able to walk with assistance and has had his feeding tube removed. This is an example of a successful rehabilitation.
Financial and Health Recovery Impact of Scenario #1:
If Mr. Jones had a Medicare Supplement policy, his 3 month nursing facility stay is paid 100%. If he had no policy or a Medicare Advantage plan, his bill would be $3,000 - $10,000 depending on the plan. Since his rehabilitation is over and his feeding tube removed, Mr. Jones no longer qualifies for skilled care. Medicare has therefore stopped paying for his stay.
Since the cost to continue his stay at the nursing facility is $5,000 per month, Mr. Jones considers other options. The assisted living facility close to home charges $4,000 monthly. Since Medicare will not cover either of these stays, Mr. Jones decides to return home.
Since Mr. Jones is not yet able to walk without help, his daughter moves in with him to help him in his house. One night, rather than disturb his daughter's sleep Mr. Jones gets out of bed and makes it to the bathroom without her help. He falls on his way back to bed, breaks his hip and is returned to the hospital for another stay. Already weakened from his stroke just 3 months ago, Mr. Jones has less energy to recover from the additional toll of a broken hip. This time, his rehabilitation is more difficult and Mr. Jones is unable to return home at the end of his 3 month stay. Since Medicare will only pay for 100 days, Mr. Jones must pay for the additional days out-of-pocket as a custodial care resident. After months of custodial care, Mr. Jones is well enough to return home but has incurred a $50,000 bill from the nursing home plus the cost of keeping his house maintained while he was away.
As unfortunate as this situation is, it is truly a best-case scenario. Just as easily, Mr. Jones could have stopped progressing and lived the rest of his life in a nursing facility.
Mr. Jones is a 70 year old male who suffers a stroke. After stabilizing in the hospital, he is discharged to a skilled nursing facility for rehabilitation. For 3 months, he undergoes daily physical therapy to regain his strength and also speech therapy to regain the ability to swallow. Mr. Jones' long-term care policy provides the extra funding so Mr. Jones can enjoy a private room rather than having a roommate. At the end of the 3 months, he is able to walk with assistance and has had his feeding tube removed. This is an example of a successful rehabilitation.
Financial and Health Recovery Impact of Scenario #2:
If Mr. Jones had a Medicare Supplement policy, his 3 month nursing facility stay is paid 100%. If he had no policy or a Medicare Advantage plan, his bill would be $3,000 - $10,000 depending on the plan, which is covered by his long-term care plan. Since his rehabilitation is over and his feeding tube removed, Mr. Jones no longer qualifies for skilled care. Medicare has therefore stopped paying for his stay.
The cost to continue his stay at the nursing facility is $5,000 per month, and the assisted living facility close to home charges $4,000 per month. Since Mr. Jones has a long-term care policy, he can choose either. Additionally, his long-term care policy will provide for caregivers to come into his house while he recuperates. Knowing that his policy will pay for any of these options, Mr. Jones decides to recuperate at home. Mr. Jones' daughter still moved in to be with her father while he recuperated, but she did not have to worry about the risk of hurting herself while helping him walk. Instead, they visited while Mr. Jones regained his strength. Whenever he needed to go to the bathroom, cook a meal or take a shower, the caregiver was available to help. Since Mr. Jones didn't have to worry about burdening his daughter, the caregiver helped him and Mr. Jones didn't suffer from another fall. After just a couple of months, Mr. Jones' strength returned and he was able to resume the life he had prior to the stroke.
Responsible planning today can reduce the stress of tomorrow and let you recover on your own terms.