Turning 65 usually means the beginning of Medicare. 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:

1. Timelines

   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. For example, if you are just becoming eligible for Medicare, you have a vital window of opportunity during the 6-month window surrounding your 65th birthday to enroll in the plan of your choice. When that period ends, your guaranteed-issue rights may end as well.

   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.

2. Exceptions

   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 Michigan Benefit Planners 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.

3. Coverage Changes

   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, and 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 right kind of support can go a long way to help people continue to lead independent, productive lives at home. Medicare's Home Health Care coverage provides basic, short-term benefits but should not be relied upon to cover home care for an extended period in most circumstances.

To qualify for Medicare's short-term skilled care at home, a person must meet all of the following conditions:

• Must be getting services under a plan of care established and reviewed regularly by a doctor.
• Doctor must certify that the patient needs one or more of the following:
  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Continued occupational therapy
• Home health agency must be approved by Medicare
• Doctor must certify that the patient is homebound

Proper planning recognizes that Medicare's Home Health Care benefit is intended for short-term recovery and only covers the medical necessities. With Medicare, there is no help for an extended recovery at home. You should also consider the impact that an extended recovery would have on your ability to do those day-to-day tasks that are necessary to manage your home. Examples of these tasks include housework, bathing, going to the bathroom, yardwork, and cooking. Recognize 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.

Planning for home care coverage is included in Venture Insurance Group's "double protection" strategy. Responsible planning today can reduce the stress of tomorrow and let you recover on your own terms.

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:

Scenario #1

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.

Scenario #2

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.

A life insurance policy can be used as a valuable tool to cover many different situations depending on your particular need. Life Insurance can be used as an investment strategy, tax shelter, and wealth transfer tool. It can also be used to pay for long-term care, funerals, and final expenses.

Responsible planning recognizes that any discussion of final expenses includes more than just the cost of a funeral. It is important to realize that the majority of healthcare expenses occur in a short timeframe prior to death. Depending on the strategy you have chosen for your other needs, you may have considerable expenses at the end of your life. In that case, life insurance can be used to replenish those funds or to have tax-free cash readily available to pay for those medical bills.

According to www.medicaring.org, "The final phase of life, when living with eventually fatal chronic illnesses, has the most intense costs and treatments. Neither clinical services delivery nor Medicare has kept pace with the changes in the pattern of needs that underlie these costs." An estimate of healthcare costs over a lifetime would look like the graphic below:

When you work with Venture Insurance Group, we initially analyze your needs by asking a series of specific questions and will recommend a comprehensive plan to address your personal situation. We systematically revisit those questions with you so you can rest assured that your plan will always keep pace with your life.

The key to finding the best Medicare Part D prescription drug plan is to accept that plans change every year. Not only will your plan change, but your medications will likely change as well. Medicare provides a way to address those changes by allowing you to change your plan under special circumstances throughout the year as well as during the Annual Election Period every year from October 15 – December 7.

There are certain similarities that all Part D plans must have in common. Outside of these requirements, plans may differ significantly, and that can be reflected in their rates as premiums can range from $15 to over $100 per month depending on the plan. The low-cost plan may, in fact, be the best fit for you. But depending on your particular medications you may pay less throughout the year with a more expensive plan. The key is to find the plan that best fits your particular medications, and Venture Insurance Group is prepared to help you find that plan. The following information outlines the requirements of all Part D plans. Contact us today to find the plan that best suits your individual needs.

Medicare prescription drug plans (PDPs and MA-PDs) are required to:

• Cover "all or substantially all" drugs in these 6 categories:
  • Antidepressant medications
  • Antipsychotic drug medications
  • Anticonvulsant medications
  • Antineoplastic drugs (used by cancer patients)
  • Immunosuppressant (used by transplant patients)
  • Antiretroviral (used by patients with HIV).
• Cover at least 2 options all other drug categories.
• Make sure you have convenient access to retail pharmacies.
• Have a process in place for you to get drugs that are not on the formulary when it is medically necessary (see Part D appeals).
• Provide useful information, such as how formularies work, how to save money with generic drugs, and how to navigate the grievance and appeals processes.

Medicare prescription drug plans (MA-PDs and PDPs) are also required to cover benzodiazepines (including Xanax, Valium and other drugs often used for anxiety and insomnia) and barbiturates.

When choosing a Part D plan, it is important to find one that covers most, if not all, of the prescription drugs you take. If you join a plan that doesn't cover one of the drugs you take, check with your plan's transition policy. The plan may cover a drug that's not on the formulary for 30-90 days while you work with your doctor to find an alternative drug that is covered by the plan. If your doctor believes you need to take your current drug and should not switch to a covered drug, you can contact the plan and ask for an exception. You will probably need to provide information from your doctor explaining why you need the drug. If your plan denies the exception, you can appeal the decision.

Certain types of drugs are not covered by any standard Medicare drug plan. However, certain enhanced drug plans may cover some of these drugs. These excluded drugs include:

• Drugs used for anorexia, weight loss and weight gain
• Fertility drugs
• Drugs used for cosmetic purposes and hair growth
• Cough and cold medicines
• Prescription vitamins and mineral products
• Over-the-counter (OTC) drugs